Post on 20-May-2020
Poster No.
Department Presenting
Author Designation Abstract Title Authors
SR-96 PMSD Sryma PB Senior Resident
Topical Nasal Xylometazoline for Flexible Bronchoscopy (VAIN): A Randomized, Double Blind, Placebo-controlled Trial
PB Sryma,Madan Karan, Mittal Saurabh, Mohan Anant,Guleria Randeep,Hadda Vijay, Tiwari Pawan
SR-97 PMSD Tejas Suri Senior Resident
A comparison of a wrist worn portable device (WatchPAT) with in-lab polysomnography for the diagnosis of obstructive sleep apnea
Suri Tejas M, Mittal Saurabh, Hadda Vijay, Madan Karan, Tiwari Pawan, Mohan Anant, Guleria Randeep
SR-105
Pulmonary Medicine
Hariharan Iyer
Senior Resident
Comparison of Sample Adequacy of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration Using 0ml, 10ml and 20ml suction pressures in malignant and benign diseases
Iyer Hariharan, Anant Mohan , Deepali Jain , Karan Madan, Vijay Hadda, PawanTiwari, Saurabh Mittal, Randeep Guleria, Garg Avneet , Bansal Shweta, Pandey R.M.
SR-106
Pulmonary Medicine
Sandip Agarwal
Senior Resident
Transdiaphragmatic pressure can be calculated using ultrasound during magnetic phrenic nerve stimulation in COPD patient
Guleria R, Agarwal S, Madan K, Hadda V, Mohan A, Khilnani GC, Pandey RM
SR-107 A , B & C
Pulmonary Medicine
Avneet Kumar Garg
Senior Resident
Abstract A: Clinico-pathological Profile of Lung Cancer Patients in India-A Tertiary Care Centre Experience Abstract B: Delays During Diagnosis and Management of Lung Cancer in India- A Prospective Observational Study Abstract C: Survival and treatment response of Lung cancer patients in India: a tertiary centre experience
A,Sahu S, Gupta A, Choudhary C, Vashistha V, IyerH, Ali A, BhallaA, JainD, KumarR, PandeyR, MadanK, Hadda V, Khilnani G.C., GuleriaR, Mohan A, ,A, Mohan A, Gupta A, Sahu S, Choudhari C, AroraS, Jain D, KumarR, Bhalla A, Pandey R, Tiwari P, MittalS, Madan K, Khilnani G.C., Hadda V, Guleria
SR-96
Title: Topical Nasal Xylometazoline for Flexible Bronchoscopy (VAIN): A Randomized,
Double Blind, Placebo-controlled Trial
PB Sryma1,Madan Karan
2, Mittal Saurabh
2, Mohan Anant
3,Guleria Randeep
3,Hadda Vijay
2,
Tiwari Pawan2
Affiliation:1Senior Resident,
2Assistant Professor,
3Professor, Department of Pulmonary
Medicine and Sleep Disorders
Presenting Author:
Name: Sryma P B
Email: drsryma@gmail.com
Corresponding Author:
Name: Karan Madan
Email: drkaranmadan@gmail.com
Abstract body:
Introduction: Topical nasal vasoconstrictor (such as xylometazoline) administration during
flexible bronchoscopy is thought to ease the passage of bronchoscope leading to better patient
comfort and procedural satisfaction thoughno randomized controlled trial has assessed its
clinical utility. In this randomized, double blind, placebo-controlled study, we studied the
utility of nasally administered xylometazoline in the subjects undergoing flexible
bronchoscopy.
Aims and objectives: Primary objective was to compare the operator rated ease of
bronchoscope negotiation on visual analogue scale (VAS). Secondary objectives included
assistant rated faces pain scale on nasal bronchoscope insertion, patient rated nasal pain score
(VAS), time to reach vocal cords after bronchoscope insertion (seconds), operator rated nasal
mucosal trauma (on VAS), hemodynamic changes and complications between the two groups
Materials and methods: Consecutive subjects undergoing flexible bronchoscopy were
randomized (using variable size block randomization) to receive 3 drops (into each nostril) of
either the drug Xylometazoline (0.1%) or placebo (iesaline 0.74% w/v isotonic solution) ten
minutes prior to bronchoscopy. All patients received topical anesthesia regimen including
nasal lignocaine gel (5 ml, 2%), pharyngeal lignocaine spray (4 sprays, 10%) and 1%
lignocaine solution for “spray as you go” administration. Continuous hemodynamic
monitoring was done and noted before procedure, ten minutes after drug instillation and post
procedure. The bronchoscopist, assistant and the patient were blinded to the group
assignment.
