Clinical and prognostic implications of sarcopenia in patients affected by locally advanced NSCLC.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20046-e20046
Author(s):  
Sabrina Rossi ◽  
Luca Disconzi ◽  
Luca Toschi ◽  
Giovanna Finocchiaro ◽  
Laura Giordano ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Induction Chemotherapy ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Stage Iii ◽  
Rank Test ◽  
Skeletal Muscle Index ◽  
Computed Tomography Images ◽  
Locally Advanced Nsclc ◽  
The Impact

e20046 Background: Sarcopenia is a loss of skeletal muscle mass that has been studied as prognostic factor in several cancers. Retrospective studies have suggested that sarcopenia is associated with poorer survival outcomes and with an increase of major chemotherapy toxicities resulting in dose reduction and delay. This study examined the value of sarcopenia in patients with stage III non-small cell lung cancer (NSCLC). Methods: This retrospective analysis includes 68 patients affected by stage III NSCLC treated with induction chemotherapy followed by surgery or radical radiation therapy in our cancer center. Weight and height were obtained from medical records at diagnosis. Skeletal muscle index (SMI) was measured by the analysis of electronically stored computed tomography images obtained before the start of chemotherapy; sarcopenia was defined by international consensus as a SMI≤39 cm2/m2 for women and ≤55 cm2/m2 for men. Kaplan-Meier method and Log-Rank test were used to determine the impact of sarcopenia on overall survival (OS) and progression-free survival (PFS). Exact Fisher test and Chi-squared test were used to establish the association between the presence of sarcopenia and other variables. Results: A total of 68 patients (stage 3A = 39; stage 3B = 29) with performance status 0-1 and median age 67 yrs were analyzed. Forty-five patients (66%) were sarcopenic: 100% of underweight patients (BMI ≤18.5), 83% of patients with normal weight (BMI 18.5-24.9), 56% of overweight patients (BMI 25-29.9) and 30% of obese (BMI≥30). Sarcopenia was not associated with age≥70 yrs (p = 0.67), Charlson Comorbidity Index (p = 1.00), stage (p = 0.53), response rate to chemotherapy (p = 0.78) or toxicities of grade≥3 (p = 0.83). Median OS in sarcopenic patients was 18.2 months compared with 33.2 months in nonsarcopenic patients (p = 0.03); the difference in terms of PFS was not statistically significant (10.7 vs 14.9 months; p = 0.19). Conclusions: Sarcopenia is associated with shorter OS in patients with locally advanced NSCLC but it seems not related with worse response to induction chemotherapy or higher toxicities. These data should be validated in larger prospective clinical studies.

Induction chemotherapy with docetaxel plus carboplatin followed by concomitant chemoradiotherapy (CRT) in locally advanced non-small cell lung cancer (NSCLC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e18505-e18505
Author(s):  
Inas Ibraheim Abdel Halim ◽  
Wael El-Sadda ◽  
Mohamed El Ashry ◽  
Nehal Mohammed Elmashad
Keyword(s):  
Lung Cancer ◽  
Induction Chemotherapy ◽  
Median Survival ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Substantial Improvement ◽  
Stage Iii ◽  
Time To Progression ◽  
Locally Advanced Nsclc ◽  
Carboplatin Auc

