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M. Mackean
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P2.02 - Poster Session with Presenters Present (ID 462)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-008 - How Do We Really Treat Patients with Stage III Non-Small Cell Lung Cancer (NSCLC)? (ID 3924)
14:30 - 14:30 | Author(s): M. Mackean
- Abstract
Background:
About a quarter of patients with NSCLC have stage III disease. Standard treatment is cisplatin-based concomitant chemoradiotherapy, established in trials with participants younger and fitter than many patients seen in clinics. We have reviewed the treatment delivered to all patients registered on the South East Scotland Cancer Network (SCAN) database in 2011 to determine how many patients received standard of care therapy, and what might have influenced the decision not to administer this treatment.
Methods:
Individuals with stage III NSCLC presenting between January and December 2011 were identified from the SCAN database. Data were extracted on patient age, stage, histology, performance status, co-morbidities and treatment delivered.
Results:
154 patients were identified who presented with stage III NSCLC between January and December 2011. 11 patients declined treatment, one after initial surgical exploration, and 12 died before treatment could start. Only 48 of 130 (37%) patients received curative intent treatment, 13 (10%) with concomitant and 11(8%) with sequential chemoradiotherapy, 17 (13%) with radical radiotherapy and 7 (5%) with surgery. 44 (34%) received best supportive care, 33 (25%) palliative radiotherapy and 13 (10%) palliative chemotherapy. The strongest predictor of curative therapy was performance status (PS), with 41/70 (59%) PS 0-1 and 7/60 (12%) PS 2-4 (Χ[2] =30.5, p < 0.0001) respectively receiving this. Patients with 2 or more co-morbidities including emphysema (COPD), ischaemic heart disease (IHD), cerebrovascular disease (CVD) or second malignancy were also less likely to receive curative intent treatment (Χ[2] =6.4, p = 0.01) or chemotherapy (Χ[2] =4.4, p = 0.04). Absence of histological proof of disease and age did not affect treatment intent, although no patients over age 80 years received chemotherapy. Review of the 18 patients who were documented as PS 0-1 with one or fewer co-morbidity who did not receive curative intent treatment revealed 29 comorbidities between the 18 patients including 5 with thromboembolic disease, 4 with pulmonary fibrosis, 4 with COPD, 4 with IHD, 3 with atrial fibrillation 2 with second malignancy, 2 with CVD, 2 with hypertension and 1 each with diabetes, vasculitis and chronic kidney disease.
Conclusion:
Standard of care curative intent concomitant chemoradiotherapy is delivered to only a minority of patients with stage III NSCLC. Progress in improving patient outcomes in this disease requires not only the refinement of standard therapies, but research directed at patients with PS2 disease and those with multiple co-morbidities.
