Recurrence patterns and progression-free survival after chemoradiotherapy with or without consolidation durvalumab for stage III non-small cell lung cancer

Journal of Radiation Research - Tập 64 Số 1 - Trang 142-153 - 2023
Noriko Kishi1,2, Yukinori Matsuo1,2, Takashi Shintani3, Masakazu Ogura4, Takamasa Mitsuyoshi5, Norio Araki6, Kimio Fujii7, Setsuko Okumura8, Kiyoshi Nakamatsu9, Takahiro Kishi10, Tomoko Atsuta11,12, Takashi Sakamoto13, Shuji Ohtsu14, Toshimasa Katagiri15, Masaru Narabayashi3, S. Fujishiro16, Yusuke Iizuka17, Hiroaki Ozasa18,2, Toyohiro Hirai18,2, Takashi Mizowaki1,2
1Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
2Kyoto University , Graduate School of Medicine, , 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 , Japan
3Department of Radiology, Japanese Red Cross Fukui Hospital , 2-4-1 Tsukimi, Fukui, 918-8501 , Japan
4Department of Radiation Oncology, Kishiwada City Hospital , 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501 , Japan
5Department of Radiation Oncology, Kobe City Medical Center General Hospital , 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-0047 , Japan
6Department of Radiology, National Hospital Organization Kyoto Medical Center , 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 612-8555 , Japan
7Department of Radiation Oncology, Kurashiki Central Hospital , 1-1-1 Miwa, Kurashiki, Okayama, 710-8602 , Japan
8Department of Radiation Oncology, Hyogo Prefectural Amagasaki General Medical Center , 2-17-77 Higashinanba-cho, Amagasaki, Hyogo, 660-8550 , Japan
9Department of Radiation Oncology, Kindai University Faculty of Medicine , 377-2, Onohigashi, Osakasayama-shi, Osaka, 589-8511 , Japan
10Department of Radiation Oncology, Osaka Red Cross Hospital , 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555 , Japan
11Department of Radiation Oncology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20, Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
12Tazuke Kofukai Medical Research Institute , Kitano Hospital, , 2-4-20, Ohgimachi, Kita-ku, Osaka, 530-8480 , Japan
13Department of Radiation Oncology, Kyoto Katsura Hospital , 17 Yamadahirao-cho, Nishikyo-ku, Kyoto, 615-8256 , Japan
14Department of Radiation Oncology, Kyoto City Hospital , 1-2 Mibuhigashitakada-cho, Nakagyo-ku, Kyoto, 604-8845 , Japan
15Department of Radiation Oncology, Tenri Hospital , 200 Mishima-cho, Tenri, Nara, 632-8552 , Japan
16Department of Radiation Oncology, Shinko Hospital , 1-4-47 Wakihama-cho, Chuo-ku, Kobe, Hyogo, 651-0072 , Japan
17Department of Radiation Oncology, Shizuoka City Shizuoka Hospital , 10-93 Otemachi, Aoi-ku, Shizuoka, 420-8630 , Japan
18Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

Tóm tắt

Abstract Chemoradiotherapy followed by consolidation durvalumab (CCRT+D) improves survival in patients with stage III non-small-cell lung cancer (NSCLC). We compared recurrence patterns and survival in the CCRT+D and CCRT cohorts. We conducted a multicenter, retrospective study in Japan. Patients who received CCRT for stage III NSCLC were included in this study. Of 178 eligible patients, 136 were in the CCRT+D and 42 were in the CCRT cohorts. Locoregional recurrence (LR), LR plus distant metastases (DM), and DM were observed in 20.6%, 8.8%, 27.9% of the CCRT+D, and 26.2%, 16.7% and 33.3% of the CCRT cohorts, respectively. In-field recurrence was the most common LR pattern in both cohorts. Squamous cell carcinoma and PD-L1 expression < 1%, and female sex and EGFR mutations were significantly associated with an increased risk of LR and DM. In patients with any risk factors for LR, the incidence of LR was similar in the CCRT+D and CCRT (39.5% vs 45.5%). The 24 month progression-free survival (PFS) and overall survival (OS) were 40.3% and 69.4% in the CCRT+D and 24.7% and 61.0% in the CCRT cohorts, respectively. Poor performance status and no consolidation durvalumab were significantly associated with shorter PFS. There was a significant difference in PFS between the CCRT+D and CCRT in the propensity score-matched cohort (HR = 0.51, P = 0.005). In conclusion, consolidation durvalumab decreased both LR and DM, and significantly improved PFS. However, in-field recurrence was still a major problem, as well as DM.

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Journal of Radiation Research

Tập 64 Số 1

142-153

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