Incomplete (R1) Resection for Early Stage Non Small Cell Lung Cancer (Nsclc): a Single Institution Experience from the University Hospital of South Manchester (Uhsm)

Abstract

ABSTRACT Aim: Radical lobectomy or pneumonectomy is the standard of care for operable early stage NSCLC. Incomplete (R1) resection occurs in about 9% of patients (pts) and is a known negative prognostic factor for recurrence and survival (OS). There is limited evidence to guide the use of adjuvant chemotherapy (CT) and post-operative radiotherapy (PORT) in this setting. Methods: We reviewed all consecutive pts who underwent surgery for early stage NSCLC at UHSM, between January 2008 and September 2013. Data collected: demographics, stage, type of surgery, histology, resection margins, adjuvant treatment, follow up (f-up) and OS. Primary outcome: percentage (%) of pts who underwent an R1-resection. Secondary outcomes: % of pts who received adjuvant CT and PORT, recurrence rate and OS. Results: Out of 1190 operated pts, we identified 144 (12%) with an R1 resection. Male 51%, median age 66 yo (range 37 – 81 years). Surgery: pneumonectomy/lobectomy/wedge: 21%/76%/3%. Histology: squamous/adenocarcinoma/large cell/adenosquamous/large cell neuroendocrine: 51%/40%/4%/3%/1%. Stage: IA/IB/IIA/IIB/IIIA/IIIB: 5%/8%/17%/28%/ 40%/1%. Post-operative PS: 0-1 (62%), 2 (20%) and 3 (14%). Adjuvant CT and PORT were given to 60% and 66% of pts, respectively. Adjuvant CT regimen: cisplatin/vinorelbine, carboplatin/vinorelbine, cisplatin/etoposide: 76%, 23% and 1% respectively. Median number of cycles given was 4. Reason for not giving adjuvant CT: poor PS (31%), stage 1A-1B (27%), co-morbidities (24%), patient refusal (2%), neoadjuvant CT (4%). PORT was administered to 75%/66%/60%/57% who had bronchial/medial/vascular/chest wall resection margins involved. Median f-up was 15.5 months (mos) and recurrence rate was 46%. Median OS was 23.8 mos for all pts and was 40, 37 and 20 mos for stage I, II and III respectively. Conclusions: In our series, 12% of pts had an R1 resection and this was more common for pts with stage IIIA disease. Our practice was to recommend CT (if indicated) regardless of R1 resection and the majority of pts received PORT. PORT post CT was well tolerated. OS by stage was in keeping with the literature. Median f-up is not long enough to comment on 5-year OS. Disclosure: All authors have declared no conflicts of interest.