85P - Review of radical radiotherapy +/- chemotherapy for stage III NSCLC

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 Mick Button
Citation Annals of Oncology (2015) 26 (suppl_1): 24-28. 10.1093/annonc/mdv049
Authors M. Button1, R. Evans1, E.M. Rees2, C. Bullock2
  • 1Clinical Oncology, Velindre Cancer Centre Velindre Hospital, CF14 2TL - Cardiff/UK
  • 2Student, Velindre Cancer Centre Velindre Hospital, CF14 2TL - Cardiff/UK

Abstract

Aim/Background

Review outcomes after radical radiotherapy +/- chemotherapy for stage II NSCLC, including comparison of CHART vs hypofractionated radiotherapy. Concurrent chemo-radiotherapy is not feasible in all patients with stage III NSCLC - it is important to know if there is an outcome difference between sequential chemo-RT options (neo-adjuvant chemotherapy then radical RT or RT then adjuvant chemotherapy).

Methods

Single institution retrospective review of 9 years' treatment (2005-2013).

Results

157 patients were indentified with stage III NSCLC. Median OS was 22.8 months and 5 year survival 20% which compare well with trial data. Stage IIIA (105 patients) and IIIB (52 patients) had similar survival rates. There was no difference in survival between those treated with CHART (med OS 25.4 months) and in those treated with hypofractionated radiotherapy (55/20 - med OS 21.7 months, p = 0.59), patients with adenocarcinoma and those with squamous cell carcinoma also had similar survival. Survival was non-significantly worse in patients with larger PTVs (med OS 21.7 months) compared to those with smaller PTVs (med OS 33.2 months), p = 0.21. Disappointingly, there was no improvement in survival over time but there was a trend over time for mean PTV to increase, suggesting that over time, we are treating patients with more advanced disease within the stage III group. There was no significant improvement in survival by the addition of chemotherapy, however patients who had RT then adjuvant chemotherapy had a trend to better survival (median OS 31 months) compared to those who received neo-adjuvant chemotherapy and then radical RT (median OS 18 months), p = 0.19.

Conclusions

For stage III NSCLC, CHART and conventional hypofractionated radiotherapy (55/20) had the same survival. Adjuvant chemotherapy was associated with a non-significantly improved survival when compared to neo-adjuvant chemotherapy. Tumours with larger PTVs had a non-significantly worse outcome than those with smaller PTVs. We conclude that CHART and hypofractionated radiotherapy should be viewed as equivalent and that for patients having sequential chemo-radiotherapy, outcomes may be better with radiotherapy followed by adjuvant chemotherapy than with neo-adjuvant chemotherapy prior to radical radiotherapy.

Disclosure

All authors have declared no conflicts of interest.