Patterns of failure for patients with large, node-negative non-small cell lung cancer treated with definitive radiation reveals high rates of regional and distant failure

Committee/Faculty

Presenting Author(s)

CS

Craig S. Schneider, MD, PhD

Radiation Oncology Resident Physician
University of Alabama at Birmingham
Birmingham, Alabama, United States

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

HH

Haris Hatic, DO

Hematology/Oncology Fellow
University of Alabama at Birmingham
Birmingham, Alabama, United States

Disclosure: Disclosure information not submitted.
DD

Devika Das, MD

Assistant Professor of Hematology/Oncology
University of Alabama at Birmingham
Birmingham, Alabama, United States

Disclosure: Disclosure information not submitted.
JS

John Stahl, MD

Assistant Professor of Radiation Oncology
University of Alabama at Birmingham
Birmingham, Alabama, United States

Disclosure: Disclosure information not submitted.
JB

James A. Bonner, MD

Professor and Chairman of Radiation Oncology
University of Alabama at Birmingham
Birmingham, Alabama, United States

Disclosure: Disclosure information not submitted.
AK

Adam J. Kole, MD, PhD

Assistant Professor of Radiation Oncology
University of Alabama at Birmingham
Birmingham, Alabama, United States

Disclosure: Disclosure information not submitted.

Purpose: The ideal non-operative treatment for patients with large, node-negative non-small cell lung cancer (NSCLC) is poorly defined. To inform optimal treatment paradigms for this unique cohort, we examined patterns of failure and the impact of radiation therapy (RT) and chemotherapy receipt.

Methodology: We identified node-negative NSCLC patients with large (5+ cm) primary tumors treated with definitive RT at our institution. Sites of initial progression were analyzed. Freedom from local progression, regional/distant progression, progression free-survival, and overall survival were analyzed via Kaplan-Meier. Associations between local progression versus regional/distant progression with treatment and clinicopathologic variables were assessed via univariable and multivariable competing risks regression.

Results: We identified 88 patients for analysis. Among patients with recurrent disease (N=36), initial patterns of failure analysis showed that isolated distant (27.8%) and isolated regional progression (22.2%) were most common. Distant or regional failure as a component of initial failure was seen in 88.9% of patients who progressed, while isolated local failure was less common (11.1%). Univariable and multivariable competing risks regression showed that receipt of SBRT (HR 0.23, p=0.012) was associated with reduced risk of local progression and receipt of chemotherapy was associated with reduced risk of regional/distant progression (HR 0.12, p=0.040).

Conclusions: Patients with large, node-negative NSCLC treated with definitive RT are at high risk of regional and distant progression. SBRT correlates with reduced risk of local failure while chemotherapy is associated with reduced regional and distant progression in this patient population. Ideal treatment may include SBRT when feasible with appropriate systemic therapy.

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