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Emma Ali
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P2.12 - Small Cell Lung Cancer/NET (Not CME Accredited Session) (ID 961)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 2
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.12-10 - Novel Prognostic Model for Limited-Stage Small-Cell Lung Cancer (ID 13999)
16:45 - 18:00 | Author(s): Emma Ali
- Abstract
Background
There is currently no prognostic model designed specifically for patients with limited-stage small cell lung cancer (SCLC). The objective of this study was to construct a novel prognostic model for this patient population using baseline characteristics readily available in clinic.
a9ded1e5ce5d75814730bb4caaf49419 Method
An institutional retrospective consecutive patient database was constructed by reviewing the charts of patients diagnosed with limited-stage SCLC between January 2000 and December 2013. Baseline patient characteristics, treatment details and outcomes were extracted. The primary endpoint for the prognostic model was overall survival (OS) and the secondary endpoint was progression-free survival (PFS). Univariable and multivariable Cox regression analyses were performed to identify variables associated with OS and PFS. Prognostic models were generated using recursive partitioning analysis (RPA).
4c3880bb027f159e801041b1021e88e8 Result
A total of 398 patients were eligible for analysis. Median follow-up was 8.2 years. The median age was 67 (range: 40-87). Overall, 94% of patients received chemotherapy, 82% received radiotherapy and 65% received both concurrently. Both hypofractionated (40 Gy in 15 fractions) and conventionally-fractionated (50-66 Gy in 25-33 fractions) radiotherapy were used. Prophylactic cranial irradiation was used in 45% of patients. The median OS for the entire cohort was 15.4 months, with a 5-year OS of 19.7%. Overall median PFS was 9.3 months, with a 5-year PFS of 14.1%. On multivariable Cox regression, age, Eastern Cooperative Oncology Group (ECOG) performance status, tumor location and baseline presence of any pleural effusion (non-malignant or unknown status) were prognostic of OS, while performance status and T-stage were prognostic of PFS. RPA model of OS divided patients into favorable (ECOG 0-2, no pleural effusion, middle/upper lobe location: 5-year OS 31%), intermediate (ECOG 0-2, no pleural effusion, non-middle/upper lobe location: 5-year OS 21%) and unfavorable (ECOG 3-4 or any pleural effusion: 5-year OS 5-8%) groups (log-rank p < 0.001). RPA for PFS divided patients into favorable (ECOG 0-2, <=T3: 5-year PFS 21%) and unfavorable (ECOG 3-4 or T4: 5-year PFS 5-9%) groups (log-rank p < 0.001).
8eea62084ca7e541d918e823422bd82e Conclusion
Novel prognostic factors for OS and PFS based on baseline patient characteristics were successfully identified for patients with limited-stage SCLC. RPA prognostic models were able to separate patients into distinct risk groups for OS and PFS. Our results will benefit from further external validation and can be useful in stratifying patients in future prospective studies.
6f8b794f3246b0c1e1780bb4d4d5dc53 -
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P2.12-13 - Effectiveness of Hypofractionated Thoracic Radiotherapy in Limited-Stage Small-Cell Lung Cancer: A Propensity Score Analysis (ID 13513)
16:45 - 18:00 | Author(s): Emma Ali
- Abstract
Background
Hypofractionated thoracic radiotherapy may be advantageous in limited-stage small-cell lung cancer (LS-SCLC) due to shorter overall treatment times, decreased resource utilization, and patient convenience. However, there are no randomized data comparing hypofractionated radiotherapy (HFRT; defined as 40-45 Gy in 15-20 fractions) and high dose conventionally-fractionated radiotherapy (CFRT; defined as >= 60 Gy in 2 Gy fractions) in LS-SCLC patients. The objective of this study was to compare the survival outcomes and toxicities of HFRT and CFRT using propensity score-matched retrospective data to simulate the setting of a clinical trial.
a9ded1e5ce5d75814730bb4caaf49419 Method
This retrospective study examined institutional records of patients diagnosed with LS-SCLC between January 2000 and December 2013 who were treated with HFRT or CFRT. Propensity scores were estimated by logistic regression using age, performance status, concurrent chemoradiation usage and prophylactic cranial irradiation (PCI) usage. Nearest neighbor-matching was performed on a 1:1 basis using a caliper distance of 0.1, without replacement. Overall survival (OS) and progression-free survival (PFS) endpoints were estimated by the Kaplan-Meier method and compared with log-rank tests. Cumulative incidences of normal tissue toxicity were compared with Fisher’s exact tests. A two-sided significance level of 0.05 was used.
4c3880bb027f159e801041b1021e88e8 Result
Among 398 LS-SCLC patients reviewed, 57 patients treated with HFRT and 61 patients treated with CFRT were included in the unmatched analysis. Five-year OS was 26% for the HFRT cohort and 24% for the CFRT cohort (p = 0.82). Five-year PFS was 22% for both cohorts (p = 0.79). Significant differences in age, performance status, concurrent chemoradiation usage and PCI usage were noted in the unmatched cohorts. After propensity score-matching, the balanced cohorts each contained 37 patients. Five-year OS was 25% and 27% (p = 0.72) and 5-year PFS was 25% and 24% (p = 0.63), respectively for the HFRT and CFRT cohorts. Incidence of any esophageal toxicity was not significantly different between the cohorts (92% HFRT vs. 84% CFRT, p = 0.60), though there was a trend towards a higher incidence of any pulmonary toxicity in the CFRT cohort (59% vs. 38%, p = 0.06). Skin toxicity was significantly higher for CFRT (39% vs. 14%, p = 0.01).
8eea62084ca7e541d918e823422bd82e Conclusion
OS and PFS were similar between HFRT and CFRT in balanced cohorts. HFRT was associated with a potentially reduced incidence of pulmonary and skin toxicity. As such, HFRT could result in an improved therapeutic ratio in patients with LS-SCLC. A randomized controlled trial would provide level 1 evidence in this comparison.
6f8b794f3246b0c1e1780bb4d4d5dc53
