1183P - Use of adjuvant chemotherapy (CT) and radiotherapy (RT) in incompletely resected (R1) early stage non-small cell lung cancer (NSCLC): a European sur...

Date 30 September 2012
Event ESMO Congress 2012
Session Poster presentation II
Topics Anti-Cancer Agents & Biologic Therapy
Non-Small-Cell Lung Cancer, Early Stage
Surgery and/or Radiotherapy of Cancer
Presenter Raffaele Califano
Authors R. Califano1, Y. Oncologists Committee Of European Society For Medical Oncology2
  • 1Department Of Medical Oncology, The Christie NHS Foundation Trust & University Hospital of South Manchester NHS Foundation Trust, M20 4BX - Manchester/UK
  • 2Esmo, ESMO, ESMO/CH

Abstract

Background

Early stage NSCLC is potentially curable with radical surgery. Cisplatin-based adjuvant CT improves survival and is recommended in the ESMO guidelines for stage II-III completely resected NSCLC. There is limited evidence to guide the use of adjuvant CT and RT in incompletely resected (R1) early stage NSCLC.

Design and objective

A European survey of oncologists treating lung cancer was conducted to evaluate the use of adjuvant CT and RT for R1-resected NSCLC and to identify factors influencing treatment decisions. Demographics were collected and outcomes such as clinical stage, regimens, cycles planned, radiotherapy site, multidisciplinary management and discussion about inconclusive evidence with the patient were analyzed. Logistic regression model was used to detect statistical association and to estimate Odds Ratio; Cochrane-Armitage test was used to detect trend.

Results

768 surveys were collected from 41 European countries between January to April 2012. 82.9% of participants were medical oncologists; 49.3% ESMO members; 37.1% based in a University Hospital; 32.6% practicing oncology for more than 15 years and 81.4% active in research. 91.4% of participants prescribed adjuvant CT. Prescription according to stage: IA/IB/IIA/IIB/IIIA = 13.3%/44.8%/83.9%/90.5%/94.5%, respectively. Most common CT regimens were: Cisplatin/Vinorelbine (81.2%), Cisplatin/Gemcitabine (42.9%), Carboplatin/Vinorelbine (31.6%), Carboplatin/Paclitaxel (31%) and Carboplatin/Gemcitabine (26.7%). Number of cycles planned: 3/4/6 = 7.5%/78.1%/14.5%, respectively. 85% discussed limited clinical evidence with the patient. 48.3% of participants prescribed adjuvant RT. Among these, RT to the surgical bed and for pN2 disease was prescribed by 85.1% and 84.8%, respectively. Most common RT regimens for surgical bed: 60 Gy in 30 fractions (Fx) (45.6%), 54 Gy in 27-30 Fx (29.6%), 50 Gy in 20 Fx (23.4%) and 52.5 Gy in 20 Fx (3.6%). Most common RT regimens for pN2 disease: 60 Gy in 30 Fx (35.2%), 54 Gy in 27-30 Fx (34.1%), 50 Gy in 20 Fx (24.1%) and 50 Gy in 25 Fx (4.8%).

Conclusions

This European survey indicates that adjuvant CT and RT for incompletely resected (R1) NSCLC are commonly used in clinical practice despite limited evidence. Prospective trials for R1-resected NSCLC are necessary to clarify optimal management.

Acknowledgments

ESMO Young Oncologists Committee: R. Califano, The Christie NHS Foundation Trust, Manchester, United Kingdom;

E. Martinelli, Second University of Naples, Naples, Italy; V. Guarneri, University of Modena and Reggio Emilia, Modena, Italy; S. Banerjee, Royal Marsden Hospital, London, United Kingdom; D. Olmos Hidalgo, National Cancer research Centre (CNIO), Madrid, Spain; S. Postel-Vinay, Institute of Cancer Research ICR, London, United Kingdom; K. Jordan, University Hospital of Halle, Halle, Germany; M. Karamouzis, School of Medicine, University of Athens, Athens, Greece;

K. Kamposioras, University Hospital of Larissa, Larissa, Greece; M. Preusser, Medical University of Vienna, Vienna, Austria; E. de Azambuja, Institute Jules Bordet, Brussels, Belgium; M. Hutka, Royal Marsden Hospital, London, United Kingdom.

Medical Statistics

V. Torri, Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy; L. Porcu, Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy

ESMO project management team

K. Fumasoli, L. Kristoffersen, M. Cogo, Viganello-Lugano, Switzerland

Disclosure

All authors have declared no conflicts of interest.