Poster Presentation COSA 2015 ASM

Outcome of patients with stage III non-small cell lung cancer treated with neo adjuvant chemotherapy and radiotherapy in a tertiary care center (#184)

Mihitha H Ariyapperuma 1 , Tee Lim 2 , Sanjay Sharma 3 , Sanjay Mukhedkar 4 , Wei-Sen Lam 4
  1. medical oncology, Fiona Stanley Hospital, Murdoch, WA, Australia
  2. Radiation oncology , Fiona Stanley Hospital, Murdoch, WA, Australia
  3. Cardiothoracic surgery , Fiona Stanley Hospital, Murdoch, WA, Australia
  4. Medical oncology, St John of God Hospital, Murdoch, WA, Australia

Background: Stage III Non-small cell lung cancer (NSCLC) is a hereterogenous group of lung cancer. Optimal treatment particularly in stage IIIA remains controversial and undefined.  Trimodality therapy with neoadjuvant chemoradiotherapy (CRT) followed by surgery has shown to improve progression free survival and potentially overall survival.

We are reporting the feasibility of trimodality therapy and outcomes patients with stage III NSCLC  therapy in our center.

Methods: Data was retrospectively collected from Fremantle hospital medical records for the time period February 2010 to January 2015. Eighteen patients were identified. Only patients with diseases that were deemed suitable for lobectomy and mediastinal lymph node dissection at presentation were offered neoadjuvant CRT and included in the study. All patients were treated with neoadjuvant concurrent CRT. Restaging PET scan was performed to assess tumour response and suitability for surgery. Patients with good tumour response were offered lobectomy and mediastinal lymph node dissection, rest were offered consolidative radiotherapy.

Results: Most of the patients were male (14/18) and median age was 64 years. Out of eighteen patients, eleven were diagnosed with adenocarcinoma and the remaining with squamous cell cancer. All patients were treated with neoadjuvant CRT.  Main chemotherapy agents used were cisplatin and etoposide. Median dose of radiotherapy was 51Gy. Eleven out of 18 patients successfully underwent curative lobectomy and mediastinal lymph node dissection. After median follow up of 32 months, 12 patients are still alive and 6 remain disease free. Average survival of patients who underwent surgery was 28 months. Chemotherapy doses, interruptions and complications will be assessed.

Conclusion: Trimodality therapy for highly selected group of patients with resectable and borderline resectable stage IIIA NSCLC is feasible, well tolerated, and is associated with an encouraging survival outcome.  A prospective study of this regimen should be considered in the future.