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Master Thesis

Survie des cancers du poumon non à petites cellules stade III selon la strategie thérapeutique : importance de la réunion de concertation pluri disciplinaire à l’ère de l’immunothérapie

Abstract : Introduction: Stage III Non-Small Cell Lung Cancer (NSCLC) represents a heterogeneous population. Different treatment strategies are available including surgery, radiotherapy and chemotherapy often in combination. A big change and improvement in the therapeutic strategy of these patients came with the results of the PACIFIC trial. We aimed to compare the different treatment strategies in patients with stage III NSCLC inside our institution. Methods: All stage III NSCLC patients discussed during the weekly thoracic oncology multidisciplinary team meeting between January 2010 and January 2017 at the University Hospital Grenoble Alpes (France) were included. We both compared the patients’ overall survival (OS) according to treatment strategies and recorded the strategy changes after the tumor board decision. Patients characteristics were compared according to the treatment received. Results: A total of 476 patients were identified. Of them, 34% were planned for surgery upfront, 19% were planned to receive chemo-radiotherapy (CT-RT) and 15% for neoadjuvant chemotherapy followed by surgery. Among patients initially planned to receive neoadjuvant chemotherapy followed by surgery (N=60) only 37 (62%) patients finally received a surgery. Median OS of the whole cohort was 21.3 months [IQR 25%-75%, 9.6-48.3]. Patients who received neoadjuvant chemotherapy followed by surgery had better survival than patients treated by CT-RT: 53.2 months [IQR 25%-75%, 16.1-87.3] versus 23.9 months [IQR 25%-75%, 13.3-48.1]. Survival was slightly superior for patients treated by CT-RT upfront than those planned for neoadjuvant chemotherapy followed by surgery finally converted to CT-RT (concurrent or sequential): 23.9 months [IQR 25%-75%, 13.3-48.1] versus 20.4 months [IQR 25%-75%, 10.8-36] respectively. Conclusion: Although patients with neo-adjuvant chemotherapy followed by surgery had a better survival than those treated with CT-RT, we reported that conversion from surgery to CT-RT shortened survival. These results confirm the importance of the tumor board in order to decide which is the best therapeutic strategy for patients with stage III disease. In borderline cases, an early assessment of the response to neoadjuvant treatment is necessary, in order to be able to switch to a CT-RT in case of inoperability and benefit from maintenance treatment with immunotherapy.
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https://dumas.ccsd.cnrs.fr/dumas-02955565
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Justin Bénet. Survie des cancers du poumon non à petites cellules stade III selon la strategie thérapeutique : importance de la réunion de concertation pluri disciplinaire à l’ère de l’immunothérapie. Médecine humaine et pathologie. 2020. ⟨dumas-02955565⟩

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