NSCLC

Question 1

National Lung Screening Trial: P/D/R

Answer 1

P: age 55-74 with more than 30 pack years
D: CXR vs. low dose CT every 3 years
R: all cause mortality reduced by 7% with CT

Question 2

LCSG 821 (Ginsberg): P/D/R

Answer 2

P: T1-2N0
D: lobectomy vs. wedge resection (2cm margins)
R: improved LC and DFS with lobectomy, trend toward improved OS

Question 3

London metaanalysis: P/D/R

Answer 3

P: NSCLC who underwent CRT
D: metaanalysis looking at pneumonitis
R: V2040%: 36% grade 2 and 3.5% grade 5

Question 4

Wash U lung pneumonitis: P/D/R

Answer 4

P: inoperable who underwent RT +/- chemo
D: rates of grade 2 pneumonitis
R: V20 < 22% - zero pneumonitis, V20 > 40% - 35% pneumonitis

Question 5

PORT metaanalysis: P/D/R

Answer 5

P/D: all available clinical trials of PORT vs. surgery alone

R: inferior OS with PORT especially in early stage, but patients treated before 3DCRT

Question 6

ANITA: P/D/R

Answer 6

P: resected stage IB-IIIA
D: adjuvant chemo vs. observation, some received PORT
R: N1 patients benefit from PORT if no chemo, N2 patients benefit from PORT regardless of chemo

Question 7

What two main trials examined the utility of post-operative RT?

Answer 7

1. PORT metaanalysis

2. ANITA

Question 8

CALGB 8433: P/D/R

Answer 8

P: locally advanced NSCLC
D: RT 60Gy +/- induction cisplatin/vinblastine
R: 5yr OS improved with induction chemo