Results: 148 subjects were randomized, 73 to placebo and 75 to xylometazoline arms.
Baseline characteristics were comparable. Operator rated ease of nasal bronchoscope
negotiation by VAS was similar in both the groups [median (IQR) 1(1-2) in both
xylometazoline and placebo groups,p 0.79]. Assistant rated pain on faces pain scale(p= 0.36),
patient rated nasal pain on procedure completion [VAS median (IQR): placebo 2 (1-2) and
xylometazoline 2(1-3), p= 0.28], and Operator rated nasal mucosal trauma [VAS median
(IQR) placebo 1(0-2) and xylometazoline 1(0-1), p= 0.28] were similar between the two
groups. There were no significant differences in the blood pressure, heart rate or other
complications between the two groups.
Conclusion: The addition of nasal vasoconstrictor xylometazoline did not improve the ease
of bronchoscope negotiation, nasal pain or nasal mucosal trauma in trans-nasal flexible
bronchoscopy.
Trial registry: www.clinicaltrials.gov: NCT03424889
SR-97
Title: A comparison of a wrist worn portable device (WatchPAT) with in-lab polysomnography for
the diagnosis of obstructive sleep apnea
Suri Tejas M1, Mittal Saurabh2, Hadda Vijay2, Madan Karan2, Tiwari Pawan2, Mohan Anant3, Guleria
Randeep3
Affiliation:1 Senior Resident, 2 Assistant Professor, 3 Professor, Department of Pulmonary Medicine
and Sleep Disorders, All India Institute of Medical Sciences, New Delhi
Presenting author:
Name: Dr. Tejas M Suri
Email: tejassuri001@gmail.com
Corresponding author:
Name: Dr. Saurabh Mittal
Email: Saurabh_kgmu@yahoo.co.in
Introduction: Overnight in-lab technician attended polysomnography (PSG) is the gold standard
method for the diagnosis of obstructive sleep apnea (OSA). However, long waiting period results in
the delay in diagnosis and therapy leading to significant morbidity. Newer portable devicesare
available for the diagnosis of sleep apnea, such as WatchPAT which is based upon peripheral arterial
tonometry rather than conventional flow sensor-based technology. This device has not been well
studied in Indian subjects.
Aim: To assess the correlation of apnea hypopnea index (AHI) measured using WatchPAT and in-lab
polysomnography and to estimate the sensitivity and specificity of WatchPAT for the diagnosis of
moderate to severe obstructive sleep apnea.
Materials &Methods: We prospectively evaluated the diagnostic performance of wrist worn
portable sleep study device, the WatchPAT 200, which is a combination of oximetry, actigraphy and
peripheral arterial tonometry. Patients with suspected obstructive sleep apnea underwent
simultaneous in-lab diagnostic polysomnography and WatchPAT testing. The results from both
modalities were compared. The PSG scorer was blinded to the result of the WatchPAT study.
Results:19 patients (16 males and 3 females) were studied and had a mean (SD) age of 50.05
(±12.22) years. The mean (SD) body mass index of study subjects was 31.68 (±5.17) kg/m2. 16 out of
19 patients were found to have moderate to severe OSA by polysomnography (AHI ≥ 15). The mean
WatchPATsleep efficiency was 80.32%, whereas the mean PSG sleep efficiency was 79.83% (r=
0.366). There was a strong correlation (r=0.906) between the mean WatchPATAHI (43.08
events/hour) and the mean PSG AHI (32.7 events/hr). The sensitivity and specificity ofWatchPAT for
the diagnosis of moderate to severe OSA (AHI > 15) were both100%. The sensitivity and specificity of
WatchPAT for the diagnosis of severe OSA (AHI > 30) were 100% and 63.63% respectively.
Conclusions:WatchPAT is a very useful portable diagnostic device for the diagnosis of obstructive
sleep apnea especially for moderate to severe disease.
