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Arun Thimmarayappa



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    EP1.01 - Advanced NSCLC (ID 150)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.01-77 - Locally Advanced Non Small Cell Lung Cancer - Treatment Outcome in Real World Setting (Now Available) (ID 1626)

      08:00 - 18:00  |  Presenting Author(s): Arun Thimmarayappa

      • Abstract
      • Slides

      Background

      Lung cancer is one of the leading cancers in India. About two-thirds present in advanced /metastatic stage. The mainstay therapy for advanced non small cell lung cancer (NSCLC) is concurrent chemoradiation. Locoregional failure constitutes the predominant failure pattern.

      A larger proportion of the patients are treated with palliative intent. The current study evaluates the demographic profile, treatment pattern, and outcome and radiation practice for palliative treatment at a tertiary care academic medical institution.

      Method

      Medical records of patients treated between June 2016- June 2018 were evaluated Clinical presentation, treatment details and outcome was recorded. Case records with incomplete workup or treatment was excluded.

      Result

      A total of 181 patients of NSCLC were registered of which 108 were metastatic at presentation 96 patients received palliative radiotherapy and are analysed. 11 patients has pulmonary metastasis and 85 had extrapulmonary metastasis of which 21 patients had multiple extrapulmonary disease.

      Ninety-six patients received palliative radiotherapy. 84 patients had ≤ 1comorbidity. Most of the patients were aged ≤65years (80%) with a female preponderance. Cough, chest pain and dyspnea each were present in one-third of patients. Twenty-six patients had bony pain, 18 had symptoms of raised intracranial pressure and 7 patients had SVCO.

      Adenocarcinoma was the commonest histology observed in 86.4% patients. Bone was the most common site of metastasis, seen in 65(65.7%) patients; followed by brain in 23(24%).

      Palliative radiotherapy was given to primary in 13(13.5%), brain in 27(28%), bone in 56(58%). Palliative radiotherapy to weight bearing sites was treated with 8Gy in single fraction. Whole brain radiotherapy was treated with 20Gy in 5 fractions. 65% of patients received palliative chemotherapy. Platinum- taxane and platinum- pemetrexed regimens were the most common regimen practiced for among squamous and adenocarcinoma histology respectively. Median follow up was 6.6 months (2 to 37 months). Median time for oncological intervention was 1.2 months (0.1 to 5.4months). Median PFS was 6months (IQR 3- 11.2months)

      Conclusion

      The study concludes that a large proportion of patients present in advanced/metastatic disease. In the metastatic setting bone metastasis was the most common site followed by brain. The outcome is dismal and newer treatment techniques /modalities may result in improved outcome in this group of patients.

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    EP1.18 - Treatment of Locoregional Disease - NSCLC (ID 208)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 2
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.18-25 - Definitive Radiotherapy in Lung Cancer – A Glimpse Over the Narrow Window   (ID 2128)

      08:00 - 18:00  |  Presenting Author(s): Arun Thimmarayappa

      • Abstract

      Background

      Lung cancer is one of the leading global malignancies. Locally advanced NSCLC (LA-NSCLC) comprises of a significant proportion of patient burden. Despite advances in the treatment definitive radiotherapy is delivered only to a small proportion of patients.

      The current study was carried out to analyze various factors associated with change of curative treatment plan to palliative treatment at a tertiary cancer Centre

      Method

      Medical records of patients of LA-NSCLC lung cancer treated between June 2016 to June 2018 were evaluated. Clinical presentation, evaluation, treatment details and outcome were recorded. Patients who were not eligible for radical treatment were excluded. All patients were taken for radical treatment but could not receive definitive radiotherapy were analyzed

      Result

      Of 67 patients of LA-NSCLC 8 patients that were non metastastic were planned for upfront palliative intent.25 patients needed change in their treatment plan to palliative treatment. Majority of them were ≥ 65years. Median number of chemotherapy cycles was 2 (0-6). Patients were assessed after 2 cycles of chemotherapy for concurrent chemoradiation as our institute practice. Patients were assessed at the end of 2nd chemotherapy. Reasons for ineligibility was noted and categorized into patient, tumor and treatment factors.