e18505 Background: Lung cancer remains the leading cause of cancer death in both men and women. One third of patients with NSCLC presents with localized unresectable disease. With the adavance in the diagnostic and therapeutic procedures, the median survival has shown substantial improvement. The aim of the study was to evaluate the efficacy of induction chemotherapy with docetaxel and carboplatin followed by chemo-radiotherapy in locally advanced NSCLC. Methods: A total of 30 patients (25 males and 5 females) aged between 49–60 years (mean age 51 years) with NSCLC stage III A (10 pts) stage III B (20 pts) were enrolled in the study. Patients received docetaxel 75 mg/m2 IV plus carboplatin AUC 5 on day 1 every 21 days for 4 cycles in combination with G-CSF. Patients then received radiotherapy (RT) at a dose 40-45 Gy depending on patients' tolerability combined with a low dose of carboplatin AUC 2 on the 1st day of each week during RT. Patients underwent CT chest and bronchoscopy before treatment and after completion of treatment to assess response and time to progression, patients with PR and SD received further 2 cycles of DC. Results: Of all patients received 4 cycles of IC were enrolled, 3 pts (10%) demonstrated CR, 9 pts (30%) had PR, 15 pts (50%) had SD and 3pts (10%) had PD. Twenty seven pts underwent CRT, 25 of these pts have completed CRT, five pts had CR, 15 pts had PR and 5pts had SD. No grade 4 toxicities were detected. The most common grade 3 toxicities were mucositis (6%), neutropenia (12%) and alopecia 50%. The median time to progression and median survival were 7 months and 9 months, respectively. Conclusions: IC with docetaxel and carboplatin followed by CRT with weekly carboplatin is feasible effective therapeutic strategy with manageable toxicity in patients with locally advanced NSCLC.

Infusional topotecan with concurrent radiation followed by consolidation etoposide platinum and docetaxel for patients with high risk unresectable stage III non-small cell lung cancer (NSCLC)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17042-17042
Author(s):  
S. Seung ◽  
B. K. Fisher ◽  
H. J. Ross
Keyword(s):  
High Risk ◽  
Continuous Infusion ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Stage Iii ◽  
Consolidation Chemotherapy ◽  
Cns Metastases ◽  
Unresectable Stage ◽  
Locally Advanced Nsclc ◽  
Grade 3

17042 Background: Good PS patients (pts) with locally advanced NSCLC treated with concurrent chemoradiotherapy have a 20–40% 3 year survival. Treatment is arduous and poor PS or high risk pts often cannot complete a full course of treatment. The optimal combination of chemotherapy and radiation and the role of consolidation chemotherapy are unknown. Despite response rates exceeding 50%, most pts eventually progress with brain as the first site of relapse in up to 30%. Continuous infusion chemotherapy is better tolerated than intermittent chemotherapy combined with radiation and may improve outcome in other locally advanced aerodigestive malignancies, however it has not been studied extensively in NSCLC. Topotecan is active in NSCLC, can safely be combined with radiation, can be given by continuous infusion and penetrates the CNS making it an attractive study agent in locally advanced NSCLC. Methods: In this pilot study, 20 pts were treated with infusional topotecan 0.4 mg/m2/d with 3D conformal radiation to 63 Gy both delivered M-F for 7 weeks. Pts without progressive disease underwent consolidation chemotherapy with etoposide and platinum for one cycle to take advantage of upregulation of topoisomerase II by topotecan. Two cycles of docetaxel consolidation followed. Study endpoints include response, time to progression, survival, toxicity and development of CNS metastases. Results: All pts have completed induction chemoradiotherapy. 12/20 have completed consolidation. 17/20 pts had a PR and 1/20 SD after induction chemoradiation. 1 pt developed CNS metastases 228 days after study entry and is alive with disease at 541 days. 3 pts had pulmonary emboli. Therapy has been well tolerated with 1/20 grade 4 lymphopenia. Grade 3 hematologic toxicity was seen in 17/20 pts. Other grade 3 toxicities include esophagitis (3/20), esophageal stricture (2/20), pneumonitis (6/20), fatigue (6/20), weight loss (1/20). Conclusion: Continuous infusion topotecan with radiation is well tolerated and shows evidence of activity in the management of poor risk patients with unresectable stage III NSCLC. Survival data will be presented at the meeting. No significant financial relationships to disclose.

scholarly journals Surgery after chemoradiotherapy in patients with stage III (N2 or N3, excluding T4) non-small cell lung cancer: a systematic review

