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Sharanya Mohan
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P2.05 - Early Stage NSCLC (ID 706)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.05-004 - Radiotherapy Patterns of Care for Stage I and II Non-small-cell Lung Cancer in Sydney, Australia (ID 8424)
09:30 - 09:30 | Author(s): Sharanya Mohan
- Abstract
Background:
Radiotherapy is an alternative to surgery for patients with Stage I and II non-small cell lung cancer (NSCLC) who are medically inoperable or refuse surgery. However, the use of curative radiotherapy in these patients is variable. The aim of this study is to document radiotherapy patterns of care in Stage I and II NSCLC patients at three institutions in Sydney, Australia and evaluate reasons for palliative rather than curative treatment. Stereotactic ablative body radiotherapy (SABR) is a newer treatment technique. However, eligibility for this depends on tumour size and location. A secondary aim is to identify the proportion of patients who would be suitable for SABR treatment.
Method:
Electronic oncology databases at three institutions were queried to retrieve data on patients with Stage I or II NSCLC, who did not undergo surgery and were seen in a radiation oncology clinic between 1/1/2008 to 31/12/2014. Curative radiotherapy was defined as a minimum dose of 50Gy for conventional and 48Gy for SABR. Suitability for SABR was defined as peripheral tumours less than 5cm in size. Factors associated with curative treatment were determined using univariate and multivariate analyses and variables were compared using Chi-square and t-test.
Result:
There were 315 patients, with a median age of 77 years (30-93). Two-hundred-and-five (65%) had Stage I and 110 (35%) Stage II NSCLC. Eastern Cooperative Oncology Group performance status (ECOG PS) at first clinic visit was 0-2 in 252 (80%) patients. Two-hundred-and-six (65%) and 151 (48%) had pulmonary and cardiovascular comorbidities, respectively. Seventy-six (24%) patients received no radiotherapy, 58 (18%) palliative radiotherapy and 178 (56%) curative radiotherapy. Use of curative radiotherapy varied from 43% to 81% between the three institutions and increased from 51% during 2008-2011 to 64% during 2012-2014. The main reasons for receiving palliative or no radiotherapy were chronic obstructive pulmonary disease (COPD) or poor pulmonary function (26%) and comorbidities other than COPD or cardiovascular comorbidities (22%). Excluding patients with N1 disease, 25% who received palliative radiotherapy, 42% of patients who received no treatment and 37% of patients who received conventional radiotherapy were suitable for SABR treatment. ECOG PS (p=0.011), FEV1% (p=0.025) and institution (p=0.001) were significantly associated with use of curative radiotherapy in both univariate and multivariate analyses.
Conclusion:
Use of curative radiotherapy varied among cancer institutions. Patient factors were the predominant reason for palliative treatment. A significant proportion of patients who underwent palliative or no radiotherapy were potential candidates for SABR treatment.
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P3.14 - Radiotherapy (ID 730)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.14-003 - Patterns of Follow-Up Care After Curative Radiotherapy for Stage I-III Non-Small Cell Lung Cancer (ID 9707)
09:30 - 09:30 | Presenting Author(s): Sharanya Mohan
- Abstract
Background:
Evidence regarding optimal follow-up (FU) strategies for patients after curative radiotherapy for NSCLC is limited, resulting in variable FU practice. The aim of this study was to describe the patterns of FU care for patients undergoing curative radiotherapy +/- chemotherapy.
Method:
A retrospective study was conducted of patients with Stage I-III NSCLC, undergoing a course of curative radiotherapy (a minimum dose of 50Gy), between 1/1/2007-31/12/2011 at three institutions. Data was collected from oncology records, including patient demographics, tumour characteristics, treatment and follow-up. At each FU, the reason for FU (routine or symptomatic), specialist seen and imaging performed were recorded, until an event (recurrence or new primary) was diagnosed. The censor date was 31/12/2016. Analysis of FU included univariate chi-square tests for categorical variables, t-tests for continuous variables, multivariate logistic regression analyses, and Kaplan Meier survival curves.
Result:
Two-hundred-and-eighty-three patients (183 males, 100 females) were identified with a median age of 72(36-91) years. Eighty-four (29.7%) were Stage I, 47 (16.6%) were Stage II, and 152 (53.7%) were Stage III. Pathology was large cell in 91 patients (32.2%), squamous cell in 100 (35.3%), adenocarcinoma in 68 (24.0%), and NSCLC NOS in 24 (8.5%). One-hundred-and-sixty-five (56.5%) patients received radiotherapy alone and the remaining 123(43.5%) received chemoradiotherapy. The average frequency of FU visits per year was 5.12, median number of FU visits to first event was 6, and median time to first event was 11 months. 73.7% of FU were routine, while only 16.2% were symptomatic. 1641 imaging tests were performed, equating to an average of 5.8 scans per patient, with only 98 resulting in a diagnosis of an event. Overall, recurrences were diagnosed in 175 patients of whom 85 were symptomatic and 90 diagnosed on routine imaging. New primaries were diagnosed in 23 patients, 15 with symptoms and 8 on routine imaging. Subsequent treatment was curative in 25 (14.3%) patients with recurrent disease and 18 (85.7%) with new primaries. Univariate and multivariate analysis determined that the method of diagnosis of an event (symptomatic vs routine) had no statistically significant impact on the intent of further treatment (curative treatment 13.8% v 7.7%, p=0.089) or on overall survival (2y OS 49.5% vs 51.6%, p=0.772).
Conclusion:
Following curative radiotherapy, patients undergo frequent FU with regular imaging. Despite this only a minority of patients who develop recurrence are suitable for curative treatment. The use of routine imaging did not impact on further curative treatment or improve overall survival.
