- Email: [email protected]
P2.08-004 Pathologic Complete Response as an Independed Prognostic Factor in Patients with Locally Advanced Non-Small Cell Lung Cancer
November 2017 analyzed. Overall and progression free survival were calculated. In addition, correlations between clinical/dosimetry parameter and clinical diagnosis of radiation pneumonitis were analyzed. Result: 58 patients were included in the study. Median follow up was 18.6 months. 66% of patients received weekly carboplatin/paclitaxel and the rest received 3 weekly cisplatin or carboplatin with etoposide. 78% of patients completed both chemotherapy and radiotherapy. For all radiotherapy plans, median V20 was 20.9Gy (range 3.4-29.8Gy), median MLD was 12.8Gy (range 2.3-16.5Gy) and median PTV was 395cc (range 73-819cc). 34% of patients developed grade 3-4 neutropenia, 64% grade 3-4 lymphopenia and 5% grade 3-4 thrombocytopenia. Neutropenic sepsis occurred in 10% of patients with one grade 5 toxicity. Radiation pneumonitis was diagnosed in 17% of patients, all below grade 3. Median time to pneumonitis was 133 days post radiotherapy. Radiation pneumonitis correlated strongly with V20(r ¼ 0.93). Correlations with MLD and PTV were less. There were no correlations with neutropenia, lymphopenia or thrombocytopenia during treatment. 2/3 of the recurrences were distant metastases. 90 day mortality was 5% (three patients died from oesophageal perforation, colitis and pneumonia). The median progression free survival was 20.1 months. The median overall survival was not reached. Conclusion: At the LCC, chemoradiotherapy has been a safe and effective treatment for locally advanced lung cancer. Consistent with existing evidence, V20 remains the most powerful predictor of radiation pneumonitis following lung radiotherapy. Keywords: Chemoradiotherapy, locally advanced lung cancer, Radiation pneumonitis
P2.08-004 Pathologic Complete Response as an Independed Prognostic Factor in Patients with Locally Advanced Non-Small Cell Lung Cancer W. Schreiner,1 W. Dudek,1 R. Fietkau,2 H. Sirbu1 1Thoracic Surgery, Friedrich-Alexander-University, Erlangen/DE, 2Radiation Oncology, Friedrich-Alexander-University, Erlangen/DE Background: Pathological complete response (pCR) after trimodality therapy in locally advanced non-small cell lung cancer (NSCLC) is associated with favorable long-term survival (LTS). The implication of pCR into daily practice is poorly defined. The aim of the study was to identify the correlation of pCR and different prognostic factors influencing long-term survival (LTS), tumor recurrence pattern and progressive-free interval (PFI). Method: A cohort of patients with locally advanced stage III NSCLC treated with induction chemoradiation (CRT) and subsequent surgery at a single center was retrospective reviewed. The subgroup of patients with pCR after the initial CRT, combined with application of 45Gy radiation dose, was extracted for further analysis. The statistical analysis stratified by descriptive statistics, Kaplan-Meier survival curves and estimated 3- and 5-years survival time combined with long-rank tests and Cox multivariate-analysis. Result: Between March 2008 and December 2016, a total of 24 patients with proven pCR were included in the retrospective analysis. The median age was 58.8 years [range, 46.4-76]. Fourteen patients (63.6%) were younger than 65. The median radiation dose applied was 50.4 Gy (range 45-56 Gy). The mean interval between the induction therapy and operation was 7.4±3.3 weeks and complete (R0) resection was achieved in 22 (91.6%) patients. The prognostic influence of gender, age, initial tumor stage and grade, histological subtype on pCR was analyzed using logrank test and multivariate Cox regression model. The estimated 3- and 5-year survival rates for LTS were 64% and 57%, respectively. The estimated 3- and 5-year rates for PFI were 53% and 48%, respectively. Conclusion: Favorable LTS is associated with pCR after CRT and followed by curative surgical resection. During the analysis pCR was identified as an independent prognostic factor. The distant tumor control remains the main limiting factor for LTS.
Abstracts
S2155
P2.08-005 Salvage Lung Surgery Following Definitive Chemoradiation in Locally Advanced Non-Small Cell Lung Cancer W. Schreiner,1 W. Dudek,1 R. Fietkau,2 H. Sirbu1 1Thoracic Surgery, Friedrich-Alexander-University, Erlangen/DE, 2Radiation Oncology, Friedrich-Alexander-University, Erlangen/DE Background: The incidence of local failure and residual tumor after definitive chemoradiation therapy (dCRT) for locally advanced nonsmall-cell lung cancer is even as high as 30%, irrespective of applied radiation dose (>59 Gy). So-called salvage surgery has been suggested a feasible treatment option after failure of definitive chemoradiation for locally advanced non-small cell lung cancer. Experience with salvage lung surgery is limited and long-term survival is rarely reported. The aim of this retrospective study was to assess postoperative survival and perioperative morbidity/mortality in order to identify prognostic factors and to define patient selection criteria. Method: Records of 13 consecutive patients with locally advanced non-small cell lung cancer, who underwent salvage lung surgery for local recurrence and persistent tumor after definitive chemoradiation therapy at a single institution between March 2011 and November 2016, were reviewed. Descriptive statistics were applied for patient characteristics, surgical and oncological outcome. Survival rates were calculated using Kaplan-Meier method and compared with long-rank test. Result: All patients initially received curative-intent definitive chemoradiation with median radiation doses of 66 Gy (range 59.4-72) and concurrent platin-based chemotherapy. Clinical tumor stage before definitive chemoradiation was IIIA in 9, IIIB in 3, IV in 1 patients. The indication for salvage surgery were in 6a local recurrence and in 7 patients a persistent primary tumor. Median interval between definitive chemoradiation and salvage surgery was 6.7 months. Perioperative morbidity and 30-days-mortality was 38% and 7.7%, respectively. The median postoperative survival and estimated 5-year survival rate were 29.7 months and 46%, respectively. Conclusion: Salvage lung surgery for local failure in patients with locally advanced non-small cell lung surgery following definitive chemoradiation therapy is feasible, prolongs long-term survival and allows local tumor control. Selection criteria remain undefined and patients should be considered surgical candidates during multidisciplinary team conference.
