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Francesc Casas
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MA03 - New and Revisited Prognostic Factors in Early Stage Lung Cancer (ID 119)
- Event: WCLC 2020
- Type: Mini Oral
- Track: Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/29/2021, 15:30 - 16:30, Scientific Program Auditorium
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MA03.08 - Impact of COVID-19 Pandemic in the Diagnosis and Prognosis of Lung Cancer (ID 3700)
15:30 - 16:30 | Author(s): Francesc Casas
- Abstract
- Presentation
Introduction
COVID-19 pandemic has drastically changed the management of patients with cancer. The prioritization of the healthcare towards COVID-19 patients could interfere with the initial diagnosis, resulting in delayed treatment and worse outcome. We aimed to study the incidence of lung cancer new diagnosis, severity and clinical outcomes during Covid-19-period (during-COVID) compared to the same period in 2019 (before-COVID).
Methods
Bicenter retrospective cohort study of newly diagnosed non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) patients before (Jan-Jun/19) and during COVID-19 (Jan-Jun/20) in Spain. Clinical data were collected. We primarily assessed the difference on new lung cancer cases between both periods, and the disease severity considering: Performance status (PS), stage and any significant complication at diagnosis. Secondarily, we assessed the 30 days-mortality rate, progression-free survival (PFS) and overall survival (OS) by period.
Results
162 newly diagnosed lung cancer patients (68% NSCLC and 32% SCLC) were enrolled, with median age of 66 years, 70% were male, 33% smokers, 25% with PS ≥2. Advanced disease was diagnosed in 50% of NSCLC and 61% SCLC; 13% of NSCLC harbored driver alterations.
During-COVID, the number of new cases diagnosed decreased by 38% (43 NSCLC; 19 SCLC), compared to before-COVID period (67 NSCLC; 33 SCLC). More symptomatic cases were new diagnosed during vs. before-COVID. The Table 1 summarized clinical data and complications of new lung cancer cases by period and histology.
In NSCLC population diagnosed during-COVID, we observed more respiratory symptoms at diagnosis (30% vs. 23% before-COVID) with mainly locally-advanced/advanced disease (82% vs. 76% before-COVID). Among the cases hospitalized, the mortality during-hospitalization was 44% (2/9) vs. 17% before-COVID.
In SCLC population diagnosed during-COVID, respiratory symptoms were more common (32% vs. 24% before-COVID), but no more aggressive disease observed in terms of stage, complications and hospitalizations. Among the 4 cases hospitalized at diagnosis, none died during-hospitalization vs. 18% before-COVID (2/11).
Overall, during-Covid the mOS was 6.7 months [95% CI, 5.4-not reached] vs. 7.9 months [95% CI, 4.7-12] before-COVID. In NSCLC, the 30-days mortality was 49% vs. 25% before-COVID; in SCLC, it was 32% vs. 18% before-COVID. Updated data and treatment outcomes will be presented in the meeting.
Conclusion
Lung cancer diagnosis has been affected during the COVID-19 pandemic with fewer cases diagnosed and more symptomatic disease compared to 2019, which seems to be associated with worse outcomes. This study is still ongoing.
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P18 - Locoregional and Oligometastatic Disease - Misc. Topics (ID 128)
- Event: WCLC 2020
- Type: Posters
- Track: Locoregional and Oligometastatic Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P18.03 - Randomized Trial With BIALOE to Prevent Esophagitis in Lung Cancer Patients Treated With Concurrent Radical Chemoradiotherapy (ID 1062)
00:00 - 00:00 | Presenting Author(s): Francesc Casas
- Abstract
Introduction
Acute radiation esophagitis (ARE) is a frequent complication of chemoradiotherapy (CRT). In 2014 a retrospective pilot study to prevent ARE was performed with BIALOE (20 ml. orally) previous to the first session of radiotherapy (RT) until 10 days after the end of RT at Hospital Clínic de Barcelona. 32 patients with lung cancer (LC) treated with concurrent CRT were evaluated. The result showed a delay in the appearance of symptoms and in the need for analgesia compared to historical controls; with an ARE grade 2 (G2) with a median dose of 40 Gy.
Methods
After approval from the ethical committee a multicenter randomized double-blind, multicenter trial was initiated, including LC patients who underwent to concurrent platinum-based CRT with total dose of 45 Gy. (hyperfractionated in SCLC) and 60 Gy. (normofractionated in NSCLC). All patients provided written informed consent. BIALOE is a pure juice of aloe vera, organically grown in the volcanic soil of the Canary Islands, together with the favorable climatic conditions, extraction and processing techniques, it is possible to preserve the natural properties of the leaves of this plant. BIALOE and placebo administration was performed in the same way as in the previous plilot study. To calculate the sample size we use the following mathematical formula (fig1). For this study, a 95% (two tails) confidence level was established, with a statistical power of 90%. We estimate that 208 patients would be necessary (104 in each group), and a decrease of 5% or more of ARE with BIALOE was considered clinically relevant.
The primary endpoint is the incidence of ARE G2 or higher (CTCAE v3.0). Secondary endpoints are pain evaluation trough numeric rating scale, need for analgesia, quality of life (QoL C30), oral intake and the relation between leucopenia and ARE. The evaluation of these outcomes were assessed at the baseline in the treatment planning and during the RT at 20, 40 and 60 Gy, and follow-up after 15 days post treatment for a final evaluation. The dosimetric parameters analyzed are length and volume of esophagus (E), percentage of E volume treated to V10 to V60 Gy. and the maximum and mean doses delivered to the E.
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Results
Seven hospitals participated in this trial using the same planning protocol. Between 2016-2019, 165 patients were randomized. The study closed prematurely because slow recruitment. In March 2020 the data has begun to be analyzed, hoping to present the results throughout this year.
