P-203 Adjuvant chemotherapy versus radiotherapy for resected state IIIA (N2) non small cell lung cancer, a phase III study

$168

Posters/Combined moda/tty therapy for NSCLC

stage Ilia and 20 included IliA and IIIB. Histologic findings were reported in 28 articles with a predominance of adenocarclnomas Clinical staging was carried out in 5 articles with mediastinosoopy reported in 20 Twenty-five defined the RDT target volume with classical or split-course free,closet]on, median 40 Gcy (3(~60) up to 1995 followed by a predominat]on of hyperfractionation thereafter CT was based on cisplatin Induct]on treatment was completed in 8,5% and surgery in 70% Adjuvant therapy was performed in 18 art]cles CT scan avaluat]on was reported in 23 art]cles with a median RP of ,55% (46~8%). stabillzat]on 2,5% (7 ,51%). RC range ((~17%) and progression ((~29%). The type of surgery performed was specified in 26 articles with a predominance of Iobectomios in stage IliA and pneumectomies in IIIB. Postoporetlve morbimortallty vaned widely, with a greater mertallty related to a lower number of patients included in the study. Induction therapy mortality was 3% and the mean survival in stage Ilia was needy 20 months (greater after 1995) and 16 months in stage IIIB. The mean survival at 1.3 and 5 years was ,58%. 26%. and 30%. respa~vely Conduslons: Indu~on CT+RT seems to obtain good response but potent]al morbimertality should he aware

~Long

term outcome of muRImodallty treatment of non small carl tung cancer (NSCLC) brain metastases: Expsrlenca of alght years

A Cassano I A Pompucoi. E D'Argento. G SchJn,zari. C Pozzo. M Basso. M. Qulrlno. S. Trlgila. C. Anile. C. Barons. IMedfcal Oncology, Cathefic

Universi~ Rome, Italy, 2Neurosurgety Deparfment, Catholic UniversIty, Rome, Italy Background: Lung carcinoma is the leaclng cause of death ~om cancer. More than 30% of those with Non Small Cell Lung Cancer develop bran metastases. Corticostero~d agents, resect]en and radiotherapy have been the mainstay of treatment Whole brain radiat]on therapy ('¢,~.RT) is reported to improve local control after resection of NSCLC brain metastases The authors conducted a study to evaluate the long-term outcome in a sedas of pat]ents treated with mlt]modality tTetment including sistemic chemotherapy, rase~on of brain metastases and radiotherapy Methods: The study is based on the retToepective analysis of dinieal and radiologicel records obtained during a 8. years period (1997 2004). concerning ,59 lesions in 50 pat]ents. Crltena for incluslen into this retrespoct]ve analysis were solitary or multiple brain metastases suitable of surgery. Karnofsky performance status ~>70% and conb-ollod ~ c r a n i a l disease with Cisplatin (CDDI~ based chemotherapy. Surgery was followed by 40 Gy WBRT. Stat]stical analysis was performed using the Kaplan Meier method and Io~trank test. Results: ,50 pat]ents were included. The most common histological type was adenocarcinoma in 30 pts (60%). squarnous cell carcinoma in 11 pts (22%). and large cell carcinoma in g pts (18.%) The lesions were single in 38./50 pts (76%) and mult]ple in the other pts (24%) Radical surgery was performed in 38. pts with single metastasis, in 4 pts with 2 metastases, in 1 pt with 3 metastases. while surgical citerequct]on was possible in 7 pts The mean follow-up period was 19 7"6 months (range 2 86 months) Local centrol was obtained in 3,5 pts (70%) Overall survival (OS) of the whole group was 12 months: OS of pts submitted to racicel surgery was 16 months while OS of pts submitted only to part]al resection was 7 months: the difference was statist]celly s~gnificant (p = 0.00128). The number of sistemic4"elated deaths amounted to 18/32 pts (56.2%). Conclusions. Analysis of leng4erm outcome seems to confirm that the combined treatment of NSCLC brain metastases is a pnmary therapeutic opt]on in those pat]ents. Eady detection of brain metastases, aggressive treatment of systemic clsease, and a therapeutic slzategy including surgery and radiotherapy can extend survival

prolonged su~val. The results for eady stage disease, although in favour of chemotherapy, were less dear-cut The results suggested survival benefits are moderate ( - 5%) but potentially important and that there was no good evidence that any subgroup of pat]ents (age. sex. stage, histology, performance status) benefits more or less than any other group Since the meta-analysis was published, there has been renewed enthusiasm for investigations of chemotherapy in NSCLC and a considerable number of new RCTs have been completed An update of the IPD meta analysis has been initiated by the NSCLC Ccllaberatrve Group. it's aim isto provide an upto date and reliable review of the role of chemotherapy, both to act as a sound basis for evidence based medicine and to help guide future research. The total number of patients randomised has nsen from around 9000 to around 23.000. There have been many new RCTs and a number of new agents and timings of treatments have boon invest]gateq in all settings. Seven therapeutic compansens are being explored: 1 Surgery vs surgery + adjuvant chemotherapy 2 Surgery vs neoadjovant chemotherapy + surgery 3 Surgery + radiotherapy vs surgery + radiotherapy + chemotherapy 4 Raciotherapy vs raciotherapy + sequent]a/chemotherapy ,5 Raciotherapy vs raciotherapy + concomitant chemotherapy 6 Raciotherapy + sequential chemotherapy vs radiotherapy + concomitant chemotherapy 7. Supportive care vs supportive care + chemotherapy Three of these comparlsens (2. 5 and 6) are ne,v and include around 4000 pat]ents; this reflects changes in practice and interest since the 1995 meta analysis and ensures that this systemat]e review is as inclusive and comprehensrve as possible. Data is currently being collected and It is hoped that the results vail be presented to thalists in 2005. Progress so far. Progress of the project vail be presented.

