Recurrence pattern and its prognostic impact following definitive chemo-radiotherapy in stage III non-small cell lung cancer

Background

The influence of the recurrence pattern on outcome of patients (pts) with stage III NSCLC following definitive chemo-radiotherapy (CRT) has been scarcely addressed in the literature. The aim of this study was to assess the relevance of oligoprogression (OP) in this clinical setting.

Methods

Pts diagnosed with stage III NSCLC who underwent concurrent CRT from 2010 to 2014 at the Catalan Institute of Oncology were retrospectively studied.The recurrence pattern at the first progression was recorded. OPwas defined as a single metastatic site with no more than 3 lesions. Overall Survival (OS),Progression-Free Survival (PFS) and Postprogression OS (PPOS) were plotted using the Kaplan Meiermethod and multivariate Cox proportional hazards models were developed.

Results

From 171 pts: median age 62 (37-81),male 87%; ECOG ≤ 1 92%; smoking status: current 49%, former 46%, never 5%; histology: adenocarcinoma (ADC) 34%,squamous (SCC) 43%, NSCLC (NOS + large cell) 23%; Stage:IIIA 51%, IIIB 49%; cN0-1 21%, cN2 60%, cN3 19%.Platinum doublet CT: Cisplatin 62%, Carboplatin 38%. Rate between 60 and 70 Gy:94%. At a median follow-up of 48months (m), 108 patients relapsed (63%), the mPFS was 13m (95% CI 10-16) and the mOS was 28m (95% CI 22-34). Recurrence pattern: Distant (D) 36%; Loco-regional (LR) 33%;both(LR + D) 30%.Twenty-five pts (23%) developed OP (48% ADC, 52% SCC) and the organs involved were17 visceral, 3 lymph nodes, 4 brain and 1 bone. Treatments performed in OP pts: 4 surgery, 4 stereotactic radiosurgery, 1 salvage CRT, 3 RT (WBRTx2 + 1 RTE 20 Gy), 9 CT, 4 none. From all pts who progressed (n = 108)mOS was 26m for those who received 2nd line treatment (n = 77,72%), vs 13m for those without treatment (p 

Conclusions

In this cohort, the frequency of OP was remarkable and associated with improved OS. Pts with OP that might benefit from salvage therapies should be better characterized and proactively detected during follow-up after definitive CRT.

Clinical trial identification

Legal entity responsible for the study

Institut Català d'Oncologia

Funding

Institut Català d'Oncologia

Disclosure

All authors have declared no conflicts of interest.