Postpneumonectomy Radical Accelerated (Re-)irradiation and Concurrent Chemotherapy for Patients With Contralateral Central Lung Cancer Relapses

Abstract

Materials/Methods: Pts with stage III NSCLC treated at a large cancer center 1997-2009 with radical radiation (RT) (50Gy or more) (+/chemo), but no surgery, were retrospectively identified. Pt, tumor and treatment characteristics were extracted from an existing database or from electronic pt records. Acute toxicity, (esophagitis (RE) and pneumonitis (RP)), were graded with CTC AE V3. To investigate associations between cohort and time-to-event outcomes, including loco-regional failure (LRF) and distant failure free survival (DFFS), Gray’s test and multivariable competing risks models were employed. Both cohorts were correlated with disease-free survival (DFS) and overall survival (OS), by the log rank test and Cox proportional hazards models. In the multivariable analyses, N3 disease, stage , weight loss, age , sex, ECOG score, comorbidity score, use of PET and chemotherapy were assessed. Toxicity was correlated with cohort, chemotherapy, N3, larger field disease and RT dose using logistic regression analysis techniques. Results: Three hundred twenty-four pts were identified: 217 in the ‘3DCRT Cohort’ and 107 in the IMRT Cohort’. The only differences in demographic and tumor characteristics between the two cohorts were the N-stage (pZ0.002) and PET staging (p ZG2 RP between the groups (23.5% 3DCRT vs 17.78% IMRT pZ0.248). Conclusions: Although the IMRT cohort had more pts with N3 disease, their toxicity and distant relapse rates were comparable to the 3DCRT cohort, and the OS was better. Higher rate of LRF may be due to longer OS or increased use of cross-sectional imaging in follow-up. Author Disclosure: P.M. McCloskey: None. S. Atallah: None. L. Coate: None. A. Albert-Green: None. A.J. Hope: E. Research Grant; Elekta. J. Cho: None. A.M. Brade: None. A. Sun: None. F.A. Shepherd: None. A. Bezjak: None.