SR-105
TITLE:
Comparison of Sample Adequacy of Endobronchial Ultrasound Guided Transbronchial Needle
Aspiration Using 0ml, 10ml and 20ml suction pressures in malignant and benign diseases
Authors: Dr. Iyer Hariharan1, Dr. Anant Mohan
2, Dr. Deepali Jain
3, Dr. Karan Madan
4, Dr. Vijay
Hadda4, Dr. PawanTiwari
4, Dr. Saurabh Mittal
4, Dr. RandeepGuleria
5, Dr. Garg Avneet
1, Dr Bansal
Shweta1, Dr. Pandey R.M.
6
Affiliations:
1: Senior Resident: Dept of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical
Sciences, New Delhi, India
2. Professor and Head: Dept of Pulmonary Medicine and Sleep Disorders, All India Institute of
Medical Sciences, New Delhi, India
3: Associate Professor: Dept. of Pathology, All India Institute of Medical Sciences, New Delhi, India
4. Assistant Professor: Dept of Pulmonary Medicine and Sleep Disorders, All India Institute of
Medical Sciences, New Delhi, India
5. Director: AIIMS
6: Professor and Head: Dept. of Biostatistics, All India Institute of Medical Sciences, New Delhi,
India
Presenting Author:
Name: Dr Hariharan Iyer
E Mail: hriyer25@gmail.com
Corresponding Author:
Name: Dr Hariharan Iyer
E Mail: hriyer25@gmail.com
ABSTRACT BODY
INTRODUCTION:
The optimum level of suction required for best sample adequacy and diagnostic yield during
Endobronchial Ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA) is unknown. A
significant proportion of EBUS-TBNA in India is performed for presumed benign etiology. Hence,
this study aimed to compare the sample adequacy obtained by EBUS- TBNA aspirates using three
different suction pressures in lesions of malignant as well as benign etiology.
AIIMS and OBJECTIVES:
Primary:
To compare sample adequacy of EBUS TBNA aspirates obtained with 0 ml, 10 ml and 20 ml
suction pressures
Secondary:
To compare the diagnostic yield of the EBUS TBNA aspirates obtained with 0ml, 10 ml and
20 ml suction pressures
To assess the effect of various lymph node characteristics on the adequacy and diagnostic
yield of the EBUS TBNA aspirates with each of the suction pressure used
MATERIALS and METHODS:
This was a prospective Randomized non- inferiority study. Adult patients with undiagnosed
mediastinal lymphadenopathy referred for EBUS and having EBUS assessed lymph node size more
than 0.5cm (short axis) were recruited. A sample size of 300 was considered adequate for three group
parallel non- inferiority trial keeping 20 ml suction pressure as control and 10ml and 0 ml as the test
groups to compare adequacy rate amongst the three suction pressures, with non-inferiority margin of
15%.
One node per patient was sampled with either of the three suction pressures (using computer
generated randomization) and specimens were assessed by a dedicated pathologist masked to the
suction pressure applied. Primary end point was the difference in the sample adequacy achieved using
the three suction pressures.
RESULTS:
300 patients and 300 lymph nodes were studied. The overall baseline characteristics such as age,
lymph node size, lymph node echogenicity, presence of intra nodal vessels and nodal necrosis were
similar in the three groups. Of all patients, 101 patients were sampled with a suspicion of malignant
etiology and 199 patients with benign etiology.
The overall adequacy of EBUS- TBNA samples obtained with suction pressure 0 ml, 10 mland 20 ml
were 91.09%, 86.14% and 77.08% respectively.The sample adequacy in the 0 ml (No suction) group
was 14.01 % more than 20 ml suction group [one sided 95% CI:5.5 to 22.4%]. The sample adequacy
of 10 ml suction group was 9.06% more than 20 ml suction group [one sided 95% C.I. 0.01 to 18.1%].
The adequacy of EBUS- TBNA samples obtained with suction pressure 0 ml, 10 mland 20 ml was
91.2%, 75.8% and 75.8% respectively in the malignant group, and 91 %, 91.2 % and 77.8 %
respectively in the benign group.
CONCLUSIONS:
Application of 0 ml (no suction) and 10 ml suction pressure during EBUS-TBNA is non-inferior to
applying 20 ml suction pressure in terms of adequacy of samples obtained.
