Author of

• 11001

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11037

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    P1.24-036 - Combined Modality Treatment for inoperable Non-Small Cell Lung Cancer - a retrospective study from a New Zealand regional cancer centre. (ID 2593)

    09:30 - 09:30  |  Author(s): J. Nel
    • Abstract

    Background
    Lung cancer in New Zealand is associated with poor survival and regional inequalities. Non-small cell lung cancer (NSCLC) accounts for 80%–85% of all newly diagnosed lung cancer cases. Forty five percent of these patients present with stage III disease (mediastinal node involvement). The Regional Cancer Treatment Service (RCTS), Palmerston North Hospital is using combined modality treatment (CMT) chemotherapy / radiotherapy protocol for inoperable Stage II and Stage III NSCLC since 2006. The chemotherapy regimen employs 3 cycles of Cisplatinum/Vineralbine. This audit reviews the outcomes and side effects of treatment.

    Methods
    This retrospective study comprises patients with a clinical diagnosis of inoperable NSCLC from the RCTS, Palmerston North Hospital database. Patients confirmed to have stage IIIB and/or inoperable stage II and IIIA NSCLC are included. These patients completed treatment based on the RCTS NSCLC CMT guideline from 1[st] July 2005 to 31[st] May 2012. Information was obtained from Oncology electronic records and paper based clinical notes in RCTS. The treatment protocol includes one neoadjuvant cycle of chemotherapy, given 3 weeks prior to commencing of the radiotherapy. It is followed by further two cycles of Cisplatin/Vinorelbine, given concurrently with radical radiation therapy on day 1 and 22 of the radiotherapy. All patients were treated with 3D conformal radiotherapy to total dose is 60Gy in 30 fractions, over 6 to 7 weeks. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 were applied. Progression free survival (PFS) and median survival were estimated and reviewed.

    Results
    From 1[st] of July 2005 to 31[st] of May 2012, 39 patients completed CMT. All cases in the study had a history of smoking. Thirty two (82%) patients had inoperable stage III NSCLC (IIIA - 15 cases, IIIB - 17 cases). The remaining seven patients had stage II disease, (IIA - 3 cases, IIB - 4 cases), who were deemed inoperable due to significant medical problems. Protocol doses were maintained in 79% of patients, with dose reduction typically used due to transient renal impairment, ototoxicity and myelosuppression. Neutropenia (ANC <1000/mm3) was documented in 21% of patients. Six patients (15%) had neutropenia on day 14-15 and 2 patients (5%) on day 22-23. One patient had hospital admission for febrile neutropenia. Five other patients developed neutropenia but remained asymptomatic. Grade III anaemia (Hb <80 g/L) was noted in 6 patients - all of them had 2 units of blood transfusion. There were no treatment related deaths. 23 patients developed progression of the disease. At the time this study is completed, 16 patients are remaining progression free. The median progression free survival is 9.4 months (mean 12.4), with a median overall survival of 16.6 months. This study demonstrated a 3-year survival rate of just below 20 %.

    Conclusion
    These outcomes and toxicities are comparable to the reported international studies and would support continued use of our current protocol. Further studies may be helpful to identify the optimum chemotherapy regimen in concurrent therapy for inoperable NSCLC. The future role of molecular tailored regimens in subgroups of patients undergoing CMT is evolving.