Abstract 230P
Background
Definitive chemoradiotherapy (CRT) followed by durvalumab is the standard of care for unresectable stage III NSCLC. Recommendations for surveillance imaging vary across guidelines. The Canadian guidelines recommend imaging with CT of the chest and upper abdomen every 3 months for the first year after CRT, then every 6 months for the second year and annually up to 5 years. This study aimed to assess practice patterns of imaging surveillance and patterns of recurrence following CRT for unresectable stage III NSCLC.
Methods
Patients with unresectable stage III NSCLC treated at BC Cancer, British Columbia, Canada from January 2018-December 2021 were identified. A retrospective chart review was performed including patient characteristics, surveillance compliance, recurrence patterns and treatment. Minimum of CT chest imaging was collected from the index date set at CRT completion until progression, death or 5 years after completion of CRT.
Results
459 patients with unresectable stage III NSCLC treated with CRT were identified; 433 completed planned CRT and had follow up. Patients were male 54%, median age 68 years, never/ever smokers 10/90%, adenocarcinoma 61%, stage IIIA/B/C 48/45/7%. The median radiation dose was 60 Gy with radio-sensitizing platinum. 67% received durvalumab consolidation. The median times from end of CRT to CT imaging for the first 2 years of surveillance were 2.8 months (m), 6.3 m, 12.8 m, 17.4 m, 21.6 m and 26.1 m. After a median follow-up of 17.3 m, 280 (65%) patients had recurrence, of which 51 (18%) were eligible for curative salvage. There was no difference in surveillance patterns between curative/non-curative treatment eligible recurrences.
Conclusions
In this retrospective analysis, we demonstrated that compliance with surveillance guidelines was reasonable. By 2 years, over half of the patients experienced recurrence and 82% had locoregional or metastatic recurrence not amenable to curative salvage. These findings support the current guidelines for surveillance following curative intent treatment for unresectable stage III NSCLC to ensure access to curative salvage or metastatic therapies.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
M. D’Amours: Financial Interests, Personal, Invited Speaker: Pfizer. M. Denault: Financial Interests, Personal, Invited Speaker: AstraZeneca, BMS, Janssen, Merck, Pfizer; Financial Interests, Personal, Advisory Board: Amgen, BMS, EMD-Serono, Janssen, Merck, Roche. J. Feng: Financial Interests, Personal, Invited Speaker: AstraZeneca, Merck, Pfizer, Amgen; Financial Interests, Personal, Advisory Board: Amgen, Merck; Financial Interests, Personal, Other, Travel support: DAVA. J. Laskin: Financial Interests, Personal, Invited Speaker: Ely, Lilly, Pfizer, Roche; Financial Interests, Institutional, Research Grant: Roche. B. Leung: Financial Interests, Personal, Invited Speaker: AstraZeneca, Pfizer. B. Melosky: Financial Interests, Personal, Invited Speaker: AstraZeneca, BI, BMS, Merck, Pfizer, Novartis, Jansen, Roche, GSK, Sanofi, Amgen; Financial Interests, Personal, Advisory Board: AstraZeneca, BI, BMS, Merck, Pfizer, Novartis, Jansen, Roche, GSK, Sanofi, Amgen. C. Ho: Financial Interests, Personal, Advisory Board: AbbVie, Amgen, AstraZeneca, Bayer, BMS, Janssen, Jazz, Merck, Novertism Pfizer, Roche, Sanofi, GSK; Financial Interests, Institutional, Research Grant, Grant: AstraZeneca, Roche. All other authors have declared no conflicts of interest.