SR-106
Transdiaphragmatic pressure can be calculated using ultrasound during
magnetic phrenic nerve stimulation in COPD patient.
Author Block: Guleria R1,Agarwal S2,Madan K3,Hadda V3,Mohan A4,Khilnani
GC5,Pandey RM6
1Director of All India Institute of Medical Sciences, New Delhi, India ,4
Pulmonary medicine and sleep disorders, Professor
and HOD ,All India Institute of Medical Sciences, New Delhi, India , 5
Pulmonary medicine and sleep disorders, Ex-Professor
and HOD , All India Institute of Medical Sciences, New Delhi, India , 3 Pulmonary medicine and sleep disorders, assistant
Professor, All India Institute of Medical Sciences, New Delhi, India, 6 Biostatistics, All India Institute of Medical Sciences,
new Delhi, India.
Presenting Author:
Name:Sandip Agarwal
Email:sandipagarwal1988@gmail.com
Corresponding Author:
Name: Prof. RandeepGuleria
Email: randeepguleria2002@gmail.com
Rationale:
Diaphragm is the main inspiratory muscle and its function is compromised in
COPD.Magnetic phrenic nerve stimulation is the gold standard to assess diaphragm function
by measuring transdiaphragmatic pressure (Pdi)using esophageal and gastric balloon.
Ultrasound has been used to accurately assess diaphragm function. We evaluated whether
Pdicould be calculated using ultrasound assessment of diaphragm movement during
magnetic phrenic nerve stimulation along with spirometry in COPD patients.
Methods:
We enrolled 60 stable moderate to severe COPD patients attending pulmonary medicine
out-patient department of AIIMS,New Delhi. Patients underwent detailed pulmonary
function tests. Transdiaphragmatic pressure(Pdi) was measured by magnetic stimulation of
phrenic nerve(Magstim dual 200) using esophageal and gastric catheter (FLUXMED GRT,
M.B.Med ). Ultrasound of diaphragm was done to assess diaphragm thickness (TD). Real
time diaphragm excursion was measured with the ultrasound while stimulating phrenic
nerve by 90 mm magnetic circular coil in cervical area. Prediction equation was formulated
to predict Pdi using spirometry and ultrasound data. Equation developed using data from
the first 40 patients was validated in the next 20 patients.
Results:
Of the60 patients,58 were male and 2 were female; all 60 patients were smoker;28 had
moderate and 32 patients had severe COPD. Mean FEV1 ,FVC ,TLC ,RV/TLC were 1.44
L(56.8% predicted), 2.57L(81.3%), 6.43L(121%) and 63.42% respectively. On diaphragmatic
ultrasound mean TD at FRC(mm), TD at RV(mm), TD at TLC(mm), tidal excursion (cm) and
forced excursion (cm) was 1.60, 1.56, 2.32, 2.17, 3.22respectively.Mean twitch Pdi was 22
cm H20 (max 35 and min 15 cm H2O),mean sniff Pdi was 64.9 cm H2O (max 75 and min 35
cm H20).Sniff Pdi correlated with real time excursion(REX),TDRV, tidal excursion and twitch
Pdi correlated with real time excursion and FVC. Sniff Pdi was = 31+15.11(REX) with r2 value
of 0.62 and twitch Pdi was = 11.84+4.54( REX) with r2 value of 0.48.Using multivariate
regression analysis sniff Pdi was calculated as,10.3+13.11(TD RV) +6.19(Tidal
excursion)+10.20(REX) with r2 value of 0.76 and twitch pdiwas calculated as, 3.56
+3.98(FVC)+3.73(REX) with r2 value of 0.66.
Conclusion:
Twitch Pdi during magnetic stimulation and sniff Pdi can be calculated using ultrasound and
spirometry parameters.This is a non-invasive method and has significant utility in clinical
practice and in the ICU.
