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Wee Yao Koh
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P1.08 - Locally Advanced NSCLC (ID 694)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.08-001 - Surgical versus Non-Surgical Treatments for Resectable Stage III NSCLC: A Systematic Review and Meta-Analysis (ID 7413)
09:30 - 09:30 | Presenting Author(s): Wee Yao Koh
- Abstract
Background:
To determine if the surgical approach is the preferred curative treatment option over non-surgical approach for resectable stage III NSCLC
Method:
We searched MEDLINE for comparative studies comparing the effects of surgical and non-surgical approaches on progression-free survival (PFS), overall survival (OS) and treatment related mortality (TRM). We assessed the methodological quality of the included studies using the MERGE criteria. We estimated the pooled hazard ratios (HR), risk ratios (RR), confidence intervals (CI), P values (P) and I squared statistic (I[2]) with random effects model using Revman 5.3. We assessed the quality of the summarized randomized trials evidence using the GRADE approach.
Result:
We found five randomized trials and one retrospective population based comparative study including 12,229 Stage III NSCLC patients. These studies have low to moderate risk of bias in their methodology. The randomized trials (n = 981) showed that surgery did not improve PFS (HR 0.93, 95% CI 0.74 to 1.17, P = 0.56, I[2] = 0%, low quality), OS (HR 0.95, 95% CI 0.82 to 1.11, P = 0.53, I[2] = 0%, moderate quality) and cause more TRM (RR 3.75, 95% CI 1.65 to 8.54, P = 0.002, I[2] = 0%, moderate quality). Subgroup analyses showed that the effect on OS was no different between the trials that use concurrent chemoradiotherapy versus those that do not and trials that use PET/CT for staging versus those that do not. Although retrospective study favored surgical approach (OS: HR 0.64, 95% CI 0.53 to 0.77, P < 0.00001, I[2] = 82%), this discrepancy in OS is likely due to selection bias.
Conclusion:
Surgical approach did not delay disease progression or improve survival and may cause more treatment related deaths compared to non-surgical approach in the curative treatment of resectable stage III NSCLC. Future research should focus on optimizing the non-surgical approach using more effective systemic agents and advanced imaging and radiotherapy techniques.
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P1.15 - SCLC/Neuroendocrine Tumors (ID 701)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: SCLC/Neuroendocrine Tumors
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.15-017 - Adoption of Prophylactic Cranial Irradiation for Extensive Stage Small Cell Lung Cancer: A Population Based Outcomes Study (ID 7457)
09:30 - 09:30 | Author(s): Wee Yao Koh
- Abstract
Background:
The survival benefit of prophylactic cranial irradiation (PCI) in extensive stage small cell lung cancer (ES-SCLC) is unclear. This study aimed to determine the use of PCI and the factors associated with its use as well as its impact on overall survival (OS) in the Singapore population.
Method:
We conducted a retrospective cohort study including patients diagnosed with ES-SCLC without brain metastases treated in the only two Singapore national cancer centres from 2003 to 2010. We identified the patients using the institutions’ pathology registries and linked the electronic medical records to the National Death Registry. We used multivariable logistic regression to identify factors associated with the use of PCI and its impact on OS. All analyses were performed using STATA version 11.0.
Result:
We identified 224 eligible patients. 65 of 224 patients did not receive chemotherapy. 71 of 159 patients had at least stable disease (SD) after first line chemotherapy. 16 of these 71 patients received PCI. There was an increase in the use of PCI from the period 2007 to 2010 compared with 2003 to 2006 (13 patients versus 3 patients, chi-square P value = 0.01). The use of consolidation thoracic radiation therapy (TRT) was associated with use of PCI (odds ratio 18.3, 95% confidence interval (CI) 4.70 to 71.96, P value (P) < 0.001). PCI improved OS (adjusted hazard ratio 0.47, 95% CI 0.24 to 0.91, P = 0.02) compared to no PCI use among the 71 patients who had at least SD after first line chemotherapy. Consolidation TRT did not improve OS among this group of patients.
Conclusion:
The utilization rate of PCI remained low in the Singapore population between 2003 to 2010 despite an increase in its use since 2007. Patients who had at least SD after first line chemotherapy or had consolidation thoracic radiation therapy were more likely to receive PCI. Among patients who had at least stable disease after first line chemotherapy, the use of PCI was associated with an improved survival outcome.
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P2.14 - Radiotherapy (ID 715)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.14-002 - Impact of Pre-Existing Cardiac Disease and Heart Doses on Survival in Nsclc Treated with Post-Operative Thoracic Radiotherapy (ID 8530)
09:30 - 09:30 | Author(s): Wee Yao Koh
- Abstract
Background:
Recent randomized and observational studies suggested that pre-existing cardiac disease and higher radiation heart doses were associated with more cardiac events and worse overall survival (OS) in locally-advanced non-small cell lung cancer (NSCLC) treated with definitive chemoradiation. Post-operative thoracic radiotherapy (PORT) delivered via non-modern radiation techniques had also been shown to increase cardiac mortality. Hence we performed this study to determine the impact of pre-existing ischaemic heart disease and radiation heart dose on OS in NSCLC patients treated with PORT using contemporary radiation techniques.
Method:
Study eligibility criteria included stage I to III NSCLC treated with PORT at two institutions from 2007 to 2014. Clinical data and dosimetric parameters affecting overall survival were collected from the institutional electronic medical records as well as the national death and acute myocardial infarction registries. Univariate cox regression was performed using Stata version 13.
Result:
Twenty eligible patients were identified. Median follow-up duration was 30.4 months (2.3- 81.9). Median age was 59 years. Median prescription dose was 57 Gy. Median mean heart dose was 12Gy. 10% had pre-existing ischaemic heart disease. 75% underwent lobectomy. 60% had pathological stage III disease. 40% had left-sided disease. 70% received chemotherapy. The 1- and 2-year OS were 75% and 60% respectively. Univariate analysis showed that pre-existing ischaemic heart disease was significantly associated with worse OS (hazard ratio 7.13, 95% confidence interval 1.17-43.47, P value < 0.03). Mean heart dose and the other cardiac dosimetric parameters (volume of heart receiving ≥ 5, 25, 30, 40, 50Gy, and dose to ≥ 30% of heart volume) were not associated with OS.
Conclusion:
Pre-existing ischaemic heart disease was a significant predictor for worse OS in NSCLC patients treated with modern PORT. We plan to expand the cohort to confirm these findings. Patients should be screened for ischaemic heart disease and cardiac function optimised prior to PORT and on follow-up.
