Analysis of patterns of care and benefit of thoracic radiotherapy for patients with stage IV NSCLC in the immunotherapy-era from a national hospital-based registry.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 9123-9123
Author(s):  
Michael Kharouta ◽  
Andrew Jonathan Gross ◽  
Kevin Kelley ◽  
Serah Choi ◽  
Tithi Biswas
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Median Income ◽  
Thoracic Radiotherapy ◽  
Small Cell Lung ◽  
Comorbidity Score

9123 Background: Metastatic non-small cell lung cancer (mNSCLC) has classically been treated with platinum-doublet chemotherapy. Recent studies have established immunotherapy as an integral part of therapy for mNSCLC without targetable mutations. There are limited data on the role of consolidative thoracic radiotherapy (TRT) for patients with mNSCLC in the immunotherapy-era. A secondary analysis of KEYNOTE-001 showed significant improvement in overall survival in patients who received radiotherapy with pembrolizumab compared to patients not previously receiving radiotherapy. Methods: We queried the National Cancer Database (NCDB) for patients with metastatic presentation, stage IVA/IVB non-small cell lung cancer between the ages of 18-90 years treated between 2012-2017 with a combination of chemotherapy, immunotherapy, and thoracic radiotherapy. Patients with unknown treatment status, follow up time, or vital status were excluded. Overall survival (OS) was estimated using the Kaplan-Meier method and compared between treatment groups utilizing log-rank testing. A 3:1 nearest-neighbor propensity-score matching was performed utilizing clinical and demographic covariates to reduce the impact of potential confounders of overall survival on the probability of receipt of TRT. Cox proportional hazards regression was used to identify predictors of overall survival. Results: A total of 81,382 patients were identified that met inclusion criteria. The median age was 68 (18-90) years. The majority of patients (n = 51,681, 64%) had chemotherapy, while 7,929 (10%) patients received immunotherapy, and 15,984 (20%) received TRT. The median follow-up was 6.18 (range 0-76.9) months. For the entire cohort of patients receiving immunotherapy, 2 year OS was 29.4% with TRT compared to 32.7% without. Following propensity matching by age, sex, race, and comorbidity score, a total number of 4,264 patients receiving immunotherapy were matched. The 2 year OS was 27.7% in patients receiving TRT and immunotherapy vs. 22.2% in patients with immunotherapy alone (p = 0.004). On multivariable analysis receipt of TRT was a significant predictor of OS after adjustment for age, race, comorbidity score, sex, and median income (p = 0.0003, HR 0.87, 95% CI 0.80 - 0.94). For patients receiving BED10 > 39 Gy (equivalent to 30 Gy in 10 fractions), 2 year OS was significantly improved at 37.0% vs 18.1% (p < 0.0001). Conclusions: In patients with mNSCLC, the addition of TRT to immunotherapy is associated with improved overall survival at 2 years. Receipt of a higher BED10 is associated with further improved survival. Selection of mNSCLC patients receiving immunotherapy for TRT approaching definitive doses warrants further investigation. Data from prospective, randomized trials may better elucidate this benefit and identify a potential mechanism.

scholarly journals Anemia Is a Predictive Factor for Overall Survival Rate in Patients With Non-small Cell Lung Cancer Treated With Stereotactic Body Radiation Therapy

2021 ◽  
Author(s):  
Hidekazu Tanaka ◽  
Taiki Ono ◽  
Yuki Manabe ◽  
Miki Kajima ◽  
Koya Fujimoto ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Prognostic Factor ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Stereotactic Body Radiation Therapy ◽  
Small Cell ◽  
Small Cell Lung

Abstract Purpose: Anemia has been associated with poor prognosis in patients with cancer across several cancer types. It has been identified as a prognostic factor in patients with non-small cell lung cancer (NSCLC) who have undergone surgery or chemoradiotherapy. However, there are only a few reports that have evaluated the prognostic significance of anemia in patients with NSCLC undergoing stereotactic body radiation therapy (SBRT). Material and Methods: A total of 77 patients were enrolled this study. The pretreatment hemoglobin (Hb) levels, within 2 weeks before SBRT, were available for all patients. The median age of the participants (56 men, 21 women) was 80 (range, 50-90) years. The median Hb level was 12.8 (range, 7.8-18.3) g/dL. The median follow-up period was 24 (range, 1-87) months. Results: Local recurrence was observed in 8 (10.4%) cases during the follow-up period. The 1- and 2-year local control (LC) rates were 94.8 and 86.4%, respectively. Seventeen (22.1%) patients died during the follow-up period. The 1- and 2-year overall survival (OS) rates were 93.1 and 85.2%, respectively. Univariate analysis identified anemia and body mass index as significant prognostic factors for predicting OS. On multivariate analysis, anemia was confirmed to be the only significant factor (p = 0.02469). Conclusion: Our data suggest that anemia is a prognostic factor for predicting the OS rate in patients with early-stage NSCLC treated with SBRT.

