P2.02-018 Chemoradiotherapy in Elderly Patients with Locally Advanced Non-Small Cell Lung Cancer

P2.02-018 Chemoradiotherapy in Elderly Patients with Locally Advanced Non-Small Cell Lung Cancer

January 2017 Abstracts S857 Methods: Between 1991 and 2011, a total of 917 patients with small-sized ( 2cm) NSCLC underwent curative pulmonary res...

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January 2017



Methods: Between 1991 and 2011, a total of 917 patients with small-sized ( 2cm) NSCLC underwent curative pulmonary resection with systematic lymph node dissection at Tokyo Medical University Hospital and Tokyo Medical University Ibaraki Medical Center. We retrospectively evaluated their postoperative clinical outcomes and survival rates. Survival was analyzed using the Kaplan-Meier method and log-rank test.

cancer (NSCLC) patients are over 70 years old. Combined modality therapy is standard of care for patients with unresectable locally advanced non-small cell lung cancer (NSCLC), however, despite the multitude of clinical trials performed, elderly patients have been underrepresented in these studies. Objective: To investigate outcomes for elderly patients treated with chemoradiotherapy (CRT).

Results: There were 46 (5.0%) patients with mediastinal lymph node metastasis in pT1a ( 2cm). And there were 6 (0.6%) patients with pT1a ( 1cm) N2M0. The histological types were 3 cases of adenocarcinoma, 2 case of squamous cell carcinoma, and one large cell carcinoma. The respectively status of lymph node metastasis was single station in 2 cases and multiple station in 4 cases. Skip lymph node metastasis was observed in 2 cases. There were 26 cases (56.5%) that were upstaged from clinical diagnosis in pT1a ( 2 cm) N2M0 patients. There was one upstaging case from cT1a ( 1 cm) N0M0 to pT1a ( 2 cm) N2M0. The median overall survival period and 5-year survival of patients in pT1 ( 2 cm) N2M0 was 52.1 months and 45%. And patients with pT1a ( 1 cm) N2M0 has 29.8 months and 0% (3 year overall survival rate was 33.3%). The recurrence rate was 71.7% (5/6) and disease free survival was 13.2 months.

Methods: Patients with locally advanced stage NSCLC admitted in a tertiary hospital, between 1st January 2014 and 31st May 2016, who received CRT were selected. Patients were divided in two groups by age (<70 vs. 70-years old). Clinical-demographic variables, overall survival (OS) and progression free survival (PFS) were compared between the two groups. Results: Fifty-one patients were included. The results are presented in the table: <70 years n¼23(45,1%)

70 years n¼28(54,9%)


Male[n;(%)] 19(82.6) Performance status (at diagnosis)[n;(%)]



0 1

6(26.1) 16(69.6)

10(35.7) 13(46.4)





Conclusion: This study showed that 5.0% of small-sized ( 2 cm) NSCLC had N2 disease and 0.6% of T1a ( 1 cm) NSCLC has pN2. Moreover, 56.5% of small-sized ( 2 cm) NSCLC was upstaged from clinical diagnosis to pathological diagnosis. The patients with pT1a ( 1 cm) N2M0 had worse survival data than the patients with pT1a ( 2 cm) N2M0. We recommend systematic lymph node dissection for local treatment as well as accurate diagnosis. As multiple mediastinal node metastases showed an unfavorable prognosis, surgery combined with systematic treatment is recommended.

2 Weight loss (at diagnosis)[n;(%)] 0%

Keywords: Surgery, Small-sized NSCLC, pT1aN2M0, less than 1cm


P2.02-018 Chemoradiotherapy in Elderly Patients with Locally Advanced Non-Small Cell Lung Cancer Topic: Clinical Outcome Ana Linhas, Margarida Dias, Sérgio Campainha, Sara Conde, Ana Barroso Centro Hospitalar Vila Nova de Gaia/espinho, Vila Nova de Gaia/Portugal Background: The incidence of lung cancer increases with age and approximately 50% of non-small cell lung



5% 10% Clinical stage[n;(%)]

6(26.1) 3(13.0)

7(25.0) 5(17.9)

IIIA IIIB Comorbidities[n;(%)]

10(43.5) 13(56.5)

17(60.7) 11(39.3)


Heart failure Hypertension


4(14.8) 20(74.1)

0.076 0.002





Chemotherapy regimen[n;(%)] Carboplatin



Cisplatin CRT[n;(%)] Sequential








Second line treatment [n;(%)] No 16(69.6) Yes 7(30.4)

21(75.0) 7(25.0)