2019 ◽  
Vol 26 (3) ◽  
Author(s):  
A. Swaminath ◽  
E. T. Vella ◽  
K. Ramchandar ◽  
A. Robinson ◽  
C. Simone ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Small Cell ◽  
Stage Iii ◽  
Small Cell Lung ◽  
Locally Advanced Nsclc

Background: Chemoradiation with curative intent is considered standard of care in patients with locally-advanced, stage III non-small cell lung cancer (NSCLC). However, there may be patients with stage III (N2 or N3, including T4) NSCLC who may be eligible for surgery. The objective of this systematic review was to investigate the efficacy of surgery after chemoradiotherapy compared with chemoradiotherapy alone in patients with locally-advanced NSCLC.Methods: MEDLINE, EMBASE, and PubMed were searched for randomized controlled trials (RCTs) comparing surgery after chemoradiotherapy versus chemoradiotherapy alone in patients with stage III (N2 or N3, excluding T4) NSCLC.Results: Three included RCTs consistently found no statistically significant difference in overall survival between patients with locally-advanced NSCLC who received surgery and chemoradiotherapy or chemoradiotherapy alone. Only one RCT found a significantly longer progression-free survival (PFS) in patients treated with chemoradiation and surgery (HR, 0.77; 95% confidence interval [CI], 0.62 to 0.96). In a post-hoc analysis of the same trial, the rate of overall survival was higher in the surgical group compared with patients matched in the chemoradiation-alone group if a lobectomy was performed (p=0.002), but not when a pneumonectomy was performed. Furthermore, fewer treatment-related deaths occurred among patients who received lobectomy compared with pneumonectomy.Conclusion: For patients with locally-advanced NSCLC, the benefits of surgery following chemoradiation were uncertain. Surgery after chemoradiation for patients who do not require a pneumonectomy may be an option.

Updated results of a phase III trial comparing standard thoracic radiotherapy (RT) with or without concurrent daily low-dose carboplatin in elderly patients (pts) with locally advanced non-small cell lung cancer (NSCLC): JCOG0301.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7017-7017 ◽  
Author(s):  
Hiroaki Okamoto ◽  
Shinji Atagi ◽  
Masaaki Kawahara ◽  
Akira Yokoyama ◽  
Nobuyuki Yamamoto ◽  
...  
Keyword(s):  
Advanced Nsclc ◽  
Cox Regression ◽  
Smoking Status ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Concurrent Chemotherapy ◽  
Phase Iii ◽  
Rank Test ◽  
Cox Regression Analysis ◽  
Locally Advanced Nsclc

7017 Background: We previously reported the superiority of combined chemo-radiotherapy (CRT) over RT alone in elderly pts with locally advanced NSCLC (Atagi et al. ECCO2011). One and a half years follow-up data from last accrual are presented. Methods: Pts older than 70 years with unresectable stage III NSCLC were randomized to either RT alone (RT arm), a total dose of 60 Gy, or CRT arm including the same RT plus concurrent chemotherapy with carboplatin 30 mg/m2/day, 5 days/week × 20 days. The primary endpoint was overall survival (OS). The planned sample size was 100 pts in each arm with one-sided alpha of 5% and 80% power to detect a difference in median survival time (MST) from 10 months in RT arm to 15 months in CRT arm. Results: Between Sep 2003 and May 2010, 200 pts were randomized. Baseline characteristics were similar in the RT (n=100) vs CRT (n=100) arms: median age, 77 vs 77 years; stage IIIB (n), 46 vs 49; PS 0/1/2 (n), 41/55/4 vs 41/56/3. The second planned interim analysis was performed 10 months after the completion of accrual. In accordance with the pre-specified stopping rule, the JCOG Data and Safety Monitoring Committee recommended early publication of this trial because of the difference in OS favoring the CRT arm. In the updated analysis, OS was better in the CRT arm than the RT arm (HR = .64, 95% CI = .46-.89, one-sided p = .0033 by stratified log-rank test). In each arm (RT/CRT), MST was 16.5 mo/22.4 mo with 3-year OS of 14.3%/34.6%, response rate of 44.9%/54.6% (p=.201) and median progression-free survival of 6.9 mo/8.9 mo (p=.003). Gr 3/4 toxicities were (RT/CRT): neutropenia 0%/57.3%, infection 4.1%/12.5%, dysphagia 0%/1.0%, late RT toxicities 7.4%/7.5%. The pattern of relapse site and post-protocol treatment were almost similar between the arms. Even after an adjustment by the Cox regression analysis with six variables [stage, PS, sex, age, histology, smoking status], CRT arm showed better survival (HR=.71, p=.038). Conclusions: The CRT using daily carboplatin is considered to be the standard treatment for elderly pts with locally advanced NSCLC.