Optimal thoracic radiation dose in limited stage small cell lung cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 8562-8562
Author(s):  
Madhusmita Behera ◽  
Xinyan Zhang ◽  
Renjian Jiang ◽  
Rathi Narayana Pillai ◽  
Pretesh R Patel ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Small Cell Lung ◽  
Once Daily ◽  
Comorbidity Score ◽  
Limited Stage ◽  
Thoracic Radiation

8562 Background: Several studies have demonstrated improved overall survival in limited stage small cell lung cancer (LS-SCLC) patients (pts) with the addition of thoracic radiation therapy (RT) to chemotherapy. However, the optimal dose of thoracic RT when given daily, which is the most common practice pattern in the US, is yet to be firmly established. We analyzed outcomes associated with once-daily low dose (LD) RT relative to once-daily high dose (HD) RT for LS-SCLC in the National Cancer Data Base (NCDB). Methods: The NCDB was queried to capture pts with LS-SCLC treated with thoracic RT from 2004-2013. The cohort of pts that received 60 Gy (LD) was compared with the cohort that received RT ≥70 Gy (HD). The univariate (UV) association of overall survival (OS) was assessed using Cox proportional hazards models and log-rank tests. A multivariable (MV) Cox proportional hazard model and Kaplan-Meier (KM) analyses were performed to compare the LD vs. HD cohorts. Propensity score matching method was also implemented to reduce treatment selection bias. All analyses were performed using SAS Version 9.4. Results: A total of 5,159 pts (LD-3441; HD- 1718) were included in the analysis. Pt characteristics (LD/HD): median age 65/64 yrs; males 44/46%; whites 89/88%, academic centers 28/31%, Charlson-Deyo comorbidity score 0- 61%/64%; government insured 61/57%. 96% of pts in LD and 95% in HD cohorts had received chemotherapy. On MV analysis, no differences were found in OS between HD and LD RT(HR 0.98, p = 0.5), which was confirmed by KM analysis with 5-yr survival of 21% in LD vs 21.5% in HD (p = 0.8). On MV analysis of OS stratified by comorbidity score, LD was associated with significantly better survival compared to HD in pts with a comorbidity score of 1 and above (HR 0.87, p = 0.02). The LD group also had a better 5-yr survival than HD group in pts with higher comorbidity score (19% vs 14%, p = 0.01). No difference in survival was noted between the two cohorts for pts with no recorded comorbidities (HR 1.03, p = 0.6). Conclusions: In LS SCLC pts, survival was similar in pts who received daily RT of 60 Gy compared to those that received 70 Gy and above. In pts with worse performance status, those who received LD RT of 60 Gy had better survival.

Trends in immunotherapy use and survival impact in stage IV non-small cell lung cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20715-e20715
Author(s):  
Zachary Otaibi ◽  
Amir Kamran ◽  
Rodney E Wegner ◽  
Athanasios Colonias ◽  
Benny Weksler ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Private Insurance ◽  
Stage Iv ◽  
Small Cell ◽  
Small Cell Lung ◽  
Comorbidity Score ◽  
Nsclc Patients

e20715 Background: Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. 5-year survival rate for metastatic non-small cell lung cancer (NSCLC) is estimated at 4%. For patients who lack a driver mutation, platinum based chemotherapy had been the cornerstone treatment, but the addition of immunotherapy has altered the treatment landscape for many advanced NSCLC patients. Immunotherapy, with or without chemotherapy, has been demonstrated in many clinical trials to extend survival in both the first-line setting as well as subsequent lines of therapy. While the clinical trial data over the past several years has been robust, less is known about how these agents have fared in routine clinical practice. To understand this better, we utilized the National Cancer Data Base (NCDB) to examine the survival of patients who received immunotherapy for stage IV NSCLC. Methods: We queried the NCDB from 2004-2015 for patients with stage IV NSCLC treated with chemotherapy and at least 3 months of follow-up. Multivariable logistic regression was used to determine predictors of immunotherapy use. Multivariable cox regression was used to determine predictors of overall survival. A propensity score was calculated and used to mitigate indication bias. Results: Of 203,069 eligible patients, 5,877 received immunotherapy. The median age was 65 years (40-90). The median follow up was 10.6 months (3-154). Patients were more likely to receive immunotherapy if they were younger, had a lower comorbidity score, received treatment at an academic facility, had adenocarcinoma histology, private insurance, Caucasian race, and a more recent treatment year. The use of immunotherapy rose steadily across the dataset years, rising from 1% to 12%. Predictors of survival were younger age, lower comorbidity score, lower grade tumor, treatment at an academic facility, higher education, higher income, private insurance, metropolitan location, immunotherapy use, adenocarcinoma histology, and more recent year of treatment. On propensity-matched Kaplan-Meier analysis patients treated with immunotherapy in addition to chemotherapy had improved survival, 13.7 months compared to 11.8 months, p < 0.0001. Conclusions: This analysis demonstrates improved overall survival in stage IV NSCLC patients who received immunotherapy. There are inherent limitations of retrospective analyses of data from large databases, however the survival improvement noted in this study is concordant with the more robust prospective clinical research published to date.