SR-107A
Clinico-pathological Profile of Lung Cancer Patients in India-A Tertiary Care
Centre Experience
Author Block: Garg1 A,Sahu1 S, Gupta1 A, Choudhary1 C, Vashistha2 V, Iyer1H, Ali1 A, Bhalla3A, Jain4D, Kumar5R,
Pandey6R, Madan1K, Hadda1 V, Khilnani1 G.C., Guleria1R, Mohan1 A 1Pulmonary medicine and sleep disorders, All India Institute of Medical Sciences, New Delhi, India, 2Hematology and
Oncology, Duke University Health System, Durham, NC, U.S.A., NC, United States, 3Radio-diagnosis, All India Institute of
Medical Sciences, New Delhi, India, 4Pathology, All India Institute of Medical Sciences, New Delhi, India, 5Nuclear
Medicine, All India Institute of Medical Sciences, New Delhi, India, 6Biostatistics, All India Institute of Medical Sciences, new Delhi, India.
Presenting Author:
Name: Avneet Garg
Email: dravneetgarg@gmail.com
Corresponding Author:
Name:Avneet Garg
Email: dravneetgarg@gmail.com
Abstract Body:
Aiims and Objectives:
Lung cancer remains the leading cause of cancer-related death in the world. Over the past few decades,
significant changes have occurred in the demographic profile of lung cancer, possibly due to changing
smoking habits, environmental conditions or other unknown reasons. However, Indian data regarding the
changing trends in clinico-pathological profile in lung cancer has shown an inconsistent trend. We
therefore attempted to characterize the clinical characteristics of lung cancer at our centre over a period
of last 11 years.
Material and methods:
We performed an ambispective study of 1862 pathologically proven lung cancer patients over 11 years
from January 2008 to March 2018 at department of Pulmonary Medicine and Sleep disorders, AIIMS New
Delhi, including 1384 patients (74.3%) retrospectively and 478 patients (26.7%) prospectively, to study
the clinical spectrum of the lung cancer in India.
Results:
Mean age of subjects was 58 (+11.01) years, of whom 82.9% were males.. Most were smokers (76.2%)
withmedian smoking indexof500 (range, 2-3500). The smoking rates in male and female remained
unchanged over last 11 years. Performance status was ECOG 0 or 1 in 50.8%. Adenocarcinoma was most
common type (34%), followed by squamous cell carcinoma (28.6%). Adenocarcinoma showed an
increasing trend, from 9.5% in 2008 to 35.9% in 2018, SCC increased from 25.4% to 30.6%, whereas
NSCLC (NOS) decreasedfrom 33% to 14.6%. Majority of NSCLC (95%) continued to bediagnosed at
advanced stage (3 or 4); 75.2% of SCLC had extensive disease. Cough was the most common symptom
(81.3%), followed by loss of appetite and dyspnoea (65.9% and 64.9%) respectively.RUL was the most
common lobe to be involved (26.9%) followed by LUL (24.4%). Lung (including pleura) was the most
common metastatic site (47.1%) followed by bone (36.3%) and adrenal (17.8%). EGFR mutations in tissue
were present in 23.7% of adenocarcinoma, with exon 19 deletion mutationbeing most common(71.7%),
followed by exon 21 (19.7%);ALK mutations were positive in 11.5%. EGFR positive patients were
significantly younger, females and light smokers than EGFR negative. Among 1635 patients in whom
treatment details were known, 66.2% received definitive treatment for lung cancer. Chemotherapy was
the most common treatment modality (79.2%) and Carboplatin-paclitaxel was the most common regimen
administered (53.4% ). TKIs (EGFR and ALK inhibitors)were prescribed in 8.8% of all subjects as first line
therapy. The median overall survival (1803 patients) was 8.8 (IQR 3.7-19), median progression free
survival (527 patients) was 5.6 (IQR 3.1-9.4) months and median time to progression (204 patients) was
6.3 months (IQR 4.0-10.5).
Conclusion:
Our centreseems to be following the global trend with increasing incidence of adenocarcinoma. The most
likely reason for which in our study seems to be an advancement in immune-histo/cyto-chemical
techniques resulting in improved histological classification rather than changing smoking trends like in
western studies as smoking rates among male and female remain largely unchanged over last 11 years in
our study. EGFR mutation positivity and survival appears at par with most existing reports, while higher
ALK positivity was detected.Our study is the largest study till date to evaluate clinical spectrum of lung
cancer patients in India.
