EP-1376 Robotic SBRT with fiducial tracking for medically inoperable peripheral stage I NSCLC: final report

Purpose or ObjectiveThe Eastern Cooperative Oncology Group performance score (ECOG-PS) is widely used in clinical routine to quantify patients' general condition.We evaluated ECOG-PS before, after and its alteration in the course of chemoradiotherapy (CRT) in patients with stage III nonsmall cell lung cancer (NSCLC). Material and MethodsThe data of ninety-eight patients with NSCLC of UICC 7 th edition stage IIIA/B and performance status ECOG 0-1 before treatment was evaluated.ECOG-PS before treatment, on first medical aftercare and the difference between, was examined for their impact on overall survival (OS) from initial diagnosis and time to local progression (TTLP), time to distant metastasis (TTDM) and event free survival (EFS) from the first day of irradiation. ResultsThe majority of patients were treated with concurrent (79%) or sequential (11%) chemoradiotherapy, while 51% received induction chemotherapy.Median survival for the entire cohort was 20.8 (range: 15.3-26.2) months.Our cohort consisted of 62% males and 38% females.Before treatment ECOG-PS was 0 in 48% and 1 in 52% of patients, their median OS, one-year and two-year survival was 26.4 months, 85%, 53% and 18.9 months, 69%, 37% (p=0.108).After completion of CRT ECOG-PS was 0 in 34%, 1 in 46%, 2 in 18% and 3 in 2% of patients, median OS, one-year and two-year survival was 40.3 months, 88%, 64% for ECOG-PS 0, 19.3 months, 82%, 40% for ECOG-PS 1, 11.9 months, 50%, 28% for ECOG-PS 2 and 7.6 months, 0%, 0% for ECOG-PS 2 (p<0.001).During treatment ECOG-PS remained the same in 62%, was reduced by one in 3% and was increased by one in 30% and by two in 5 % of patients.Taken together, 65% of patients had the same or better (=stable) and 35% of patients had worse ECOG-PS after CRT, with median OS, one-year and two-year survival of 29.3 months, 84%, 53% and 13.7 months, 62%, 29%, respectively (p<0.001).Increase of ECOG-PS during treatment impaired OS in both patient subgroups with initial ECOG-PS 0 (p=0.005,median OS 19.1 vs 31.4 months) and 1 (p=0.001,median OS 22.9 vs 11.1 months).Distant metastasis (DM) were diagnosed in 40 patients after completion of CRT.ECOG-PS before and after CRT did not predict occurrence of DM.Patients with an ECOG-PS increase during treatment however showed significantly more distant metastasis (53% vs 35%) with a median TTDM of 9.1 months (p<0.001).EFS was not affected by ECOG-PS before treatment but was impaired by ECOG-PS increase during CRT with median EFS of 9.4 vs 7.7 months (p=0.049) and by ECOG-PS after CRT with median EFS of 9.6 months, 9.0 months, 7.9 months and 3.5 months for ECOG-PS 0, 1, 2, 3, respectively (p=0.018).TTLP was not affected by ECOG-PS before and after treatment or ECOG-PS increase during treatment. ConclusionECOG-PS and its changes have a strong impact on patients' outcome.Reduction of performance status was a significant negative factor for patients' probability to develop DM, for EFS and OS.