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khaled Hassouni
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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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EP1.01-79 - Chemoradiotherapy in Advanced Non Small Cell Lung Cancer (Now Available) (ID 2557)
08:00 - 18:00 | Author(s): khaled Hassouni
- Abstract
Background
Advanced NSCLC is a frequent cancer among our patients. Delay in diagnosis and treatment leads to advanced stages that require complex treatment modalities and poor prognosis. We report our experience in term of epidemiological, diagnostic, therapeutic and prognostic aspects of this disease in our department.
Method
This is a retrospective study of 38 cases of advanced NSCLC treated with concurrent chemoradiotherapy, collected in the radiotherapy department in the University Hospital Hassan II in Fez, between January 2012 and January 2017. All cancers were prooved histologically by biopsy. The standard treatment was concurrent chemoradiotherapy alone or after induction chemotherapy mostly due to a large tumor volume where radiotherapy is not feasible upfront. Chemotherapy drugs were mainly cisplatin-based with vinorelbine or paclitaxel and in some cases carboplatin if renal function is not correct. Radiotherapy was delivered through 3D conformal technique after CT-simulation and image fusion with CT or in rare cases PET-CT. After completion of treatment, no patient received adjuvant chemotherapy. Immune therapy was not affordable due to the high price. Follow-up was done clinically and with control CTscan. Tobacco control counseling was recommended to all our patients.
Result
The average age was 59 years (38 to 81 years). The patients were all males and chronic smokers. Significant clinical symptoms were mainly chest pain, dyspnea and hemoptysis. There were 21 cases of adenocarcinoma, 17 cases of squamous cell carcinoma. 18 cases were classified as stage IIIA, 20 cases as stage IIIB.
Neoadjuvant chemotherapy was received in 23 cases from 2 to 4 cycles. All patients received radiotherapy with doses to PTV between 60-70Gy with concomitant chemotherapy including cisplatin or carboplatin.
Conclusion
After an average follow-up of 12 months, the evolution was marked by the occurrence of 2 deaths, distant metastasis in 14 patients (6 cases of cerebral metastasis and 8 cases of bone metastasis), 2 cases of progressive disease, 14 patients in complete clinical remission and are always followed, and 6 patients were lost to follow-up,
It is now proven that the survival of patients with locally advanced lung cancer is better if chemotherapy is combined with radiotherapy. The survival gain obtained is essentially related to better control of micro-metastases even though the local control remains very poor. Some irradiation techniques seem to be able to improve this local control: conformal radiotherapy with intensity modulation, hypofractionation. Immue therapy concomitant to radiation might be the future but still needs randomized clinical trials to approve it.
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EP1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 206)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.16-24 - Overcoming Appointment Delay in Radiotherapy: A Single Institution Experience (Now Available) (ID 2603)
08:00 - 18:00 | Author(s): khaled Hassouni
- Abstract
Background
Delay to access to radiation therapy in developing countries is challenging and compromising the cancer prognosis. In our department, we have one linear accelerator for a whole region in the country. We treated about 50 to 60 patient a day and appointments were for more than 3 months. The medical and psychological impact on patients was important. Our objective was to shorten this delay.
Method
The radiotherapy treatment delivery was to treat 50 to 60 patients from Monday to Friday as the majority of radiation therapy departments. Treatments started at 8 AM to finish at about 7 to 8 PM. The idea was to treat more patients and quickly. Therefore, actions were taken on three main situations: 1st Before radiotherapy, we had to shorten the time from the first consultation to the first radiotherapy fraction. 2nd during radiation, we extended treatment period to above 8 PM.and 3rd concerns fractionation regimens.
Result
The hospital executive decided to transform the oncology hospital to an emergency hospital with the possibility to treat 24/7. With this way, we could treat up to 100 patient a day or more. we also treat on weekends especially palliative patients. Concerning the patient workflow, patients were seen immediately when they arrive at the department, and if the medical file is complete and ready to radiation, CT scan simulation was done within a week, contouring, dosimetry, and validation with safety checks were done within 3 days. and finally, when possible, we chose hypo-fractionated regimens.
The appointment time started to drop from more than 3 months to almost 2 weeks.
Conclusion
In developing countries, access to radiotherapy is a real problem. The number of linear accelerators per capita is very low. Therefore delays are very long. This kind of approach, if sufficient human resources, could solve the problem while waiting for a second and maybe other machines.
