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W. Wong
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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): W. Wong
- 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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P2.15 - SCLC/Neuroendocrine Tumors (ID 716)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: SCLC/Neuroendocrine Tumors
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.15-007 - Extensive Stage Small Cell Lung Cancer: Patterns of Care and Outcomes of a Single Institution over 15 Years (ID 8908)
09:30 - 09:30 | Author(s): W. Wong
- Abstract
Background:
Survival outcomes for extensive stage small cell lung cancer (ES-SCLC) remain poor. The standard management of ES-SCLC is chemotherapy. For those achieving a good response consolidation thoracic radiotherapy and prophylactic cranial irradiation (PCI) is considered. This retrospective audit analysed patterns of care and survival for all patients with ES-SCLC treated at Prince of Wales Hospital (POWH) over 15 years. Factors correlating with survival were also analysed. A literature review was performed to benchmark our results.
Method:
We identified 187 patients diagnosed with SCLC at Prince of Wales Hospital between 2000 and 2014 from the departmental electronic patient information system (MOSAIQ, Elekta). Eligibility criteria were: age >18 years, histopathologically confirmed diagnosis of SCLC, extensive stage according to the two-stage Veterans’ Affairs Lung Study Group staging criteria, and treatment at POWH. Median progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and log-rank test (IBM SPSS version 24).
Result:
Eighty-three patients fulfilled the eligibility criteria. Median age was 70 years. 42% of patients were female and 63.9% had an Eastern Cooperative Oncology Group performance status (PS) of 0-1. Median PFS and OS were 5.0 and 8.2 months respectively, comparable with published literature. There was correlation between PS (0-1 versus >2) and OS (p=0.025) but not PFS (p=0.16). 79.5% of patients received initial chemotherapy, 48.5% of these patients received 6 cycles, of which 89.4% was carboplatin and etoposide. Median time from date of diagnosis to start of chemotherapy was 12 days, with correlation between time to chemotherapy and OS (p=0.006) and PFS (p=0.003). 75.9% patients received radiotherapy of any kind, but only radiotherapy directed at the thorax was associated with improved OS (p=0.01) but not PFS (p=0.5). Five (6%) patients underwent consolidation thoracic radiotherapy, while 32.5% underwent palliative thoracic radiotherapy. Palliative whole brain radiotherapy was given to 11 (13.3%) patients and only 2 patients received PCI. 78.3% of patients had documented progression after treatment, with simultaneous loco-regional and distant progression the most common pattern. 66.2% of patients had treatment at progression, with most (86%) receiving palliative radiotherapy.
Conclusion:
Our current analysis demonstrates an association between survival outcomes and baseline PS, time to initiation of chemotherapy and receipt of thoracic radiotherapy for patients with ES-SCLC. The survival outcomes are comparable to the reported literature. This highlights the importance of early referral and treatment commencement for improved outcomes in ES-SCLC.