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C Chen ~'2 J Hsia I 1Division of Thoracic Surgery, Taichung Veterans

General Hospital, Tatch~g, Ta/wan: 2 ChungShan Med/cal Un/vers~ Ta/wan Background: About 2,5% to 30% of pat]ent with non-small cell lung cancer can be resected with ourat]ve intent But for stage Ilia. bulky. N2-posltive cisease in technically feasible for complete resect]on, the 5-year survival is only appre~dmately 20 30%. mainly became of development of distant metastasis The poor outcome has been promoted the invest]gat]on of adjuvant chemotherapy given after resect]on We conduct a phase III study of adjuvant chemotherapy for operable stage Ilia (N2) NSCLC The purpose of this study was to evaluate the sunaval and recurrent pattern in patients wtth N2 operable NSCLC. Methods: Group ?. 60 pat]ents, adjuvant Gemcitabline was given 1000 mg/m 2 as IV infusion. Day 1.8 and 1,5 Cieplation was given 80 mgim 2 IV injection in Day 1,5 Cycles were repeated avery 4 weeks, with total 4 o/cles after the racicel eperat]on Group ";'. 79 pat]ents, as a comparative group, received postoperative radiotherapy, average ,5200 Gys 3 4 weeks after the radical operat]en. Both group were the same surgical pN2 Ilia NCSLC. RssuRs: The cumulative 4 years survival for greup?and ? were 70% and 33.2% respectively (13: 0.0067) and the distant recurrence were 21% and 35% respectively. There is no b-eatment related mortality. Conclusions: Our data shews postoperative chemotherapy for resocting N2 Ilia NSCLC vath a premising result of using gam~abine and cisplatin. The cumulative survival has much improvement compare with local postoperactlve raciotherapy The tTeatment related complication and mortality is minimal

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Combined rnodality therapy for NSCLC Tuesday, 5 July 2005

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Adjuvant chemotherapy versus radiotherapy for rsssctsd state IliA (N2) non small call tung cancer, a phase III study

Isolated msclastlnal recurrence following prlmary treatment of non-small cell lung cancer. Curative or palliative approach?

A Cylon I . E Rake~vsky2. A Sella ~ lAssar Haters Hospital, Dept

10:00-17:00

Chemotherapy In non-small call lung cancer (NSCLC): An Inclvldual paUent data msta-analysls

S Burdett I . A Aupedr~. L Stewart I . J PJgnon2 ~MRC Clinical Trials

Unrt, London, UK, 2Serwce de Btosta#st/que et d'Ep/dermetogte, tns#tut Gustav~Roussz 94805 Vtllej~t Cedex, Fran~ Background: In 199b the NSCLC Collaborat]ve Group published (BMJ 1995:311:899) an individual pat]ent data meta-analysis of the efficeo/ of chemotherapy in non-small cell lung cancer This mete-analysis looked at the effect of chemotherapy in 4 cifferent sett]ngs and incorporated over 9000 pat]ents ~orn 52 randomised controlled tnals (RCTs). The meta analysis concluded that despite previous scepticism and controversy, modem chemotherapy could have a role in treat]ng NSCLC. In particular, there was sb-eng evidence that for more advanced disease, chemotherapy grven in adclt]on to radJsal radJetherapy and given In addt]on to best supportive care.

OncologZ Israel, 2andRabin Medical Center, Dept or Oncology, Saclder Medical School, Tel Aviv Universi~ tsraa/ Background: Patients Cots) with recurrent NSCLC have a poor prognosis and are mostly treated with a palliative intent There is no standard tTeatment for pts with isolated mediast]nal recurrence following pnmary curative treatment for NSCLC Most pts are tTeated with a single modality tTeatment like radiat]en and a minonty of pts undergoes new surgery. There is a group of pts who may benefit from a combined modality approach of chemotherapy and raclat]on with a curatrve intent. Methods: Nineteen pts. male;female (13/6). meclan age 64 (48-85) years. performance status 0/1 (14/5) recedved primary treatment with surgery (n = 16). chemo4-adiat]en induction and surgery (n = 2) and surgery and radiation (n = 1) developed isolated mediast]nal recurrence. Restage fcllowlng recurrence: dinieal (including CAT scans) (n ,5). clinlcel + PET i n 7) and pathological i n 7) pts Restage resulted in N2 (N g) and N3(n 10) cisease Cisplat]n 75mg/m 2 day 1 and oral Etoposide 100mg/d d 1-14 every 28 days for 3 cycles followed by radiat]on 45 Gy in 5 weeks with dally Cisplat]n 3 mg/m2/d as radiosen=tr.,er (n = 10) pts. Carboplat]n (AUC = 6) and Paclitaxel 225 mg/m 2