Follow+up!of!Stage!I+III!NSCLC:! Who,WhenandHow? ·...
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Interna(onal Guidelines vary in their recommenda(ons for followup (FU) a=er treatment for NonSmall Cell Lung Cancer (NSCLC) Australian 5 , ACCP 6 , ESMO 7 and NCCN 8 : 6m for 2/3 y and yearly therea=er. ASCO 2 , Canada 3 , and Chinese 4 guidelines: 3m for 2y, 6m 25y, and yearly >5y. FU is important to manage treatment toxici(es, diagnose events (recurrence or new primaries) and provide suppor(ve management CONCLUSION • FOLLOWUP PRACTICE WAS VARIABLE ACROSS THE THREE INSTITUTIONS. • THE MAJORITY OF EVENTS OCCURRED WITHIN 3 YEARS POSTRADIOTHERAPY • THERE WAS A STEADY INCREASED RISK OF NEW PRIMARY CANCERS UP TO 9 YEARS AFTER TREATMENT • ROUTINE IMAGING WAS NOT ASSOCIATED WITH IMPROVED SURVIVAL • STANDARDISED ROUTINE FOLLOWUP PROTOCOL MAY PREVENT SYMPTOMATIC HOSPITAL PRESENTATIONS • Median no. of FU visits = 6 (046) & Median period of FU = 10.8 months (0104.2) • 73.7% were rou(ne, 26.3% were symptoma(c visits • 1641 imaging tests were performed = an average of 5.8 scans/pa(ent • 98 imaging studies resulted in the asymptoma(c diagnosis of an event METHODS AND MATERIALS Retrospec(ve data collec(on of Oncology and Hospital records at 3 Cancer Therapy Centers: St George Illawarra Liverpool/Macarthur Inclusion criteria Stage IIII NSCLC pa(ents Completed cura(ve dose of radiotherapy (min: 50Gy) +/ chemotherapy between 20072011 Not treated with surgery Sample size = 283 pa(ents Data collec(on: Demographics: Age, Gender, ECOG, Alive/Dead status, Date of death, Cause of death Cancer Factors: Date of diagnosis, Stage, Histopathology, Treatment Followup: Date, Specialist, Symptoms, Imaging Recurrence/New Primary: Date of diagnosis, Method of diagnosis, Treatment, Intent PURPOSE 1. To compare paberns of postradiotherapy FU care at 3 metropolitan Sydney Hospitals 2. To evaluate the role of rou(ne imaging in FU 3. To es(mate the propor(on of pa(ents suitable for cura(ve interven(ons a=er diagnosis of recurrence or new primary lung cancer during FU Figure 1 ProporFons of rouFne and symptomaFc FU by hospital 1 AIHW. Cancer in Australia 2017 Canberra: Australian Government. 2017. 2 Pfister DG, et al. J Clin Oncol. 2004;22(2):33053. 3 Ung YC, et al. Followup and surveillance of cura(vely treated lung cancer pa(ents. Ontario: Cancer Care Ontario. 2014. 4 Zhi XY, Yu JM, Shi YK. Chinese guidelines on the diagnosis and treatment of primary lung cancer. Cancer. 2015;121(17):316581. 5 Party TW. Clinical Prac(ce Guidelines for the Preven(on, Diagnosis and Management of Lung Cancer. NHMRC. 2004. 6 Colt HG, et al. Followup and surveillance of the pa(ent with lung cancer a=er cura(veintent therapy: Diagnosis and management of lung cancer, 3rd ed: ACCP. Chest. 2013;143(5):43754. 7 Vansteenkiste J, et al. 2nd ESMO Consensus Conference on Lung Cancer: earlystage nonsmallcell lung cancer consensus on diagnosis, treatment and followup. Ann Oncol. 2014;25(8):146274. 8 Shead DA, et al. NCCN guidelines for pa(ents. NCCN. 2016:5984. Followup of Stage IIII NSCLC: Who, When and How? S. MOHAN 1 , J. SHAFIQ 2 , N. BEYDOUN 3 , E. NASSER 4 , A. NGUYEN 1 and S. VINOD 5 1 University of New South Wales, Sydney, NSW, Australia, 2 Ingham Ins(tute, Liverpool, NSW, Australia, 3 St George Hospital Cancer Care Centre, Kogarah, NSW, Australia, 4 Illawarra Cancer Care Centre, Wollongong, NSW, Australia, 5 Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia RESULTS N % Gender Male 183 64.7 Female 100 36.3 Age at diagnosis <60 years 36 12.7 6069 years 83 29.3 7079 years 89 31.4 80+ years 75 26.5 Histopathology Large Cell Carcinoma 90 31.8 Squamous Cell Carcinoma 100 35.3 Adenocarcinoma 69 24.4 NSCLC NOS 25 8.8 ECOG 0 80 28.3 1 152 53.7 2 39 13.8 3 6 2.1 Unknown 6 2.1 Stage Stage I 79 29.7 Stage II 47 16.6 Stage III 105 53.7 IniSal Treatment Radiotherapy 160 56.5 Sequen(al Chemoradiotherapy 18 6.4 Concurrent Chemoradiotherapy 105 37.1 Table 1 – CharacterisFcs of study paFents 59% 13% 8% 4% 1% 6% 9% Liverpool 49% 7% 18% 2% 4% 20% Illawarra 46% 22% 14% 2% 2% 7% 7% St George Routine RO Routine MO Routine Specialist Symptomatic RO Symptomatic MO Symptomatic