PV QA 4 - Poster Viewing Q&A 4
Purpose/Objective(s): Basic strategy on the treatment of non-small cell lung cancer is surgery, but locoregional recurrence is observed in 10% to 40% of patients after surgical resection. Although Radiotherapy (RT) for the locoregional recurrence might be curative, the optimal strategy is not defined well. The purpose of this study is to evaluate the treatment outcomes for radiotherapy or chemoradiotherapy for postoperative locoregional recurrence of non-small cell lung cancer.
Materials/Methods: Patients with postoperative LC of NSCLC treated with RT alone or CRT between 2009 and 2017 were retrospectively evaluated. CT and/or 18-F FDG PET/CT with or without histological confirmation was used for the diagnosis of recurrence. LC was defined as the disease recurrence at the surgical margin, ipsilateral hemithorax, or mediastinum. Staging at recurrence was performed according to the 7th edition of the TNM classification and treatment related toxicity was evaluated by CTCAE v 4.0. The probability of survival was estimated using the Kaplan-Meier method. Differences in survivals were evaluated using the log rank test. A P values less than 0.05 was considered significant.
Results: Fifty patients were evaluable in this study. Patients’ median age was 69 years (range: 47 to 85). Median follow up period was 19 months (range: 5.0-71.1 months). Stage at recurrence was mainly T0 (n=35 [70%]) and N2 (N=25 [50%]). Median total RT dose was 60 Gy (range: 48 to 70Gy). Most frequently used regimen of chemotherapy was carboplatin and paclitaxel. The 1- / 2-year overall survival (OS) rates and progression-free survival (PFS) rates after postoperative recurrence were 89 / 71%, and were 72.4 / 67.1%, respectively. The median survival time after postoperative recurrence was 17.1 months. The 2-year OS and PFS rates for the patients who experienced LC less than and more than 12 months after surgery were 60 / 87 % and 53 / 86 %, respectively (P=0.03, and 0.01). As for the patients who experienced LC more than 12 months after surgery, the 2- / 3-year OS rates and PFS rates were 84 / 71% and 86% / 72% in RT alone group (n=18) and were 100%/100% and 97% / 97% in CRT group (n=6), respectively, showing a marginal significance with a P value of 0.07 and 0.09, respectively. One patient had Grade 3 esophagitis, three patients had Grade 3 cytopenia. Seen Grade 3 and 5 radiation pneumonitis to two patients, they died both of them.
Conclusion: Treatment outcomes of RT alone and CRT for postoperative LC of NSCLC were retrospectively evaluated. Our results indicated that patients who experienced LCR more than 12 months after surgery had better prognosis. For such patients, CRT was quite effective. To evaluate more accurate outcome, larger number of patients with longer follow up is necessary.
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