PV QA 4 - Poster Viewing Q&A 4
TU_31_3626 - 70 years or Older Stage III Non-small Cell Lung Cancer: Impact of Technology on Outcomes of Definitive Chemoradiation
Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3
Pranshu Mohindra, MD, DABR
University of Maryland School of Medicine: Asst. Professor: Employee
Alliance for Clinical Trials in Oncology: Board Member; American College of Radiology: Panel Chair-Thoracic Section
70 years or Older Stage III Non-small Cell Lung Cancer: Impact of Technology on Outcomes of Definitive Chemoradiation
P. Mohindra1, M. A. L. Vyfhuis1, M. J. Edelman2, N. Bhooshan3, J. Feliciano4, W. Burrows5, S. N. Badiyan1, M. Suntharalingam1, S. J. Feigenberg6, and C. B. Simone II1; 1Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 2Division of Hematology/ Oncology, Fox Chase Cancer Center, Cheltenham, PA, 3Pinnacle Health Radiation Oncology, Harrisburg, PA, 4Division of Oncology, The Johns Hopkins School of Medicine, Baltimore, MD, 5Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, 6Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
Purpose/Objective(s): The elderly population (≥ 70 years) remains underrepresented in clinical trials with limited data on oncological outcomes of stage III non-small cell lung cancer (NSCLC). Uncertainty regarding expected outcomes or fear of toxicity may lead to suboptimal treatments. Using a mature institutional IRB approved database of patients treated with a uniform multidisciplinary approach, we test the hypothesis that definitive treatment in the modern era yields comparable outcomes for elderly patients.
Materials/Methods: Between January 2000 and December 2013, 355 patients with stage III NSCLC at our institution were offered definitive intent chemoradiation (CRT) as bimodality therapy or followed by surgery (trimodality). Kaplan-Meier estimates of overall survival (OS) and freedom-from recurrence (FFR) with log rank test for univariate and Cox regression multivariate analysis (MVA) was performed. The chi-square test was used to compare categorical variables.
Results: 70 years or older patients comprised 24% (N = 86) of the cohort and were more likely to be non-Black (p = 0.004) with higher Charlson score (p < 0.001) in comparison to younger (<70y) patients. There were no differences (p>0.05) in PS, COPD diagnosis, marital status or residential median income. Likelihood of receiving concurrent CRT (88% vs 93%, p=0.14) and RT dose ≥ 66 Gy (43% vs 46%, p=0.58) were similar, though ≥ 70y patients were less likely to undergo consolidation chemotherapy (consCT, 59% vs 73%, p=0.03) or trimodality therapy (15% vs 28%, p=0.017). Median RT duration (p = 0.74) and RT dose (p = 0.56) were not different and were independent of RT technique (3D or IMRT). With a median follow-up of 1.7y for all patients and 4.1y for surviving patients (range:0.2–14.5y), 5-year estimated OS for older and younger patients was 15% vs 26%, respectively (p =0.004). 5-y estimated FFR rate was comparable (24% vs 23%, p =0.69). On MVA, age group (<70 vs ≥ 70) did not impact OS or FFR. Overall, female gender, marital status, IMRT use, consCT and trimodality therapy were factors associated with significant survival benefit. On pairwise stratified analysis, factors associated with favorable OS in older patients were female gender, recent diagnosis (after 2005) which matched with increasing use of IMRT. Survival benefit of IMRT was larger in older patients (37% vs 9.9%, p=0.009) vs younger patients (37% vs 24%, p=0.074).
Conclusion: 70 years or older patients appear to derive larger survival benefit from use of modern RT techniques when using high-dose CRT. Lower utilization of trimodality therapy or consCT may justify exploration of potentially less morbid consolidative approaches, such as immunotherapy.
Author Disclosure: P. Mohindra: Honoraria; American Brachytherapy Society. Board Member; Alliance for Clinical Trials in Oncology. Panel Chair-Thoracic Section; American College of Radiology. M.A. Vyfhuis: None. M.J. Edelman: Research Grant; BMS, Clovis, Genentech, Heat Biologics, Novartis, Peregrine. Advisory Board; Hospira. Stock Options; Andarix. Board of Directors; Alliance for Clinical Trials in Oncology. Chair, Education Committee (Lung Cancer); ASCO. Co-chair, Lung Committee; NRG. N. Bhooshan: None. W. Burrows: None. S.N. Badiyan: Honoraria; Varian. M. Suntharalingam: CEO; University of Maryland Medical System. S.J. Feigenberg: None. C.B. Simone: Employee; Nemours/Alfred I. duPont Hospital for Children. Chair, Executive Council; Chair, Lung Committee; Proton Collaborative Group (PCG). Editor-in-Chief; Annals of Palliative Medicine. Chair, Lung Resource Panel; American Society for Radiation Oncology.