P2.08-004 Pathologic Complete Response as an Independed Prognostic Factor in Patients with Locally Advanced Non-Small Cell Lung Cancer W. Schreiner,1 W. Dudek,1 R. Fietkau,2 H. Sirbu1 1Thoracic Surgery, Friedrich-Alexander-University, Erlangen/DE, 2Radiation Oncology, Friedrich-Alexander-University, Erlangen/DE Background: Pathological complete response (pCR) after trimodality therapy in locally advanced non-small cell lung cancer (NSCLC) is associated with favorable long-term survival (LTS). The implication of pCR into daily practice is poorly defined. The aim of the study was to identify the correlation of pCR and different prognostic factors influencing long-term survival (LTS), tumor recurrence pattern and progressive-free interval (PFI). Method: A cohort of patients with locally advanced stage III NSCLC treated with induction chemoradiation (CRT) and subsequent surgery at a single center was retrospective reviewed. The subgroup of patients with pCR after the initial CRT, combined with application of 45Gy radiation dose, was extracted for further analysis. The statistical analysis stratified by descriptive statistics, Kaplan-Meier survival curves and estimated 3- and 5-years survival time combined with long-rank tests and Cox multivariate-analysis. Result: Between March 2008 and December 2016, a total of 24 patients with proven pCR were included in the retrospective analysis. The median age was 58.8 years [range, 46.4-76]. Fourteen patients (63.6%) were younger than 65. The median radiation dose applied was 50.4 Gy (range 45-56 Gy). The mean interval between the induction therapy and operation was 7.4±3.3 weeks and complete (R0) resection was achieved in 22 (91.6%) patients. The prognostic influence of gender, age, initial tumor stage and grade, histological subtype on pCR was analyzed using logrank test and multivariate Cox regression model. The estimated 3- and 5-year survival rates for LTS were 64% and 57%, respectively. The estimated 3- and 5-year rates for PFI were 53% and 48%, respectively. Conclusion: Favorable LTS is associated with pCR after CRT and followed by curative surgical resection. During the analysis pCR was identified as an independent prognostic factor. The distant tumor control remains the main limiting factor for LTS.
Abstracts
S2155
P2.08-005 Salvage Lung Surgery Following Definitive Chemoradiation in Locally Advanced Non-Small Cell Lung Cancer W. Schreiner,1 W. Dudek,1 R. Fietkau,2 H. Sirbu1 1Thoracic Surgery, Friedrich-Alexander-University, Erlangen/DE, 2Radiation Oncology, Friedrich-Alexander-University, Erlangen/DE Background: The incidence of local failure and residual tumor after definitive chemoradiation therapy (dCRT) for locally advanced nonsmall-cell lung cancer is even as high as 30%, irrespective of applied radiation dose (>59 Gy). So-called salvage surgery has been suggested a feasible treatment option after failure of definitive chemoradiation for locally advanced non-small cell lung cancer. Experience with salvage lung surgery is limited and long-term survival is rarely reported. The aim of this retrospective study was to assess postoperative survival and perioperative morbidity/mortality in order to identify prognostic factors and to define patient selection criteria. Method: Records of 13 consecutive patients with locally advanced non-small cell lung cancer, who underwent salvage lung surgery for local recurrence and persistent tumor after definitive chemoradiation therapy at a single institution between March 2011 and November 2016, were reviewed. Descriptive statistics were applied for patient characteristics, surgical and oncological outcome. Survival rates were calculated using Kaplan-Meier method and compared with long-rank test. Result: All patients initially received curative-intent definitive chemoradiation with median radiation doses of 66 Gy (range 59.4-72) and concurrent platin-based chemotherapy. Clinical tumor stage before definitive chemoradiation was IIIA in 9, IIIB in 3, IV in 1 patients. The indication for salvage surgery were in 6a local recurrence and in 7 patients a persistent primary tumor. Median interval between definitive chemoradiation and salvage surgery was 6.7 months. Perioperative morbidity and 30-days-mortality was 38% and 7.7%, respectively. The median postoperative survival and estimated 5-year survival rate were 29.7 months and 46%, respectively. Conclusion: Salvage lung surgery for local failure in patients with locally advanced non-small cell lung surgery following definitive chemoradiation therapy is feasible, prolongs long-term survival and allows local tumor control. Selection criteria remain undefined and patients should be considered surgical candidates during multidisciplinary team conference.