P3.17-09 Retrospective Analysis of the Efficacy and Safety of Multimodal Treatment for Locally-Advanced NSCLC in Elderly Patients

Abstract

Background: Locally advanced non-small cell lung cancer (LA-NSCLC) is mainly diagnosed in elderly patients. Although multimodality treatments are effective and have demonstrated clinical benefits in terms of OS and DFS, these options are frequently denied to elderly patients. Method: This is a single institution retrospective study with an observation period from January 2015 to December 2017. The primary endpoint was to investigate mortality, morbidity and short-term outcomes of pulmonary resection, after induction therapy (IT), for NSCLC elderly patients. The secondary endpoint was to identify risk factors for post-operative complications. Inclusion criteria were as follows: patients who received pre-operative chemotherapy (+/-radiation therapy) and subsequent pulmonary resection. The multimodal treatment was established by a multidisciplinary team. Comparisons between two groups were made: patients <70 years (group A) and patients 3 70 years (group B). Categorical variables were analyzed by means of chisquare tests and Multivariable logistic regression was used to identify pre-operative factors associated with overall morbidity. The variables included into the logistic regression model were chosen based on clinical relevance (age, sex, PS, ASA score, mCCI, clinical stage and pneumonectomy). Result: In the study, 70 patients (male/female¼42/ 28; adenocarcinoma 58.6% vs squamous-cell carcinoma 33%) underwent pulmonary resection after IT; among these, 26 were aged 70+ (median age 72.5 years [range: 70-80]). No significant differences in baseline characteristics as PFTs, PS, ASA score, number of comorbidities, clinical stages. 66 patients were treated with platinum-based chemotherapy. Chemoradiation therapy was used more frequently in group A (25% vs 3.8%; p¼0.02). Surgical procedures were similar in both groups, the percentage of pneumonectomies was comparable (15.9% vs 19.2%), while chest wall resections were more frequent in group A (18.2% vs 3.8%). Pathological stages were comparable between the two groups. In-hospital mortality (2.3% vs 0%) and median hospitalization were not different. The percentage of patients who suffered from any complication (36.4% vs 42.3%, p¼0.8) and the complication rate (43.1% vs 69.2%, p¼0.06) were higher in group B. In group B there was a significantly higher incidence of atrial fibrillation (p¼0.049). Despite these findings, the severity of complications was comparable between the two groups. The multivariable analysis demonstrates the absence of any significant factors associated with overall morbidity. Conclusion: Lung resection, for LA-NSCLC after IT, can be performed safely in appropriately selected elderly patients. There is a strong need to standardize the preoperative evaluation in order to reach an effective and tailored multimodal treatment for LA-NSCLC elderly patients.Background: Superior sulcus tumors are some of the most challenging thoracic malignant disease to treat because of their proximity to vital structures at the thoracic inlet. The aim of this study was to i...