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Overall Survival of Inoperable Stage II-III NSCLC Patients Treated with 3DCRT, IMRT Or SBRT Without Chemotherapy

T Podder1,2*, A Dey3 , S Datta3 , T Biswas1,2 , (1) University Hospitals Seidman Cancer Center, Cleveland, OH, (2) Case Western Reserve University, Cleveland, OH, (3) University of Akron, Akron, OH


(Tuesday, 7/16/2019) 4:30 PM - 5:30 PM

Room: Exhibit Hall | Forum 3

Purpose: EBRT with concurrent chemotherapy is the standard of care for non-operable Stage II-III non-small cell lung cancer (NSCLC) patients. However, a large number of patients were found in the National Cancer Database (NCDB) who were treated with EBRT alone. In this study, clinical outcome and effects of different EBRT modalities on survival as well as trend of care in the United States have been evaluated.

Methods: Analyzed NCDB between 2004 and 2015 of inoperable Stage II-III NSCLC patients (n=7,232) who were treated with either 3DCRT, IMRT or SBRT without chemotherapy. Radiation dose of 60-70Gy with 1.8-2Gy per fraction was considered valid for both 3DCRT and IMRT, whereas 48-60Gy in 3-5 fractions was considered for SBRT. Overall survival (OS) was computed from the date of diagnosis until the date of death or last follow up. Kaplan-Meier analysis was performed for determining the OS. IBM SPSS software (version-24) was used for statistical analysis; p-value < 0.05 was considered statistically significant.

Results: Median age of the patients was 77 years (range: 34-90 years); 54.3% male. Median follow-up was 15.7 months. During 2004-2015, out of total 7,232 patients about 37.0% was treated with 3DCRT while 29.3% and 33.7% were treated with IMRT and SBRT, respectively. Observed a trend of increasing use of IMRT/SBRT in more recent years (<10%/2% in 2004 vs. ~30%/40% in 2015). Mean/median OS of the patients were: 21.9/23.1 months, 25.2/26.9 months and 35.2/36.8 months for 3DCRT, IMRT and SBRT, respectively. One-year, three-year and five-year OS were (77.8%, 44.0%, 35.7%) significantly superior in SBRT group (p-value<0.01).

Conclusion: This study reveals that for clinical Stage II-III inoperable NSCLC, the overall survival of patients treated with SBRT is better as compared to both 3DCRT and IMRT. Nevertheless, IMRT performed better than 3DCRT for these patients. Further analysis using multivariable risk model is underway.


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