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T. Varghese Jr
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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: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.07-016 - Trends, Practice Patterns and Underuse of Surgery in the Treatment of Early Stage Small Cell Lung Cancer (ID 4070)
14:30 - 14:30 | Author(s): T. Varghese Jr
- Abstract
Background:
Current National Comprehensive Cancer Network guidelines recommend pathologic mediastinal staging and surgical resection for all patients with clinically node negative T1 and T2 small cell lung cancer (SCLC), but the extent to which surgery is used for early stage SCLC is unknown.Our obejctive was to assess trends and practice patterns in the use of surgery for SCLC.
Methods:
Clinical stage T1 or T2N0M0 SCLC cases were identified in the National Cancer Database (NCDB), 2004 – 2013. Demographics and clinical characteristics of patients undergoing resection were analyzed. Hierarchical logistic regression was used to identify individual and hospital-level predictors of receipt of surgical therapy. Trends in the rates of surgical resection for eligible patients were analyzed over the study period.
Results:
9,740 patients were identified with a diagnosis of clinical T1 or T2 N0M0 SCLC. Of these, 2,210 underwent surgery (22.7%), with 1,421 (64.3%) of these patients undergoing lobectomy, 739 (33.4%) sublobar resections and 50 (2.3%) pneumonectomies. After adjustment for clinical, demographic and facility characteristics, Medicaid patients were less likely to receive surgery (OR0.65 95% CI 0.48 – 0.89, p=0.006), as were those with T2 tumors (OR0.25 CI0.22 – 0.29, p<0.0001). Academic facilities were more likely to resect eligible patients (OR 1.90 CI1.45 – 2.49, p<0.0001). Between 2004 and 2013, rates of resection more than doubled from 9.1% to 21.7%. Overall, 68.7% of patients were not offered surgery despite having no identifiable contraindication. In patients not receiving surgery, only 7% underwent pathologic mediastinal staging.Figure 1
Conclusion:
Although rates of resection are increasing, surgery is rarely used nationally in the treatment of potentially eligible SCLC patients. About two thirds of potentially eligible patients fail to undergo potentially curative surgery. Further study is required to address the lack of concordance between guidelines and practice.
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P1.07-017 - Indications for Adjuvant Mediastinal Radiation in Surgically Resected Small Cell Lung Cancer (ID 4073)
14:30 - 14:30 | Author(s): T. Varghese Jr
- Abstract
Background:
Adjuvant mediastinal radiation (AMR) is an adjunctive therapy for patients with surgically resected small cell lung cancer (SCLC). However, little data guides its use. We sought to examine whether there was a survival benefit associated with AMR for resected SCLC patients and to define sub-populations who should be selected for AMR.
Methods:
Patients undergoing resection (lobectomy, pneumonectomy and sublobar resection) for SCLC were identified in the National Cancer Database, 2004 – 2013. Kaplan-Meier survival curves and Cox proportional hazards were used to evaluate the impact of receipt of AMR on survival. Hazard ratios were adjusted for patient comorbidity and demographic information, as well as tumor stage, grade, histology, margin status and receipt of adjuvant chemotherapy.
Results:
3,113 patients were identified. Those receiving AMR were younger, more likely to have greater pathologic T- and N- stage, more likely to undergo sublobar resection and have a positive margin. Kaplan-Meier curves showed better median survival for patients with N1-3 disease who received AMR. After adjustment, Cox models showed lower risk of death for N1, N2/3 and sublobar resection with AMR (HR0.79 CI0.65 – 0.96, p=0.02; HR 0.60 CI0.48 – 0.75, p<0.0001). In the overall cohort, AMR was not associated with better survival in node-negative patients. AMR was, however, associated with improved survival for patients receiving sublobar resection (HR0.72 CI0.58 – 0.92, p=0.006).Figure 1
Conclusion:
AMR has significant benefit for node-positive patients after resection for SCLC, especially those with pN2 or pN3. Patients undergoing sublobar resection may benefit from AMR.
