Abstract 339P
Background
Multimodality treatment for resectable limited-stage small cell lung cancer (LS-SCLC) has long remained at a therapeutic plateau, with chemoradiotherapy as the standard of care and surgery is not employed due to the low benefit. However, it is unclear whether the chemotherapy (CT) could improve surgical resectability and decrease the risk of recurrence or distant metastases in the neoadjuvant context.
Methods
Patients with resectable LD-SCLC treated with chemoradiotherapy or neoadjuvant CT followed by surgery at Shanghai Pulmonary Hospital between December 2017 and December 2023 were retrospectively reviewed.
Results
A total of 129 LD-SCLC patients were enrolled, with 47 treated with neoadjuvant CT followed by surgery and 82 with radical chemoradiotherapy. The complete pathologic response rate and major pathologic response rate were 10.64% (5/47) and 12.77% (6/47), respectively. The 1-, 2-, and 3-year event-free survival (EFS) rates were 66.64%, 37.44% and 28.16%, respectively. Median overall survival (OS) was significantly improved in the neoadjuvant group (not reached (NR)) vs chemoradiotherapy (27.13 months; HR 0.339 [95%CI 0.177–0.649]; P < 0.001). Post hoc subgroup analyses showed OS benefits with neoadjuvant CT plus surgery across subgroups. Considering the imbalance in baseline characteristics of cTNM staging between groups, propensity score matching (PSM) was done and all clinical and demographic characteristics were well balanced between two groups after PSM adjustment. A consistent OS benefit was seen with neoadjuvant CT plus surgery (NR [95%CI 44.00-NR]) versus chemoradiotherapy (29.37 months [95%CI 19.63–45.07]; HR 0.365 [95%CI 0.158–0.846]; P=0.014) in overall analysis and subgroup analysis when OS was assessed after PSM. The most common treatment-related grade 3/4 adverse events were neutrophil count decreased (6 [12.77%]). No perioperative death or other surgery-related adverse events were reported.
Conclusions
The paradigm of neoadjuvant CT plus surgery demonstrated superior efficacy and acceptable safety in patients with resectable LS-SCLC. Our results indicated the potential clinical feasibility of neoadjuvant CT plus surgery for resectable localized SCLC.
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.