Table 1. Year wise distribution of various pathologic types of lung cancer
Year Squamo
us cell
carcino
ma
Adeno-
carcinoma
NSCLC
(NOS)
Poorly
differenti
ated
carcinoma
SCC Other
s
2008
(n=63)
16 (25.4) 6 (9.5) 21 (33.3) 10 (15.9) 10(15.9) 0 (0)
2009
(n=48)
11 (22.9) 5 (10.4) 18 (37.5) 7 (14.6)
7 (14.6)
0 (0)
2010
(n=67)
13 (19.4) 10 (14.9) 25 (37.3) 4 (6.0) 15 (22.4) 0 (0)
2011
(n=70)
21 (30) 15 (21.4) 22 (31.4) 2 (2.9) 10 (14.3) 0 (0)
2012
(n=103)
26 (25.2) 37 (35.9)
16 (15.6) 9 (8.7)
14 (13.6) 1 (1.0)
2013
(n=154)
41 (26.6) 57 (37.0)
18 (11.7) 3 (1.9)
33 (21.4) 2 (1.4)
2014
(n=233)
75 (32.2) 79 (34.0) 25 (10.7) 8 (3.4) 40 (17.2) 6
(2.5)
2015
(n=286)
83 (29.0)
89 (31.1)
26 (9.1)
16 (5.6) 59 (20.6) 13
(4.6)
2016
(n=359)
101
(28.1)
162 (45.1) 23 (6.4)
9 (2.6)
51 (14.2) 13
(3.6)
2017
(n=376)
115
(30.6)
137 (36.4) 39 (10.4) 15 (4.0) 54 (14.4) 16(4.
2)
2018
(n=103)
30 (29.1) 37 (35.9) 15 (14.6) 7 (6.8) 7 (6.8) 7 (6.8)
Figure 1.Comparison of Epidemiology and histopathology between various Indian studies
Author
(reference)
Place, year Total Male:
Female
Mean
age
(years)
Smokers
(%)
SCC
(%)
ADC
(%)
SCC:ADC SCLC
Kaur H et al Chandigarh,
2017
1301 4.6:1 58.6 76.9 36.4 36.4 1 19.2
Jindal and
Behera
Chandigarh,
1990
1009 4.5:1 51 63 34.3 25.9 1.3 25.9
Prasad et al Lucknow,
2009
799 4.75:1 80.4 47.3 18.2 2.6 13.7
Sheena Sheikh
et al
Kashmir,
2010
783 6.98:1 57.8 68.1 71.3 2.6 27.9 20.8
Navneet Singh
et al
Chandigarh,
2012
654 5:1 58.2 76.9 38.1 27.5 1.38 20.5
Dey et al Kolkata,
2012
607 4.1:1 57.9 67.2 35.1 30.8 1.1 16.5
Noronha et al Mumbai,
2012
489 3.5:1 56 52 26.2 43.8 8
Mandal et al Manipur,
2013
466 1.09:1 58.5 73 49.1 30.8 1.6 14.8
Malik et al New Delhi,
2013
434 4.6:1 55 67.9 32.1 37.1 0.86 14.7
Prasad et al Lucknow,
2004
400 4.3:1 57 71 46.5 18.5 2.5 18.2
Mohan et al New Delhi,
2016
397 7.4:1 57.8 79 25.1 24.1 1.04 14.6
NA Khan et al Kashmir,
2006
321 11.3:1 88.4 77.3 5.3 14.5 17.1
Gupta et al Rajasthan,
1998
279 6.1:1 57 81.6 42 20 2.1 14
Krishnamurthy
et al
Tamil Nadu,
2012
258 3.5:1 56 60.5 15.8 42.6 13.2
Rawat et al Uttarakhand,
2009
203 8.2:1 56.4 81.77 44.83 19.38 2.2 16.75
PK Sharma et
al
Himachal
Pradesh,
2012
105 10.6:1 62.7 89.5 37.1 36.2 1.02
Baburao et al Bangalore,
2015
96 3:1 69.7 47.9 28.1 1.7
SR-107B
Delays During Diagnosis and Management of Lung Cancer in India- A
Prospective Observational Study
Author Block: Garg1 A, Mohan1 A, Gupta1 A, Sahu1 S, Choudhari1 C, Arora1S, Jain2 D, Kumar3R, Bhalla4 A, Pandey5 R,
Tiwari1 P, Mittal1S, Madan1 K, Khilnani1 G.C., Hadda1 V, Guleria1 R 1Pulmonary medicine and sleep disorders, All India Institute of Medical Sciences, New Delhi, India, 2Pathology, All India
Institute of Medical Sciences, New Delhi, India, 3Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India, 4Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India, 5Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
Presenting Author:
Name: Avneet Garg
Email: dravneetgarg@gmail.com
Corresponding Author:
Name: Avneet Garg
Email: dravneetgarg@gmail.com
Abstract Body:
Aiims and Objectives:
The majority of lung cancers (>80%) are diagnosed at an advanced stage.This may, in part, be due to
a long lag period between the onset of symptoms and establishment of a diagnosis and finally,
initiation of treatment. The reasons for this lag period are yet uncertain and may be multi-factorial.
