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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1 Department of Radiation Oncology and Image-Applied Therapy , Graduate School of Medicine, Kyoto University , 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 , Japan
2 Department of Radiology, Japanese Red Cross Fukui Hospital , 2-4-1 Tsukimi, Fukui, 918-8501 , Japan
3 Department of Radiation Oncology, Kishiwada City Hospital , 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501 , Japan
4 Department of Radiation Oncology, Kobe City Medical Center General Hospital , 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-0047 , Japan
5 Department of Radiology, National Hospital Organization Kyoto Medical Center , 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 612-8555 , Japan
6 Department of Radiation Oncology, Kurashiki Central Hospital , 1-1-1 Miwa, Kurashiki, Okayama, 710-8602 , Japan
7 Department of Radiation Oncology, Hyogo Prefectural Amagasaki General Medical Center , 2-17-77 Higashinanba-cho, Amagasaki, Hyogo, 660-8550 , Japan
8 Department of Radiation Oncology, Kindai University Faculty of Medicine , 377-2, Onohigashi, Osakasayama-shi, Osaka, 589-8511 , Japan
9 Department of Radiation Oncology, Osaka Red Cross Hospital , 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555 , Japan
10 Department of Radiation Oncology , Kitano Hospital, Tazuke Kofukai Medical Research Institute , 2-4-20, Ohgimachi, Kita-ku, Osaka, 530-8480 , Japan
11 Department of Radiation Oncology, Kyoto Katsura Hospital , 17 Yamadahirao-cho, Nishikyo-ku, Kyoto, 615-8256 , Japan
12 Department of Radiation Oncology, Kyoto City Hospital , 1-2 Mibuhigashitakada-cho, Nakagyo-ku, Kyoto, 604-8845 , Japan
13 Department of Radiation Oncology, Tenri Hospital , 200 Mishima-cho, Tenri, Nara, 632-8552 , Japan
14 Department of Radiation Oncology, Shinko Hospital , 1-4-47 Wakihama-cho, Chuo-ku, Kobe, Hyogo, 651-0072 , Japan
15 Department of Radiation Oncology, Shizuoka City Shizuoka Hospital , 10-93 Otemachi, Aoi-ku, Shizuoka, 420-8630 , Japan
16 Department of Respiratory Medicine , Graduate School of Medicine, Kyoto University , 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 , Japan