      Factors for change in treatment plan were divided as (i) Patient related factors included, treatment defaults, poor compliance, financial and social reasons, ECOG performance status at the end of chemotherapy, comorbidities, which accounted for 30.3%. (ii)Tumor related factors included, disease progression, poor response to chemotherapy, which accounted for 54.5%. (iii)Treatment factors included ,risk of toxicity due to large volume disease, volume not able to cover in one radiotherapy portal, poor respiratory reserve, which added up for remaining 15.2% of patients.

      Palliative radiotherapy to primary tumor alone was delivered in 25 patients,5 patients received palliative radiotherapy to primary and brain2 patients received palliative radiotherapy to bone and I received radiation to brain alone.

      The median time to diagnose and stage was 0.65months (0.06 to 3.6 months). Median time to start chemotherapy was 0.8 months (0.16 to 7.3 months).

      Conclusion

      Eligibility for definitive radiotherapy is a dynamic decision which need to be reviewed at every stage of treatment. Timely radical intervention need not necessarily translate into radical radiotherapy. Feasibility of definitive radiotherapy pass through a narrow window and multiple factors play pivotal role in it.

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      EP1.18-26 - Treatment Patterns and Clinical Outcomes in Locally Advanced Non Small Cell Lung Cancer: Experience from Tertiary Care Centre (Now Available) (ID 42)

      08:00 - 18:00  |  Author(s): Arun Thimmarayappa

      • Abstract
      • Slides

      Background

      Lung Cancer comprises a significant global cancer burden.About two-thirds patients with non small cell lung cancer, present in advanced/metastatic stage, of which the locally advanced group account for 30%.Combined modality approach with definitive chemoradiation is feasible in only a small proportion of patients. Several factors play a role in deciding the treatment and outcome In developing countries access to cancer centres and waiting period for oncological intervention and radiation therapy also significantly affect the management.The current study evaluates the demographic profile, treatment pattern, outcome and Radiotherapy practice and patient care at a tertiary care academic medical institution.

      Method

      Archives patients of locally advanced Non Small Cell lung cancer(LA-NSCLC) treated at our centre between, June 2016-June 2018 were included in our study. Clinical , demographic characteristics, treatment patterns, outcomes was recorded. Radiotherpy practice and patient care process including integration of radiation therapy with other specilities,waiting time, compliance to treatment was documented. Case records with incomplete work up or treatment was excluded. Univariate and multivariate analysis of factors on survival and overall survival was analysed.

      Result

      174 patients were treated during the study period. The distribution as per histology include Squamous cell carcinoma 54, Adenocarcinoma 108,Others (adenosquamous,poorly differentiated) 12. The median age was 57 years(35-84) with male preponderance .Only 67 patients belonged to locally advanced group and remaining 107 presented with metastastic disease. 59 patients of LA-NSCLC group were planned for definitive chemoradiation comprising of two cycles of induction chemotherapy followed by concurrent chemoradiation. 34 patients eventually underwent the planned treatment.The reason for conversion to palliative radiotherapy included disease progression during induction chemotherapy(18),poor performance status(7),large volume disease and risk of toxicity with radical dose ,defaulters(3). Median follow up was 11 months (range 0.7-29), overall survival 9.4 months(range 1.7-44.8). Median overall treatment time was 44 days.Progression free survival 8.9 months(range 1.6-28.6).Time to start any oncological intervention was 1 month(0.1-4.3) and time to start radiotherapy was 2.1 months(0.1-5.4). Adherence to treatment was 91.2%.Age ≥65 and performance status ≥2 were significant for overall survival in univariate analysis but did not confer any significance in multivariate analysis.

      Conclusion

      The study concludes that more than 60%of patients with Non small cell lung cancer present with metastatic disease. Only about a third are suitable for definitive chemoradiation and eventually only 20% undergo the planned treatment. Adherence to treatment is good in definitive setting

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