Virtual Library

 x 
My Library Virtual Library FAQ

Start Your Search

D. Zarate



Author of

  • +

    P1.07 - Poster Session 1 - Surgery (ID 184)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
    • +

      P1.07-039 - Predictors of one year survival after lung cancer surgery (ID 2689)

      09:30 - 16:30  |  Author(s): D. Zarate

      • Abstract

      Background
      There have been few reports regarding short term survival after lung cancer surgery in Australia. In this study, we analysed the predictors of survival at one year following lung cancer resection in Queensland, the third most populous state in Australia.

      Methods
      Data on all Queensland residents who were diagnosed with non-small lung cancer (NSCLC) between 2000 and 2010 and who subsequently underwent surgery for lung cancer was obtained from the Queensland Oncology Repository. One year survival following surgery was modelled using multivariate Cox proportional hazards regression controlling for gender, age, comorbidity, anaesthetic score, remoteness of residence, and socioeconomic status.

      Results
      A total of 2,799 NSCLC patients who underwent resection for lung cancer in 17 hospitals across the state were included in the analysis; the median age was 67 years and 61% were males. Overall one year survival was 88%. In multivariate modelling, independent predictors of death within one year of surgery included male gender (hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.0-2.0, p = 0.04), age (per 10 year increment, HR 1.2, CI 1.1-1.3, p < 0.001), presence of one or more major comorbidities (HR 1.4, CI 1.1-1.8, p = 0.004), and anaesthetic scores of severe disease or worse (HR 1.40, CI 1.1-1.8, p = 0.01). Remoteness of residence and socioeconomic status were insignificant factors in the model.

      Conclusion
      Demographic and clinical patient characteristics are significant prognostic factors for short term survival following lung cancer surgery. This study further suggests that remoteness and socioeconomic status do not influence the quality of surgical care for lung cancer in Queensland.

  • +

    P1.09 - Poster Session 1 - Combined Modality (ID 212)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
    • +

      P1.09-008 - Outcomes in a single institution series of patients with Stage III non-small cell lung carcinoma treated with curative-intent radiotherapy and concurrent carboplatin and paclitaxel chemotherapy. (ID 1150)

      09:30 - 16:30  |  Author(s): D. Zarate

      • Abstract

      Background
      The standard of care for patients with a good performance status and inoperable stage III non-small cell lung cancer (NSCLC) is concurrent chemoradiotherapy (1–3). Carboplatin and paclitaxel is an alternative to the cisplatin-based doublets that have been used traditionally (4). Early-phase studies with small numbers have been reported (5–7) but a randomised phase 3 comparison has not been performed. The objective of this study was to assess outcomes in a large cohort of patients treated with curative-intent radiotherapy and concurrent carboplatin and paclitaxel chemotherapy.

      Methods
      Consecutive patients between March 2004 and May 2012 with stage III NSCLC undergoing curative-intent 3D-conformal radiotherapy to 60-66 Gy in 30-33 daily fractions with concurrent weekly carboplatin (45mg/m[2]) and paclitaxel (AUC=2) were identified from a prospective database. Consolidation chemotherapy was not given. Individual medical charts, radiology and laboratory investigations were reviewed retrospectively. Baseline clinico-pathologic, treatment, outcome and toxicity details were recorded. A minimum follow-up of three months after completion of treatment was required unless death occurred sooner. Median follow-up and survival times were calculated from date of first contact using the Kaplan-Meier method.

      Results
      One hundred and sixteen patients were identified and baseline characteristics are provided in Table 1. Nine patients were excluded as the chemotherapy regimen changed after at least one cycle and the remaining 107 patients were analysed. Median follow-up was 43.5 months. Imaging at three months post-treatment demonstrated a complete response in 4 (4%) patients and a partial response in 68 (64%) patients. Nine (8%) patients had already died. Median progression free survival and median survival were 15 and 22 months, respectively. Locoregional control was 53%. Failure at any site occurred in 75 (70%) patients. Isolated distant failure occurred in 24 (22%) patients with 9 in the brain. Adjustments to chemotherapy dose or number of planned cycles were required in 29 (27%) patients. Fifty two (49%) patients were admitted during treatment. Seven patients experienced an acute hypersensitivity reaction to paclitaxel. Grade 3/4 neutropenia, thrombocytopenia, nephrotoxicity, oesophagitis and pneumonitis were observed in 15%, 1%, 3%, 11% and 9% of patients, respectively. There was 1 episode of fatal radiation pneumonitis.

