1196O - Postoperative radiotherapy in resected ypN2 stage III-N2 non-small cell lung cancer: can modern conformal radiotherapy compensate for the poor outc...

Date 29 September 2014
Event ESMO 2014
Session NSCLC, locally advanced and metastatic
Topics Non-Small-Cell Lung Cancer, Locally Advanced
Surgery and/or Radiotherapy of Cancer
Presenter Charlotte Billiet
Citation Annals of Oncology (2014) 25 (suppl_4): iv417-iv425. 10.1093/annonc/mdu348
Authors C. Billiet1, Z. Gouw2, G. Defraene2, H. Decaluwe2, S. Peeters1, J.F. Vansteenkiste3, C. Dooms4, P. De Leyn2, D. De Ruysscher2
  • 1Radiaton Oncology, University Hospitals Leuven, 3000 - Leuven/BE
  • 2Radiation Oncology, University Hospitals Leuven - Campus Gasthuisberg, 3000 - Leuven/BE
  • 3Respiratory Oncology Unit (pulmonology), University Hospitals Leuven - Campus Gasthuisberg, 3000 - Leuven/BE
  • 4Department Of Pulmonology And Leuven Lung Cancer Group, University Hospitals Leuven - Campus Gasthuisberg, Leuven/BE

Abstract

Aim

To investigate the effect of modern postoperative radiotherapy (PORT) ) on the 5-year overall survival (OS) in non-small cell lung cancer (NSCLC) patients with persistent N2 disease after induction chemotherapy.

Methods

Patients with resectable pathologically proven N2 NSCLC who received induction chemotherapy followed by surgery were selected from a prospective database from September 1999 to December 2010. 103 patients without progressive disease after chemotherapy underwent resection. 95% of patients were staged with FDG-PET and 85% underwent brain imaging. In case of incomplete resection or persistent ypN2 status, patients received 3D-PORT (n = 53) to a dose of 50-66 Gy in 2 Gy fractions. Patients with a complete resection and with nodal downstaging to ypN0 or ypN1 did not receive PORT.

Results

Median follow up time was 46.3 months. For the operated group (n = 103) the 5-year OS was 31.3%, relapse free survival (RFS) 29.8%, and the cumulative local recurrence (LR) rate 51.0%. Multivariate analysis identified as significant co-variables for 5-year OS: PORT (relative risk (RR) = 0.441, p = 0.017), downstaging after chemotherapy (RR = 0.478, p = 0.030) and completeness of resection (RR = 2.051, p = <0.001). Completeness of resection was also associated with a significant improvement of RFS and a significant decrease in LR.

Conclusions

Although patients having received PORT were a group with adverse prognostic factors, PORT could improve survival for patients with stage IIIA NSCLC and ypN0/1 or R1/R2. This needs to be investigated further in a prospective randomized trial. As LR remains high also in the ypN0 and ypN1 groups, PORT is worth to be investigated or considered in these patients as well.

Disclosure

All authors have declared no conflicts of interest.