83PD - Prognosis of stage III non-small-cell lung cancer patients presenting with isolated brain failure after definitive concurrent chemoradiation therapy

Date 16 April 2015
Event ELCC 2015
Session Medical and radiation oncology
Topics Anti-Cancer Agents & Biologic Therapy
Complications of Treatment
Non-Small-Cell Lung Cancer, Locally Advanced
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

We retrospectively investigated the survival outcomes of stage III non-small-cell lung cancer (NSCLC) patients presenting with isolated brain failures (IBF) after definitive concurrent chemoradiation therapy (C-CRT) and treated with whole brain radiotherapy (WBRT) ± stereotactic radiosurgery (SRS) or surgery.

Methods

A total of 162 patients with stage III NSCLC who were treated with platinum based C-CRT between January 2007 and December 2012 and presented with proven IBF with/without locoregional failures were included in this retrospective analysis. All patients received WBRT of 20-30 Gy (3-4 Gy/fx) ± SRS of 16-22 Gy or surgery. The primary and secondary end points were overall survival (OS) and identification of factors associated with longer survival.

Results

Median follow-up was 12.7 months from the IBF diagnosis. IBF occurred at median 7.8 months (range: 1.7-46.4) from the commencement of C-CRT. WBRT was the sole local intervention in 78 patients whereas 55 and 29 patients received additional SRS or surgery mostly prior to WBRT. Median and 3-year survival rates were 11.7 months and 20.4%, respectively. In univariate analysis, controlled primary (20.3 vs. 6.4 months; p < 0.001) and absence of extracranial metastasis development during follow-up (23.3 vs. 10.6 months; p < 0.001) revealed significant association with longer OS. These factors retained their independent significance in multivariate analysis. Addition of SRS/surgery was related with better brain control rates but not OS in overall population. However, in patients presenting with ≤3 brain lesions and controlled lung primary the addition of SRS/surgery to WBRT was associated with significantly superior OS times than WBRT alone (25.8 vs. 8.2 months; p < 0.001).

Conclusions

Present results demonstrated that controlled lung primary and absence of extracranial metastasis development during follow-up were the factors associated with longer OS after WBRT ± SRS/surgery in stage III NSCLC patients presenting with IBF after platinum-based C-CRT. Additionally, our results suggested superior survival with addition of SRS/surgery to WBRT in patients with 1-3 brain lesions and controlled lung primaries.

Disclosure

All authors have declared no conflicts of interest.