There is scarce Indian dataevaluating delays in the diagnosis and management of lung cancer
patients.
Material and methods:
A prospective evaluation of proven lung cancer patients between 1stJanuary 2008 and 31stJanuary
2018 was completed to quantify various timelines during the course of management and establish
reasons for delay, if any. Timelines were defined as the time intervals between symptom onset, first
physician visit, referral to our facility, definitive diagnostic investigation, date of confirmed diagnosis
and date of treatment. Various factors affecting various time-lines were determined by univariate
and multivariate analysis.
Results:
418 patients were included for analysis,with majority having advanced stage (96.2% stage 3 or 4
NSCLC and 80.8% extensive stage SCLC).Of these, 252 patients (60.2%) received definitive treatment.
Among the various time intervals, it took a median of 30 days (IQR 20-90 days) for a patient to visit a
physician for first time, 50 days (IQR 20-120 days) to be referred for our centre, 13 days (IQR 6-21
days) to undergo definitive diagnostic investigation, 9 days (IQR 6-13 days) for a pathologist to
report and despatch the diagnosis, and 25 days (IQR 13.5-35 days) to initiate chemotherapy after
obtaining definitive diagnosis.Among the various factors affecting different time intervals; poor
educational status [upto primary level education:45 days (20-90) vs above primary level:30 days (15-
60); p=0.03] and loss of weight [LOW absent: 30 days (15-85.5) vs LOA present: 32 days(20-90);
p=0.018] were independently associated with longer delay between symptom onset to first
physician visit on multivariate analysis.Administration of anti-tuberculosis treatment (ATT) was the
only independent factor that affectedthe delay between first physician visit and referral to AIIMS
[median time in those who did not receive ATT:45 days (range, 20-100) vs those who received
ATT:60 days (range,30-180); p=0.002]. Advanced disease stage(77 days for stage 1, 2 vs 28.5 days
for stage 3, 4; p value .005) and presence of EGFR (27 days vs 14 days, p value .001) and ALK
mutations (26.3 days vs 14.5 days; p value.018) remained independent factors for lesser time delays
between diagnosis and treatment on multivariate analysis. Various time delays did not affect the
overall survival.
Conclusion:
Majority of patients present with advanced stage in India. Poor education status and inappropriate
institution of ATT appear to be the major reasonsfor delay during lung cancer diagnosis and
management in our setup. Unlike western data, various delays did not affect overall survival
probably due to the fact that most of patients presented at advanced stage of lung cancer.
Keywords: Lung cancer, India. Time delays
SR-107C
Figure 1: Various time intervals during diagnosis and management of lung cancer
Survival and treatment response of Lung cancer patients in India: a tertiary
centre experience
Mohan A, M.D.1, Garg A, M.D. DM
1 , Sahu S, D.N.B.
1, Gupta A, M.D.
1,Choudhari C, M.D.
1, Vashistha V, M.D.
2, Bhalla A,
M.D.3, Jain D, M.D.
4, Pandey R.M.
5, Kumar
, R, M.D.
6, Madan K, M.D., DM
1,Hadda V, M.D.
1,Khilnani G.C., M.D.
