Lung Cancer

PD 16 - Lung 4 - Poster Discussion

1135 - The Impact of Thoracic Radiation Therapy After Chemotherapy on Survival in Extensive-Stage Small Cell Lung Cancer: A Propensity Score-Matched Analysis

Wednesday, October 24
11:00 AM - 11:06 AM
Location: Room 217 C/D

The Impact of Thoracic Radiation Therapy After Chemotherapy on Survival in Extensive-Stage Small Cell Lung Cancer: A Propensity Score-Matched Analysis
L. Deng1, Z. Zhou2, W. Zhang3, Z. Xiao1, Q. Feng2, D. Chen1, J. Lv4, J. Liang2, X. Wang4, and L. Wang2; 1Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 2Department of Radiation Oncology, National Cancer Center / Cancer Institute & Hospital, Chinese Academic of Medical Sciences, Peking Union Medical College, Beijing, China, 3National Cancer Center / Cancer Institute & Hospital, Chinese Academic of Medical Sciences, Peking Union Medical College, Beijing, China, 4National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Purpose/Objective(s): The role of thoracic radiation therapy (TRT) after chemotherapy in extensive-stage small cell lung cancer (ES-SCLC) has not been well-defined. The aim of this study was to investigate whether TRT using Intensity-modulated radiation therapy (IMRT) after chemotherapy improves outcomes in ES-SCLC compared with chemotherapy alone.

Materials/Methods: This study included 292 ES-SCLC patients treated at the Cancer Hospital, Chinese Academy of Medical Sciences from January 2007 to December 2012. Patients reaching complete response(CR), partial response(PR), or stable disease(SD) after chemotherapy were divided into two groups: Group C+TRT, comprising of patients that underwent TRT after chemotherapy and Group C, comprising of a control group of patients who underwent chemotherapy alone. TRT was performed through Intensity-modulated radiation therapy. The median thoracic radiation dose was 56 Gy(32-67 Gy), with 1.8-2.3 Gy per fractions. Propensity score matching (PSM) was used to create patient groups that were balanced across several covariates (n=72 in each group). Outcome measures included overall survival (OS), disease-free survival (DFS), and recurrence. The Kaplan-Meier, Log Rank test, and Cox regression were used for survival analysis and identification of prognostic factors. Statistically significant difference was set at P<0.05.

Results: In the overall study cohort, 2-year OS (34.7% vs. 11.1%, P<0.001) and DFS (11.8% vs. 7.4%, P=0.006) rates, and 5-year OS (12.3% vs. 3.6%, P<0.001) and DFS (3.2% vs. 1.7%, P=0.006) rates were significantly higher in Group C+TRT compared to Group C. This data was confirmed in the matched samples (2-year OS: 32.9% vs. 6.4%, 5-year OS: 10.5% vs. 1.6%, P<0.001; 2-year DFS: 10.1% vs. 5.0%, 5-year DFS: 4.3% vs. 0.0%, P=0.023). The overall (P=0.002) and locoregional (P<0.001) recurrence rates in Group C+TRT were significantly lower than in Group C. Multivariate cox analyses in the matched samples revealed that TRT after chemotherapy was independently associated with longer OS (HR=0.422, 95% CI 0.278-0.641, P<0.001) and longer DFS (HR=0.635, 95% CI 0.433-0.931, P<0.001) compared to chemotherapy alone.

Conclusion: TRT using IMRT is strongly associated with improved OS and DFS in ES-SCLC patients reaching CR, PR or SD after chemotherapy. A multicenter, randomized phase III clinical trial is warranted to confirm these findings.

Author Disclosure: L. Deng: None. W. Zhang: None. J. Lv: None.

Lei Deng, MD

Disclosure:
Employment
National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College: Employee: Employee

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