86OThe effect of prophylactic cranial irradiation (PCI) for young stage III NSCLC patients: Subgroup analyses of the NVALT-11/DLCRG-02 study
2019
Background: The NVALT-11/DLCRG-02 phase III study compared PCI to observation
after chemo-radiotherapy (RT) for stage III NSCLC and showed a significant decrease
in the cumulative incidence of symptomatic brain metastases (BM) in the PCI arm at
two years (7% vs 27% [HR 0.23]). We here performed exploratory subgroup analyses.
Methods: Two year cumulative incidence rates were calculated and competing risk
regression, with death of any cause as competing risk, was used to examine the time to
symptomatic BM in the following subgroups: age, gender, performance status, disease
stage and tumour type, prior surgery, chemotherapy cycles, thoracic RT dose and total
concurrent chemo-RT treatment time. For continuous variables, the median was used
as a cut-off value. The effect of PCI was only examined if the initial result was
significant.
Results: In total, 174 patients were analysed. The symptomatic BM incidence was significantly lower in the subgroup of older (>61 years) versus younger ( ¼ 61
years) compared to younger ( ¼ <61 years) patients, likely due to higher numbers of
adenocarcinoma in the younger patients group. The effect of PCI was only significant
in younger patients. This study was randomized based on treatment allocation and subgroups might be too small to detect significant differences. Therefore, our results are
hypothesis generating and should be prospectively tested.
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