Adjuvant thoracic radiotherapy in small cell lung cancer: ten-year follow-up of a randomized study

Lung Cancer ◽  
1991 ◽  
Vol 7 (4) ◽  
pp. 235-241 ◽  
Author(s):  
M.A. Rosenthal ◽  
M.H.N. Tattersall ◽  
R.M. Fox ◽  
R.L. Woods ◽  
G.N. Brodie
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Randomized Study ◽  
Small Cell ◽  
Thoracic Radiotherapy ◽  
Small Cell Lung

Effect of thoracic radiotherapy in extensive-disease small cell lung cancer on progression-free and overall survival: A retrospective review.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e17519-e17519
Author(s):  
James Matthew Wilson ◽  
Anna Grundy ◽  
Kate Best ◽  
Paula M Mulvenna ◽  
Rhona McMenemin
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Thoracic Radiotherapy ◽  
Small Cell Lung ◽  
Extensive Disease ◽  
Platinum Based Chemotherapy

e17519 Background: Extensive-disease small cell lung cancer (ED-SCLC) carries a poor prognosis. The current standard practice of 4-6 cycles of a platinum based chemotherapy (PC) leads to a median survival of only 9-11 months. The role of thoracic radiotherapy (TRT) in ED-SCLC remains controversial. We report patient outcomes with ED-SCLC with respect to whether they received TRT or not. Methods: The practice of two oncologists from 2005-2009 was retrospectively reviewed. Patient age, performance status (PS) at presentation and site of progression were recorded. Progression-free survival (PFS) and overall survival (OS) were calculated with respect to the patient receiving 4-6 cycles of PC or not and then again in this subgroup with respect to whether or not they had TRT at any time after chemotherapy. Survival data was compared using the log-rank test. Results: 141 patients age 42-86 years old (mean 67.4 years) were identified. 58% were PS 0-2. 56 patients (40%) completed 4-6 cycles of PC with a median PFS of 8.4 months compared to 2.4 months in those that did not (p<0.001), median OS was 8.9 and 3.1 months (p<0.001). Of the 45 who had the site of progression recorded - 49% progressed within the thorax. Of 87 patents who received any chemotherapy, 43 received TRT and 44 did not with median PFS of 7.8 and 5.4 months respectively (p= 0.003) and median OS of 8.9 and 5.9 months (p=0.002). In the 56 patients who received 4-6 cycles of PC, median PFS was 9.2 with and 7.7 months without TRT (p=0.02). Median OS was 10.2 months with and 7.7 without TRT (p=0.02). Conclusions: Patients who received TRT at some point in their treatment demonstrated improved median PFS and OS. The role of TRT in ED-SCLC warrants further evaluation. The results of the REST trial are eagerly anticipated.

scholarly journals Robotic thoracic surgery for non-small cell lung cancer: initial experience in Brazil

2020 ◽  
Vol 46 (1) ◽  
Author(s):  
Ricardo Mingarini Terra ◽  
Benoit Jacques Bibas ◽  
Rui Haddad ◽  
José Ribas Milanez-de-Campos ◽  
Pedro Henrique Xavier Nabuco-de-Araujo ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Robotic Surgery ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Complete Resection ◽  
Small Cell ◽  
Small Cell Lung ◽  
The Mean

ABSTRACT Objective: To describe the morbidity, mortality, and rate of complete resection associated with robotic surgery for the treatment of non-small cell lung cancer in Brazil, as well as to report the rates of overall survival and disease-free survival in patients so treated. Methods: This was a retrospective study of patients diagnosed with non-small cell lung carcinoma and undergoing resection by robotic surgery at one of six hospitals in Brazil between February of 2015 and July of 2018. Data were collected retrospectively from the electronic medical records. Results: A total of 154 patients were included. The mean age was 65 ± 9.5 years (range, 30-85 years). The main histological diagnosis was adenocarcinoma, which was identified in 128 patients (81.5%), followed by epidermoid carcinoma, identified in 14 (9.0%). Lobectomy was performed in 133 patients (86.3%), and segmentectomy was performed in 21 (13.7%). The mean operative time was 209 ± 80 min. Postoperative complications occurred in 32 patients (20.4%). The main complication was air leak, which occurred in 15 patients (9.5%). The median (interquartile range) values for hospital stay and drainage time were 4 days (3-6 days) and 2 days (2-4 days), respectively. There was one death in the immediate postoperative period (30-day mortality rate, 0.5%). The mean follow-up period was 326 ± 274 days (range, 3-1,110 days). Complete resection was achieved in 97.4% of the cases. Overall mortality was 1.5% (3 deaths), and overall survival was 97.5%. Conclusions: Robotic pulmonary resection proved to be a safe treatment for lung cancer. Longer follow-up periods are required in order to assess long-term survival.

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