Annemarie Therese Fernandes, Presenter: Nothing to Disclose

Nandita Mitra, Abstract Co-Author: Nothing to Disclose

Eric Xanthopoulos, Abstract Co-Author: Nothing to Disclose

Corey J Langer MD, Abstract Co-Author: Nothing to Disclose

John C Kucharczuk MD, Abstract Co-Author: Nothing to Disclose

Ramesh Rengan MD, PhD, Abstract Co-Author: Nothing to Disclose

Purpose/Objective: Several surgical series have identified subcarinal, contralateral and multi-level LN involvement as predictors of poor overall survival (OS) in stage III NSCLC treated with definitive resection. This retrospective analysis evaluates the impact of extent and location of mediastinal LN involvement on survival in patients with stage III NSCLC treated with definitive RT.Materials/Methods: We analyzed 106 consecutive patients with T1-4 N2-3 stage III NSCLC treated with definitive RT from 2003-2009. For this analysis, mediastinal LN stations were divided into 4 mutually exclusive groups: supraclavicular, ipsilateral mediastinum, contralateral mediastinum, and subcarinal. Patients were then analyzed based on the extent of involvement and location of mediastinal LN stations.Results: The median age of the patient population was 62.5 yrs, 46% were male, 69% had multilevel disease and the median RT dose was 67.5 Gy. The majority (88%) of patients received sequential or concurrent chemotherapy, which involved treatment with a platinum doublet. Median follow-up time for survivors was 32.6 months. Using multivariable analysis, chemotherapy use (HR: 0.15 [95% CI: 0.05-0.42]) was associated with improved OS. Increasing primary tumor FDG avidity (HR: 1.13 [1.06-1.19]), and subcarinal involvement (HR: 2.56 [1.25-5.21]) were significant negative predictors of OS. Survival rates are shown in the table.Patients with subcarinal involvement also had higher rates of distant failure (P<0.05). On univariate analysis, contralateral nodal involvement (HR: 0.70 [0.33-1.47]), supraclavicular nodal involvement (HR: 0.780 [0.38-1.67]), multi-level nodal involvement (HR: 0.97 [0.58-1.61]) and tumor size (HR: 1.04 [0.94-1.14]) did not predict for OS.Conclusions: Our data suggest that the addition of chemotherapy, decreased FDG avidity and absence of subcarinal disease are associated with improved prognosis in patients receiving definitive RT for stage III NSCLC. Patients with subcarinal involvement also had higher rates of distant failure. N3 nodal involvement does not appear to have an adverse effect on outcome. While surgical outcomes are sensitive to the extent and location of nodal involvement, the ultimate efficacy of radiation in stage III NSCLC is more dependent on the intrinsic biological sensitivity of the tumor.Overall Survival (OS) rates by Lymph Node GroupsSupraclavicular (N=15)Ipsilateral (N=36)Subcarinal (N=41)Contralateral (N=14)Median OS time31.3 months27.7 months13.5 months25.8 months1-year OS rate73.3%75.0%51.2%71.4%2-year OS rate51.9%52.6%23.8%57.1%4-year OS rate0%37.2%17.9%39.2%

Fernandes, A, Mitra, N, Xanthopoulos, E, Langer, C, Kucharczuk, J, Rengan, R, The Impact of Extent and Location of Mediastinal Lymph Node (LN) Involvement on Survival in Stage III Nonsmall Cell Lung Cancer (NSCLC) Patients Treated with Definitive Radiotherapy (RT) or Chemoradiation.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11030772.html