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N. Purandare



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

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P1.09-006 - Chemo-Radiotherapy For Locally Advanced NSCLC In Resource Limited Population: Is It Isoeffective? (ID 836)

      09:30 - 16:30  |  Author(s): N. Purandare

      • Abstract

      Background
      Annually 63,000 approximately new patients of lung cancer are diagnosed in India, with two-third of them in advanced stage at presentation.. Radiotherapy with concurrent chemotherapy has shown survival benefit and is the standard of care for this group of patients in western literature.

      Methods
      One hundred seventy four consecutive patients Of Non Small cell Lung cancer (NSCLC) were treated with radical (chemo)-radiotherapy at Tata Memorial hospital from January 2008 to December 2012, . Detailed study of patient, tumour and treatment related factors were performed. Outcomes in the form of progression free survival (PFS) and overall survival (OS) at two years were calculated. Follow-up and analysis of data was performed in February 2013. Univariate and multivariate analysis was performed to see the impact of patient related factors like age, smoking, KPS, presence of comorbidity, tumour related factors including T stage, N stage and stage group and treatment related factors chemotherapy timing , total dose, duration of radiotherapy and response to treatment on PFS and OS.

      Results
      Of 174 patients, Males were 154(88.5%) with median age of 58 years (range 30-84 years) and 121(69.5%) were smokers. Median KPS was 80 (range 60-100) and 59 patients had significant comorbidity. Cough was the commonest presenting symptom (28%) followed by chest pain (27%) and haemoptysis (24.7%). Most common histology was squamous carcinoma 47.1% followed by adenocarcinoma in 41.4%. Stage III (A+B) constituted 90.2% of the patients. All patients received thoracic radiotherapy using 3D Conformal technique using 6/15 MV photons to a median dose of 60Gy (range 4-66Gy) over a median duration of 44 days(2-85 days) .Of 174 patients 166 patients (95.4%) completed the planned treatment. Median GTV and PTV volumes were 132 cc (16.7-741cc) and 538 cc(56-5680 cc) respectively. The median lung-PTV volume was 2599cc and V20 Gy was 23.79 %. Out of 174 patients 76% patients received concurrent chemotherapy, while 11.5% received sequential chemotherapy also. Response assessment using WHO criteria was done at 2 months post treatment, 63 (36.1%) had complete response whereas 64patients (36.8%) had partial response or stable disease and 7 patients(3.4%) had progressive disease . At last follow-up of with mean follow up 9.3 months (range 0-37 months), 32 patients had loco-regional recurrence and 33 patients had distant metastases. Acute pneumonitis grade I and II was observed in 87(50%) and 13(7.4%), acute oesophagitis grade II and III was seen in 56(32.1%) and 7(4%) patients respectively as per RTOG grading. Median PFS and OS were 20 months and 23 months with the estimated 2 year PFS & OS was 35% & 47.4%respectvely.On Univariate analysis, complete response to treatment (p=0.000) had favourable impact on PFS whereas smoking (p=0.009), advanced T stage (p=0.002) and less than complete response (p=0.000) had negative impact on OS.

      Conclusion
      Even under resource limited conditions patients who were treated with an intensive (chemo) radiation with supportive care had an acceptable treatment compliance and comparable treatment outcomes. , Patients with advanced stage and smokers did worse. Patients treated with concurrent chemoradiation and complete responders had better OS.

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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-056 - A Tertiary cancer experience in use of TKI in metastatic lung cancer (ID 3351)

      09:30 - 16:30  |  Author(s): N. Purandare

      • Abstract

      Background
      Use of tyrosine kinase inhibitors is a attractive option due to its predicatble profile of side effects & it been a oral tablet. Its efficacy and toxicities have been well described in both east asian and western population. However not much literature is available on its use from India. The aim of this paper was to audit the population which received TKI (Erlotinib or Gefinib) in a tertiary cancer center in India.

      Methods
      All patients who received TKI in lung cancer were identified from our OPD database. There case records, electronic medical records & our OPD databases were utilized. The demographic profile, the staging details , details of EGFR mutations, the RECIST response rates, the toxicities, progression free survival (PFS) & overall survival (OS). SPSS 16 was used for statistical analysis.

      Results
      Total of 105 patients were identified with a median age of 58 years (35-77 years). There were 56 females (52.8%). The 15.2 % (16) of patients were smokers & 22.3 % (18) were tobacco chewers. The median duration of smoking & tobacco chewing was 25 & 15 years respectively. All patients had stage IV disease. There were 2 cases of squamous cell carcinoma (1.9%)& rest all were adenocarcinomas. (98.1%) Extrathoracic disease was present in 42 patients (39.6 %) The EGFR mutation invoved exon 19 , 21 & 18 in 25, 72 & 8 patients respectively. The ECOF PS was 0 & 1 in 14 (13.2%) & 51 (48.1%) patients respectively.The incidence of any grade skin and mucosal toxicites were 53% & 38% respectively. The median PFS & OS overall were 11.1 & 21 months respectively. The PFS & OS were not affected by the performnce status, comorbidities & sites of metastasis

      Conclusion
      Use of TKI in Indian population had similar toxicity & efficacy as reported in literature.