      Table 1. Patient characteristics. ECOG= Eastern Co-operative Group; FEV-1= forced expiratory volume in one second; PET= positron emission tomography; NOS = not otherwise specified.
      Total number of patients (%) 116 (100)
      Age, years
      Median 65
      Range 32-80
      Sex: number (%)
      Male 78 (67)
      Female 38 (33)
      Performance status: number (%)
      ECOG 0 45 (39)
      ECOG 1 62 (53)
      ECOG 2 7 (6)
      Unknown 2 (2)
      Smoker: number (%)
      Never 3 (3)
      Current or ex-smoker (≥10 pack-years) 111 (96)
      Unknown 2 (2)
      Smoking history, pack-years
      Mean 53.4
      Range 0-250
      FEV-1, litres
      Mean 2.05
      Range 0.62-4.25
      Loss of weight: number (%)
      None 98 (84)
      ≥10% 18 (16)
      Stage: number (%)
      IIIA 75 (65)
      IIIB 41 (35)
      PET-staged before treatment: number (%)
      Yes 113 (97)
      No 3 (3)
      Histology: number (%)
      Adenocarcioma 43 (37)
      Squamous cell carcinoma 45 (39)
      Carcinoma NOS 22 (19)
      Other 3 (3)
      Unknown 3 (3)

      Conclusion
      This review of a large, single institution series of patients with inoperable Stage III NSCLC treated with curative intent demonstrates that the concurrent administration of carboplatin and paclitaxel with radiotherapy is feasible. Survival and toxicity outcomes compare favourably to those reported with concurrent cisplatin and etoposide (4).

  • +

    P3.22 - Poster Session 3 - Epidemiology, Etiology (ID 168)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
    • +

      P3.22-006 - Incidence and 5-year survival of lung cancer in Queensland, Australia: an epidemiological study. (ID 2570)

      09:30 - 16:30  |  Author(s): D. Zarate

      • Abstract

      Background
      Lung cancer is the fourth most common invasive cancer in Australia and was the leading cause of cancer death for both males and females in 2007. Five-year relative survival for lung cancer in Australia, which compares the risk of death for that cancer with age- and sex- matched population controls and overestimates absolute survival, is 13%. Gender based disparities have been noted, with men having worse outcomes. In this study, we publish for the first time an analysis of long-term (5 year) survival for lung cancer in Queensland, a northern state of Australia, where cancer is a notifiable disease. Differential outcomes for different tumour histologies, age groups, sex and estimated socio-economic status are compared, across 25 years spanning 1982-2006.

      Methods
      Cancer incidence and survival data on all Queensland residents diagnosed with non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) between 1982 and 2009 were derived from the Oncology Analysis System, Queensland Cancer Control Analysis Team. Incidence and overall all-cause survival at five years from diagnosis were aggregated over four time periods to 2006 and stratified by histological subtype, age, gender, and estimated socioeconomic status derived from postcode information. Survival at 5 years from diagnosis was calculated using Kaplan-Meier estimates.

      Results
      The absolute incidence of lung cancer diagnoses in Queensland has increased between 1982 and 2009, from 820 cases per year (in the time period 1982-1990) to 1,632 cases per year (time period 2006-2009). The increased incidence of non-squamous NSCLC accounts for the majority of this and has increased significantly from 322/year to 1,083/year. Approximately one out of eight cases of lung cancer are SCLC. Five year survival for those diagnosed 2002-06 was 14% for all lung cancer, with a significantly worse outcome for SCLC (6%) compared with NSCLC (15%). Survival from squamous NSCLC was marginally better than non-squamous histologies (17% vs 15%). Significant discrepancies are seen in outcome related to gender (16% for women vs 13% for men) (p<0.05) and based on age (17% for those aged less than 65, and 13% for those 65 and older) (p<0.05). The outcomes are favourable compared with the five years 1982-86, where overall 5-year survival from lung cancer was 12% (4% for SCLC and 13% for NSCLC). No significant relationship was seen with outcome based on estimated socio-economic status across the entire time period, although this was not recorded for 34% of patients. For those classed as affluent or middle class, 5-year survival was 14% compared with 12% in disadvantaged areas.

      Conclusion
      Five year survival for lung cancer in Queensland, Australia compares favourably with national and international norms, and has increased over the last 25 years. There is a significantly worse outcome for men seen across all tumour subtypes, which has been noted in other tumour streams. Of note, there is no significant differential in survival based on socioeconomic status, where this could be estimated.