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M.C. Aubry
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P1.05 - Poster Session with Presenters Present (ID 457)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.05-064 - Global Practice Patterns of Multifocal Lung Cancer (ID 4398)
14:30 - 14:30 | Author(s): M.C. Aubry
- Abstract
Background:
Multifocal lung cancer (MFLC) is a clinical scenario that is more frequently diagnosed with the increased utilization of computed tomography of the chest. The management of MFLC is limited by the difficulties in accurately staging a patient and understanding whether lesions represent separate primaries or metastatic disease. We sought to understand the global practice patterns of MFLC.
Methods:
A questionnaire was developed and sent to members of the International Association for the Study of Lung Cancer through REDCap electronic data capture tools to assess how a hypothetical patient with synchronous MFLC would be evaluated and treated. Responses were compared by specialty using the χ[2] test.
Results:
We received 221 responses from multiple specialists (74 Thoracic Surgeons, 68 Medical Oncologists, 32 Pulmonologists, 22 Radiation Oncologists and 25 others) primarily from Europe (n=76) and North America (n=62). Over 87 respondents reported 20 or more years of experience in the field. Most respondents recommended surgery (n=140, 63%), but many others did not (n=39, 18%) or were uncertain (42, 19%). Surgeons (n=60/74, 81%) were significantly more likely to recommend surgery than medical oncologists (n=37/68, 54%), pulmonologists (n=21/32, 66%) or radiation oncologists (n=10/22, 45%; p=0.01). Lobectomy of the primarily involved lobe (n=42, 30%) and various combinations of segmentectomies (n=48, 34%) were the most commonly recommended surgical approaches. Of those who recommended surgery, most would obtain a PET/CT to rule out distant metastasis (n=135, 97%) and an MRI to rule out brain metastases (n=76, 55%) but in the absence of radiographic lymph node involvement most would not stage the mediastinum by bronchoscopy or mediastinoscopy prior to resection (n=90, 65%). Many preferred obtaining multiple biopsies of separate lesions (n=139, 63%) and genetic testing of these lesions (n=146, 66%) to assess their histologic and genetic agreement. In the case that surgery was not offered or declined, more respondents recommended radiation (n=114, 52%) than those who did not (n=50, 23%) or were uncertain (56, 26%). Similarly, in the absence of surgery or radiotherapy, slightly more respondents recommended systemic chemotherapy (n=83, 38%) than those who did not (n=79, 36%) or those who were uncertain (n=59, 27%).
Conclusion:
Although most respondents favored surgery when feasible for MFLC, many were uncertain as to the optimal approach for this disease. Optimal management of MFLC requires greater evidence from studies which is currently lacking, and current strategies are strongly influenced by specialty bias.
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P1.07 - Poster Session with Presenters Present (ID 459)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: SCLC/Neuroendocrine Tumors
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.07-045 - Characteristics of Exceptional Long Term Survivors in Extensive Stage Small Cell Lung Cancer (ID 5527)
14:30 - 14:30 | Author(s): M.C. Aubry
- Abstract
Background:
Small cell lung cancer (SCLC) remains a frustrating disease to all parties involved. Most patients present with extensive stage disease (ED), with a median survival of 8 to 13 months (Expected). The aim of this study is to present data on survivors who lived beyond 3 years after a diagnosis of ED-SCLC (Exceptional) in order to uncover favorable factors for better patient management and clinical outcomes.
Methods:
We retrospectively evaluated the SCLC patient cohort diagnosed and followed from 1997 to 2015 at Mayo Clinic (Minnesota), and searched for Exceptional survivors with matched Expected survivors who had passed away within 12 months of diagnosis on age and year of diagnosis. Patient characteristics, treatments, and outcomes were compared between the two groups.
Results:
To date, we identified 36 Exceptional and 144 Expected ED-SCLC patients. Women and an Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) 0-1 were higher in Exceptional than in Expected group (61.8% vs 36.1%, p<0.01; 97.2% vs 77.6%, p<0.01; respectively). Smoking history, comorbidities (COPD, prior cancers or paraneoplastic syndrome), and T or N stage did not differ significantly. The top two metastatic sites in Exceptional group were brain (26.7%) and distant lymph nodes (20.0%), and in Expected were liver (28.3%) and bone (22.5%). Use of chemotherapy and the mean cycle number were higher in the Exceptional than the Expected group (100.0% vs 80.0%, p<0.01; 5.0 vs 3.6, p<0.01; respectively), with the main regimen being platinum/etoposide. However, carboplatin was used more frequently than cisplatin in Expected group (all patients, p=0.02; ECOG 0-1 patients, p=0.05). The overall response rate of chemotherapy was significantly higher in exceptional group (91.4% vs 56.7%, p<0.01). Thoracic radiotherapy and prophylactic cranial irradiation (PCI) in Exceptional were also higher than in Expected group (58.3% vs 17.4%; p<0.01, 19.4% vs 6.9%; p=0.03). Multivariate analysis is underway. In Exceptional group, median overall survival was 5.4 years (95% CI 3.7-6.8); 9 (25%) patients were still alive. Twelve (33%) patients had disease recurrence or progression with the median progression free survival 1.2 (95% CI 0.7-2.0) years. The most common recurrent site was brain. Three patients had secondary malignancy, 2 being a non-small cell lung cancer.
Conclusion:
Although the chance of curing ED-SCLC is small, long-term survival can be achieved. This study supports the importance of good performance status and the achievement of a response to cisplatin-based chemotherapy on long-term survival. Addition of thoracic radiotherapy and PCI are beneficial in prolong life of ED-SCLC patients.
