88P - Omission of elective nodal irradiation has no impact on isolated elective nodal failure and survival outcomes in stage III non-small-cell lung cance...

Date 17 April 2015
Event ELCC 2015
Session Poster lunch
Topics Anti-Cancer Agents & Biologic Therapy
Non-Small-Cell Lung Cancer, Locally Advanced
Surgery and/or Radiotherapy of Cancer
Presenter Erkan Topkan
Citation Annals of Oncology (2015) 26 (suppl_1): 24-28. 10.1093/annonc/mdv049
Authors E. Topkan, O.C. Guler, B.A. Yildirim
  • Radiation Oncology, Baskent University Faculty of Medicine Adana Uygulama Ve Arastirma Mer., 01120 - Adana/TR

Abstract

Aim/Background

Impact of elective nodal irradiation (ENI) on hilar/mediastinal control rates and survival outcomes of stage III non-small-cell lung cancer (NSCLC) patients undergoing definitive concurrent chemoradiotherapy (C-CRT) is still controversial. With this large cohort analysis, we retrospectively compared the rates of isolated elective nodal recurrences (IENR) and survival outcomes in patients those received involved field- (IFRT) versus large field radiotherapy (LFRT= IFRT + ENI).

Methods

Institutional records of 987 patients with stage III NSCLC treated with definitive C-CRT of IFRT or LFRT technique between January 2007 and July 2012 were retrospectively analyzed. All patients received a total of 60-66 Gy (2 Gy/fr) conformal- or intensity modulated radiotherapy and at least 1 cycle of platinum-based doublet chemotherapy. FDG-PET/CT scans were utilized to define target volumes. Patients were grouped into IFRT and LFRT groups for comparative analysis of IENR and survival outcomes; namely, overall- (OS), locoregional progression free- (LRPFS) and progression free survival (PFS).

Results

Median age was 57 (range: 29-70), 71.2% were male, and 56.9% had squamous cell histology. Rates of LFRT and IFRT were 85.6% (n = 844) and 14.4% (n = 143). At a median follow-up of 23.3 months, a total of 24 (2.4%) isolated elective nodal recurrences were identified; 21 (2.5%) in LFRT and 3 (2.1%) in IFRT cohorts (p = 0.94), respectively. There was no significant difference between LFRT and IFRT groups in terms of median OS (22.3 vs. 23.7 months; p = 0.47), LRPFS (12.6 vs. 13.2 months; p = 0.58), and PFS (10.7 vs. 10.4 months; p = 0.82).

Conclusions

Similarities between the isolated elective nodal failure rates and survival outcomes of LFRT and IFRT cohorts land further support on previously reported series suggesting no role for ENI in locally-advanced NSCLC patients with a relatively large patient cohort. Omission of ENI in such patients may be beneficial in reducing acute and late toxicity rates with resultant improvement in quality of life measures, and safer escalation of the radiotherapy dose.

Disclosure

All authors have declared no conflicts of interest.