Survival benefit from combined chemoradiation (CRT) in elderly patients with unresectable stage III non-small cell lung cancer (NSCLC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e17548-e17548
Author(s):  
Pedro Masson Domingues ◽  
Ricardo Zylberberg ◽  
Thalita Matta-Castro ◽  
Clarissa Serodio Baldotto ◽  
Luiz Henrique de Lima Araujo
Keyword(s):  
Prognostic Factors ◽  
Advanced Nsclc ◽  
Cox Model ◽  
Locally Advanced ◽  
Palliative Therapy ◽  
The Elderly ◽  
Tumor Stage ◽  
Best Supportive Care ◽  
Stage Iii ◽  
Locally Advanced Nsclc

e17548 Background: CRT is the standard therapy in locally advanced NSCLC. Nevertheless, the best approach in the elderly population is still poorly defined. Methods: We retrospectively reviewed the charts of elderly (≥ 65 years) patients (pts) with diagnosed stage III (6th AJCC), unresectable, NSCLC, treated at the Brazilian National Cancer Institute (INCA) between 2003 and 2005. Pts with malignant pleural effusion were excluded. The primary outcome was overall survival (OS), measured from diagnosis until death. Prognostic factors were analyzed using log-rank and stepwise Cox model. Palliative therapy (PT) included best supportive care, radiation therapy (RT; ≤ 40 Gy), and palliative chemotherapy. Among pts treated with radical RT, OS was measured from date of treatment beginning until death (OST). Results: One hundred fifteen pts were included. Median age was 71 (range 65-83), 76% were male, 51% had squamous histology, and 82% stage IIIB. Seventy percent had more than 5% weigh loss at diagnosis, 44% had PS 0-1, while 29% and 26% had PS 2 and 3, respectively. Ninety percent were current/former-smokers, and Charlson comorbidity index (CCI) was 0 in 66% and 1-2 in 34%. Thirty-six percent received PT, 32% exclusive RT (>40 Gy), and 32% CRT (concomitant or sequential). Post-radiation surgery was not performed in this cohort. The median OS was 9.9 months (ms; 95% CI, 7.2-12.6). Survival was significantly longer among pts with PS 0-1 (p<0.0001) and no weigh loss (p=0.026), while histology (p=0.15), tumor stage (p=0.51), CCI (p=0.37), and age (p=0.54) were not prognostic factors. Pts treated with exclusive RT and CRT had better OS (median 14.3 ms [95% CI, 11.7-16.9] and 17.0 ms [95% CI, 14.1-19.9], respectively) than PT (median 4.1 ms [95% CI, 3.5-4.8]; p<0.0001). In the multivariate analysis, RT (HR 0.25 [95% CI, 0.15-0.42]; p<0.0001) and CRT (HR 0.16 [95% CI, 0.09-0.27]; p<0.0001) were independently associated with better survival in comparison to PT. Among pts receiving radical RT, the addition of chemotherapy was associated with longer OST (median 14.1 vs 10.7 ms; p=0.025). Conclusions: CRT was independently associated with longer survival in elderly pts with locally advanced NSCLC.

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