Efficacy of Concurrent Neoadjuvant Chemoradiotherapy in Patients with LA-Non-small-Cell Lung Cancer
PO-1248
Abstract
Efficacy of Concurrent Neoadjuvant Chemoradiotherapy in Patients with LA-Non-small-Cell Lung Cancer
Authors: Carlo Greco1, Aurelia Iurato2, Michele Fiore3, Elena Onorati3, Elisabetta Molfese4, Silvia Gentile4, Pierfilippo Crucitti5, Edy Ippolito4, Sara Ramella4
1Campus Bio-Medico University, Radiation Oncology, Rome, Italy; 2 Campus Bio-Medico University, Radiation Oncology, Rome, Italy; 3 Campus Bio-Medico University, Radiation Oncology, Rome, Italy; 4Campus Bio-Medico University, Radiation Oncology, Rome, Italy; 5Campus Bio-Medico University, Thoracic Surgery Unit, Rome, Italy
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Purpose or Objective
In LA-NSCLC concurrent neoadjuvant chemoradiotherapy
followed by surgery is an established strategy of treatment. The aim of this
study is to evaluate efficacy of concurrent chemoradiotherapy followed by
surgery in these patients (pts).
Material and Methods
Pts with histologically proven NSCLC and medical/functional
operability were evaluated. All pts received concurrent neoadjuvant
radiochemotherapy followed by surgery. Chemotherapy drugs used included
platinum compounds, taxanes, pemetrexed and gemcitabine. Some pts received
induction chemotherapy before concurrent radiochemotherapy, using platinum
compounds and/or taxanes. RT doses were in the range of 45-70 Gy. Primary end
points were OS and DFS.
Results
86 pts with stage IIIA-IIIB NSCLS were enrolled from
January 2011 to June 2020 and classified according to histology (57
adenocarcinoma, 28 squamous, 1 carcinosarcoma), stage (7 IIB, 35 IIIA, 44
IIIB). 39 pts received induction chemotherapy (45%). After neoadjuvant approach
all pts underwent surgery: 12,5% pneumonectomy, 14% bilobectomy, 68,5%
lobectomy and 5% wedge resections. All pts underwent R0 surgery. In 49%
downstaging was observed. 62% of pts had lymph node clearance (N0), 23% had pCR
(pT0N0). Treatment was well tolerated: G2 pulmonary toxicity was observed in
10,5%. No G3-4 pulmonary toxicities were recorded. G2 oesophageal toxicities
were recorded in 14% and 23% pts. No G3-4 oesophageal toxicities were observed.
G2 haematological toxicity was observed in 11,6%, G3 in 8% and G4 in 10,5% of pts.
With a median FUP of 30 mth, 2 and 5-year OS was 71% and 51% with median OS of
62 mth. 2 and 5- year DFS was 49% and 33% with a median DFS of 20,5 mth. Stage
IIIA had a non-significant better OS than IIIB (73 vs 48 months). A significant
improvement in OS was observed in the group with lymph node clearance with
2-years OS of 79% vs 71% in those who did not have it. Pts with pCR showed a
non-significant higher median OS in comparison with no pCR (63 vs 46 months).
Lymph node and pleural recurrences occurred in 19% pts and metastasis in 43%
(bone, brain, adrenal gland, lungs).
Conclusion
Our data showed that concurrent neoadjuvant radiochemotherapy followed by surgery is an effective approach in stage III NSCLC with excellent long - term OS and PFS as well as low treatment-related toxicity profile.