WCLC 2025 - Posters & ePosters-EP.08.17 Patterns of Recurrence and Eligibility for Salvage Therapy After Curative Intent Treatment for Unresectable Stage III NSCLC

EP.08.17 Patterns of Recurrence and Eligibility for Salvage Therapy After Curative Intent Treatment for Unresectable Stage III NSCLC

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This retrospective study evaluated patterns of recurrence and salvage therapy eligibility in patients with unresectable stage III non-small cell lung cancer (NSCLC) treated with definitive concurrent chemoradiotherapy (CRT) at BC Cancer from 2018-2021. The standard of care is CRT followed by durvalumab; however, recurrence remains common and influences salvage treatment options.<br /><br />Among 271 patients studied, 63% developed recurrence after treatment, with 43% exhibiting oligorecurrence (defined as 1-5 metastases). Oligorecurrences were detected both in the central nervous system (CNS) only and extracranially (with or without CNS involvement). Notably, at subsequent CT follow-up imaging every 3-4 months, over half of patients with oligorecurrence had persistent limited metastatic disease, underscoring the potential role of local ablative therapies such as stereotactic radiosurgery/body radiotherapy (SRS/SBRT) or surgery.<br /><br />Salvage local treatment was administered in 32% of oligorecurrent cases: 50% of CNS-only metastases and 17% of extracranial metastases received local ablative therapies. Systemic therapies were less commonly used, with many patients receiving best supportive care. Importantly, patients with 1-5 metastases who received local ablative therapy showed improved overall survival compared to those who did not. The study suggests that routine CT surveillance every 3 months during the first two years post-treatment could improve earlier detection of oligometastases and facilitate timely salvage interventions.<br /><br />In conclusion, oligorecurrence is common after curative-intent CRT for unresectable stage III NSCLC, and a substantial subset may benefit from local salvage therapies. Optimized imaging surveillance protocols and multidisciplinary management are essential to improve disease control and overall outcomes in this patient population. The study was supported by AstraZeneca and acknowledges funding from the Eleni Skalbania Lung Cancer Endowment and BC Cancer Foundation.

Asset Subtitle

Eric Bhang

Meta Tag

Speaker Eric Bhang

Topic Local-Regional Non-small Cell Lung Cancer

Keywords

unresectable stage III non-small cell lung cancer

concurrent chemoradiotherapy

durvalumab

recurrence patterns

oligorecurrence

central nervous system metastases

local ablative therapy

stereotactic radiosurgery

salvage treatment

CT surveillance