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N. Rahman



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    OA 02 - Mesothelioma: Challenges For New Treatment (ID 653)

    • Event: WCLC 2017
    • Type: Oral
    • Track: Mesothelioma
    • Presentations: 1
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      OA 02.05 - RESPECT-MESO: An International Randomised Controlled Trial to Assess Early Specialist Palliative Care in Malignant Pleural Mesothelioma (ID 8880)

      11:00 - 12:30  |  Author(s): N. Rahman

      • Abstract
      • Presentation
      • Slides

      Background:
      Malignant pleural mesothelioma (MPM) has a high symptom burden and early specialist palliative care (SPC) may have a beneficial role for these patients. We examined the effect of early SPC in patients with MPM.

      Method:
      Participants with newly diagnosed MPM (within the last 6 weeks) were randomised to early SPC integrated with standard care, or standard care alone, in a 1:1 ratio. SPC visits were 4 weekly throughout the study period. Quality of life (QoL) and mood were assessed at baseline and every 4 weeks for up to 24 weeks with the EORTC QLQ–C30 questionnaire for QoL and General Health Questionnaire (GHQ-12) for anxiety/depression. The primary outcome was the change in EORTC C30 Global Health Status (GHS) QoL 12 weeks after randomisation.

      Result:
      174 participants underwent randomisation with 148 (85.1%) completing the primary outcome. The two groups were well matched after randomisation. Median (IQR) age was 72.6 (68.5-78.3) years and 139 (79.9%) were male. Epithelioid was the most common MPM subtype in 136 (78.2%) cases, ECOG PS was 0 in 66 (37.9%) and 1 in 108 (62.1%) participants. At randomisation, 134 (77.0%) participants reported dyspnoea and 100 (57.4%) had chest pain. At least 1 cycle of chemotherapy was completed in 103 (59.2%) participants. At 24 weeks 30 (17.2%) participants had died. Table 1 presents the primary and secondary outcome data. 68 (78.2%) participants in the intervention arm completed all scheduled monthly SPC visits at 12 weeks, and 46 (52.9%) at 24 weeks. 15 (17.2%) participants in the control arm were referred to SPC within 12 weeks, and 30 (34.5%) by 24 weeks.

      Table 1. Primary and secondary outcomes
      Control SPC Mean difference* p=
      Mean (SD) GHS QoL 12 weeks 59.5 (SD 21.2) 60.2 (23.6) 1.8 (95% CI -4.0 to 8.5) 0.60
      Mean (SD) GHS QoL 24 weeks 63.7 (SD 19.8) 61.3 (20.8) -2.0 (-8.8 to 4.6) 0.55
      Mean (SD) GHQ-12 anxiety / depression scores 12 weeks 2.6 (3.2) 2.2 (3.0) -0.6 (-1.5 to 0.4) 0.24
      Mean (SD) GHQ-12 anxiety / depression scores 24 weeks 2.1 (2.55) 1.75 (2.5) -0.4 (-1.2 to 0.4) 0.28
      Median (95% CI) survival (months) 12.6 (10.7-19.7) 11.5 (9.8-15.9) - 0.51
      Mean (SD) GHS QoL alive after 6 months of randomisation 60.9 (20.9) (n=66) 64.3 (19.9) (n=63) - -
      Mean (SD) GHS QoL in those who died within 6 months of randomisation 46.4 (21.4) (n=7) 38.9 (30.6) (n=12) 3.9 (-2.8 to 10.7)** 0.25
      * adjusted for baseline score; ** post hoc analysis SPC = specialist palliative care; SD = standard deviation; CI = confidence interval; GHS = Global Health Status (from EORTC QLQ–C30; higher score – better QoL); GHQ = General Health Questionnaire (higher score - higher depression/anxiety)


      Conclusion:
      Provision of early palliative care for all patients with recently diagnosed MPM is not associated with beneficial changes in quality of life as compared to palliative care review based on symptom burden.

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    P1.05 - Early Stage NSCLC (ID 691)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 1
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      P1.05-008 - A Comparison of the Imaging Features of Early Stage Primary Lung Cancer in Patients Treated with Surgery, SABR and Microwave Ablation  (ID 9538)

      09:30 - 16:00  |  Author(s): N. Rahman

      • Abstract

      Background:
      Stereotactic Ablative Radiotherapy (SABR) and percutaneous microwave ablation (PMWA) are now being performed in patients deemed “medically inoperable” with non-small cell lung cancer (NSCLC). The majority of these patients are treated without ground truth histology, relying on imaging to establish the diagnosis. The purpose of this study was to investigate whether there were differences in the visible imaging features including CT Texture Analysis (CTTA) between patients referred for surgery, SABR and PMWA, which might suggest differences in underlying diagnosis.

      Method:
      A retrospective analysis of 92 patients with one pulmonary nodule (PN) suspected as T1N0M0 to T2AN0M0 NSCLC on imaging were treated either with SABR (22 patients), PMWA (25) or Video-assisted thorascopic surgery (45) of which 23 had NSCLC (SURG M) and 22 had benign disease (SURG B). Patient characteristics, CT nodule morphology, presence of emphysema and percentage emphysema score, FDG avidity and CT textural features were compared. Twenty texture features previously used in combination to predict nodule probability of malignancy were extracted from each automatic contoured region surrounding the PN. The Kruskal-Wallis test was used to compare texture features between the 4 patient groups (SABR, PMWA, SURG M and SURG B).

      Result:
      There was no significant difference in nodule morphology, volume at presentation (p=0.280) or nodule volume doubling times (p=0.149), and presence of emphysema (p= 0.348) or emphysema score (p= 0.367) between the 4 groups. There was no statistical difference in CTTA malignancy prediction score between the SABR, PMWA and SURG M groups (p>0.05). The probability of malignancy score was significantly lower (p-value < 0.01) for SURG B (0.58 mean ± 0.19 sd) vs. SABR (0.79 ± 0.15) treatment groups. In post-hoc analysis, 6 out of 20 texture features showed significant differences that were driven by the SURG B group.

      Conclusion:
      This is the first study to our knowledge to evaluate the radiological differences between patient groups referred for surgical and non-surgical treatments for NSCLC. On this small study, the results support the hypothesis that the non-operative patient groups comprise the same proportion of benign and malignant as those in the operative group. The results also demonstrate the potential clinical utility of CTTA in patient selection when histology is not obtainable. CTTA does not require volumetry detectable growth to detect change, and therefore may be a useful biomarker of malignancy at first diagnosis.