1, Guleria R,
M.D, DM1
1 All India Institute of Medical Sciences, Department of Pulmonary Medicine and Sleep Disorders, Delhi, India,
2 Duke
University Health System, Department of Hematology and Oncology, Durham, NC, U.S.A., 3 All India Institute of Medical
Sciences, Department of Radiology, Delhi, India., 4
All India Institute of Medical Sciences, Department of Pathology, Delhi,
India, 5
All India Institute of Medical Sciences, Department of Biostatistics, Delhi, India, 6
All India Institute of Medical
Sciences, Department of Nuclear Medicine, Delhi, India
Presenting Author:
Name: Avneet Garg
Email: dravneetgarg@gmail.com
Corresponding Author:
Name: Avneet Garg
Email: dravneetgarg@gmail.com
Abstarct Body:
Aiims and Objectives:
Inspite of several therapeutic advancements in lung cancer, response to treatment and survival
remains generally poor and highly variable in different parts of the world. However, limited data
exists regarding treatment response and outcomes in lung cancer patients in India.
Material and methods:
We performed an ambispective study of 1803proven lung cancer patients over 11 years from
1stJanuary 2008 to 31st January 2018 at a tertiary care referral facility in North India. Treatment
response and survival was assessed in terms of objective response rate (ORR), disease control rate
(DCR), time to progression (TTP), progression free survival (PFS) and overall survival (OS).
Results:
Among all patients enrolled during the above period, 60.0% received treatment, out of which 79.2%
received chemotherapy, 8.8%targeted therapy (TKIs), 15.3% radiotherapy and2.9% underwent
surgery. ORR and DCRafterfour cycles of first line doublet chemotherapy or 3 months of TKIswas
54.8% and 73.3% respectively (409 patients). TKIs achieved significantly better ORR compared to
standard chemotherapy in NSCLC (68.7% vs 53,8%; p=0.05), whereas diagnosis of well differentiated
carcinoma and non-smoking status was associated with significantly better DCR. (74.4% vs 46.1%,
p=0.02and 84.5% vs 69.9%, p=0.002respectively). The median TTP (204 patients) was 6.3 months
(IQR 4.0-10.5). The factors that were associated with significantly prolonged TTP on multivariate
analysis included: non-metastatic NSCLC [6.7 vs 5.8 months, HR 1.55 (1.09-2.19), p=0.013], non-
smoking status (7.1 vs 5.5 months, HR 1.47 (1.08-2.01), p=0.014]and treatment with TKIs(9.1 vs
5.9months, HR 0.64 (.04-0.94),p=0.024]. The median PFS (527 patients) was 5.6 months (IQR 3.1-9.4)
and young age (6.3 vs 5.0 months, HR 1.27 (1.07-1.52), p=0.005), good performance status (6.4 vs
4.7 months, HR 1.45 (1.2-1.7),p=<0.001) and non-metastatic disease NSCLC (6.7 vs 4.7 months, HR
1.6 (1.29-1.97),p=<0.001) were independent predictors of better PFS on multivariate analysis. The
median OS(1803 patients) was 8.8 months (IQR 3.7-19);non-smoking status [14.4 vs 8.0 months, HR
1.67 (1.4-2.0),p<0.001], non-metastatic NSCLC stage [11.3 vs 8.23 months, HR 1.27 (1.08-
1.5),p=0.003]and good performance status(14.3 vs 6.1 months,HR 1.67 (1.4-2.0),p=<.001) had
significantly better OS on multivariate analysis.
Conclusion:
In our study, various factors were identified that affected survival outcomes including age, smoking
status, metastatic disease, performance status and differentiation of tumour. Treatment with
targeted therapy resulted in significantly better ORR and TTP, although did not affect the PFS and OS
significantly.
Keywords: Lung cancer, India
Figure 1: Kaplan-Meier curve for Time to progression (TTP) and overall survival (OS)
Table 1: Factors affecting ORR and DCR among the treated patients
Factor/ variable Sub-group n ORR (%) DCR (%)
Chemotherapy regimen
in NSCLC
Conventional chemotherapy
TKIs (EGFR TKIs / ALK
inhibitors)
262
48
53.8
68.7
p=0.05
73.7
83.3
p=0.15
Pathological subtypes Well differentiated carcinoma
Poorly differentiated
carcinoma
387
13
55.3
30.8
p=0.08
74.4
46.1
p=0.02
Smoking status No
Yes
116
275
63.8
51.2
p=0.02
84.5
69.9
p=0.002