Comparing with younger group the elderly group presented significant worse OS and longer PFS, although without statistical significance [respectively, median 7 vs. 12 months (p¼0.006) and median 11.5 vs. 8 months (p¼0.687)]. Elderly patients with higher PS presented worse survival (p¼0.045). Patients submitted to a


chemotherapy regimen with cisplatin presented better OS and PFS in both groups, although only statistical significant for the OS in patients under 70 years (p¼0.023). There was no influence of other variables on OS and PFS. Conclusion: In our sample age was an important prognostic factor in patients submitted to CRT but other factors, as PS, also can influence prognosis. In both groups patients treated with cisplatin presented superior OS but less patients above 70 years received this treatment. Elderly patients could be considered for CRT treatment but each case should be analyzed individually. More studies are needed to guide treatment in this population. Keywords: elderly, survival, Locally advanced NSCLC, Chemoradiotherapy

P2.02-019 Lung Cancer in Young Adults (Age Group 18-50 yrs): Presentation, Clinical Features and Treatment Topic: Clinical Outcome Balaji Varadhan,1 Neena Kalsi,2 Samreen Ahmed,3 Kimuli Ryanna3 1Oncology, Leicester Royal Infirmary, Le Ww/United Kingdom, 2University Hospital of Leicester, Nottingham/United Kingdom, 3University Hospitals of Leicester, Leicester/United Kingdom Background: Non-small cell lung cancer in young adults appears to be increasing over recent years. It’s a devastating illness both for the patient and their family. It has got significant socioeconomic implications. Methods: Data were analyzed for the period between 2010 and 2015 from the University Hospitals of Leicester data base. Young adults were defined as age less than 50 and further sub divided into 18-39 years and 40-50 years of age respectively. Data were extracted regarding the histological diagnosis of cancer, performance status, disease staging and the treatment received. Results: From a total of 93 patient’s we found the majority had adenocarcinoma,with 56% in the 18-39 age group and 63.6% in 40-50 age group. A greater proportion of patients in each age group were found to have a performance status of 0.The number of male patients were noted to be slightly higher between 18 and 39 (55%), compared to the 40-50 age groups, where there was a female predominance (57%). The majority of patients in both age groups were found to have a good performance status and a larger proportion of patient’s eGFR status was negative. Young adults were more likely to have surgery and chemotherapy due to their better performance status.

Journal of Thoracic Oncology

Vol. 12 No. 1S

Conclusion: In our cohort of young adults with lung cancer, the majority of patients had a good performance status despite late stage disease. They were likely to be fit for treatment and have longer survival outcomes.

P2.02-020 Pattern of Care of Inoperable Locally Advanced (LA) NSCLC in Elderly Patients: Analysis of the Experience of Two Academic Italian Hospitals Topic: Clinical Outcome Marco Perna,1 Vieri Scotti,1 Alessio Bruni,2 Gabriele Simontacchi,1 Vanessa Di Cataldo,3 Emanuela Olmetto,1 Giulio Alberto Carta,1 Roberta Grassi,1 Carlotta Becherini,1 Carla De Luca Cardillo,1 Benedetta Agresti,1 Camilla Comin,4 Katia Ferrari,5 Elisa D’Angelo,2 Polina Vasilyeva,2 Bruno Meduri,2 Frank Lohr,2 Luca Voltolini,6 Lorenzo Livi1 1Oncology, Radiation Oncology Unit, Florence/Italy, 2Radiotherapy Unit, -Aou Policlinico of Modena, Modena/Italy, 3Cyberknife CenterI.F.C.A (Istituto Fiorentino Di Cura Ed Assistenza), University of Florence, Florence/Italy, 4Department of Experimental and Clinical Medicine, University of Florence, Section of Surgery, Histopathology and Molecular Pathology, Florence/Italy, 5Cardiothoracic Department, Pneumonology and Thoracic Phisiopathology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence/Italy, 6Cardiothoracic Department, Thoracic Surgery Unit, Florence/Italy Background: Optimal treatment in LA NSCLC patients is still debated. In fit patients concomitant radio-chemotherapy (RCT) seems to be the best treatment in terms of local control (LC), progression free survival (PFS) and overall survival (OS) while sequential RCT is a good alternative in unfit patients. Moderately hypofractionated radiotherapy improve OS in recent studies. Elderly patients often cannot be offered multimodality treatments. We report our experience with over 70 years old LA NSCLC patients deemed unfit for surgery. Methods: Characteristics of patients and treatments are summarized in table 1. All patients were treated with a platinum based doublet of chemotherapy (CT). RT target volumes included the primary lung tumor and involved mediastinal lymphnodes as defined on pre-treatment contrast enhanced CT scan. Elective nodal irradiation was not performed. Acute/late toxicities were reported in accordance to 4.0 CTCAE scale. Clinical response was evaluated according to RECIST criteria.