Definitive chemoradiotherapy for stage II-III non-small cell lung cancer: Patient outcomes in South Western Sydney Local Health District (#323)
- The survival rates of patients with unresectable stage II-III non-small-cell lung cancer (NSCLC) is low. Definitive chemoradiotherapy is the standard of care, but is associated with significant treatment-related toxicities.
- We reviewed the patient outcomes for patients with stage II-III NSCLC for whom definitive chemoradiotherapy was recommended.
- We performed a retrospective review including patients aged ≥18 years with biopsy proven stage II-III non-small-cell lung cancer treated at Liverpool, Macarthur and Bankstown Cancer Centres (Sydney) between 2000-2015. We reviewed electronic and paper medical records to obtain patient and tumour characteristics, treatment modalities, toxicities and patient outcomes. Univariate Cox regression was used to analyse overall survival (OS).
- A total of 264 patients were identified. The median age was 68 years (39-88); 73% were male; 67% of Caucasian background; and 89% were current/ex-smokers. The majority were good ECOG performance status (PS) 0-1 (87%). The median age-adjusted Charlson Comorbidity Index was 6. Two thirds (64%) received concurrent chemoradiotherapy, with Cisplatin/Etoposide used in 50% and Carboplatin/Paclitaxel in 38%. Grade 3 or more haematological toxicity was seen in 13% and non-haematological toxicity in 11%. Radiation oesophagitis was described in 29% and radiation pneumonitis in 11%. Local, distant and local and distant disease recurrence occurred in 27%, 31% and 3% respectively. Only 44% of these patients received subsequent therapy. The median OS was 23.2 months (18.4-26.2), median progression-free survival 20.3 months (15.6-23.9) and 5-year survival 13%. On univariate analysis, weight loss at diagnosis and poor baseline ECOG PS were associated with worse OS (P<0.05).
- In our patient cohort, the survival outcomes are consistent with the published literature. The utility of concurrent treatment is lower than expected with less than half of patients receiving subsequent therapy on disease progression. The use of immunotherapy post definitive chemoradiotherapy promises further advances in this patient population.