Specialist Symptomatic Hospital 17% 42% 11% 9% 6% 1% 3% 2% 9% Liverpool 39% 28% 6% 4% 5% 2% 5% 2% 9% Illawarra 9% 54% 11% 8% 4% 2% 3% 3% 6% St George CXR CT Chest CT Abdomen CT Pelvis CT Brain MRI Brain Bone Scan PET Other Figure 2 – Types of imaging done at FU by hospital Figure 5 – Flowchart of events, method of diagnosis and subsequent treatment intent BACKGROUND Author Contact: Sharanya Mohan Email: [email protected] REFERENCES Figure 3 – No. of events (recurrence/new primary) by Fme for Stage I+II paFents 0 10 20 30 40 50 60 70 80 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 Time posttreatment (years) Stage I+II Recurrence Stage I+II New Primary Figure 4 – No. of events (recurrence/new primary) by Fme for Stage III paFents 0 20 40 60 80 100 120 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 Time posttreatment (years) Stage III Recurrence Stage III New Primary 90% of Stage I&II recurrences occurred by 4.37 years 90% of Stage III recurrences occurred by 2.20 years • Symptoma(c diagnosis of an event was associated with delivery of subsequent cura(ve treatment (p=0.049) but was not significantly associated with overall survival (p=0.862) • No other pa(ent, tumor or ini(al treatment factors were significantly associated with subsequent cura(ve treatment (p>0.05) Event Recurrence (175) Symptomatic diagnosis (85) Palliative (70) Curative (15) Imaging diagnosis (90) Palliative (80) Curative (10) New Primary (23) Symptomatic diagnosis (16) Palliative (3) Curative (13) Imaging diagnosis (5) Palliative (0) Curative (5) 18% 11% 81% 100%
Transcript of Follow+up!of!Stage!I+III!NSCLC:! Who,WhenandHow? ·...
-‐ Interna(onal Guidelines vary in their recommenda(ons for follow-‐up (FU) a=er treatment for Non-‐Small Cell Lung Cancer (NSCLC)
-‐ Australian5, ACCP6, ESMO7 and NCCN8: 6m for 2/3 y and yearly therea=er. -‐ ASCO2, Canada3, and Chinese4 guidelines: 3m for 2y, 6m 2-‐5y, and yearly >5y. -‐ FU is important to manage treatment toxici(es, diagnose events (recurrence or new
primaries) and provide suppor(ve management
CONCLUSION • FOLLOW-‐UP PRACTICE WAS VARIABLE ACROSS THE THREE INSTITUTIONS.
• THE MAJORITY OF EVENTS OCCURRED WITHIN 3 YEARS POST-‐RADIOTHERAPY
• THERE WAS A STEADY INCREASED RISK OF NEW PRIMARY CANCERS UP TO 9 YEARS AFTER TREATMENT
• ROUTINE IMAGING WAS NOT ASSOCIATED WITH IMPROVED SURVIVAL
• STANDARDISED ROUTINE FOLLOW-‐UP PROTOCOL MAY PREVENT SYMPTOMATIC HOSPITAL PRESENTATIONS
• Median no. of FU visits = 6 (0-‐46) & Median period of FU = 10.8 months (0-‐104.2)
• 73.7% were rou(ne, 26.3% were symptoma(c visits
• 1641 imaging tests were performed = an average of 5.8 scans/pa(ent • 98 imaging studies resulted in the asymptoma(c diagnosis of an event
METHODS AND MATERIALS
-‐ Retrospec(ve data collec(on of Oncology and Hospital records at 3 Cancer Therapy Centers: -‐ St George -‐ Illawarra -‐ Liverpool/Macarthur
Inclusion criteria -‐ Stage I-‐III NSCLC pa(ents -‐ Completed cura(ve dose of radiotherapy (min: 50Gy) +/-‐ chemotherapy between
2007-‐2011 -‐ Not treated with surgery Sample size = 283 pa(ents
Data collec(on: -‐ Demographics: Age, Gender, ECOG, Alive/Dead status, Date of death, Cause of death -‐ Cancer Factors: Date of diagnosis, Stage, Histopathology, Treatment -‐ Follow-‐up: Date, Specialist, Symptoms, Imaging -‐ Recurrence/New Primary: Date of diagnosis, Method of diagnosis, Treatment, Intent
PURPOSE 1. To compare paberns of post-‐radiotherapy FU care at 3 metropolitan Sydney Hospitals
2. To evaluate the role of rou(ne imaging in FU
3. To es(mate the propor(on of pa(ents suitable for cura(ve interven(ons a=er diagnosis of recurrence or new primary lung cancer during FU
Figure 1 -‐ ProporFons of rouFne and symptomaFc FU by hospital
1AIHW. Cancer in Australia 2017 Canberra: Australian Government. 2017. 2Pfister DG, et al. J Clin Oncol. 2004;22(2):330-‐53. 3Ung YC, et al. Follow-‐up and surveillance of cura(vely treated lung cancer pa(ents. Ontario: Cancer Care Ontario. 2014. 4Zhi XY, Yu JM, Shi YK. Chinese guidelines on the diagnosis and treatment of primary lung cancer. Cancer. 2015;121(17):3165-‐81. 5Party TW. Clinical Prac(ce Guidelines for the Preven(on, Diagnosis and Management of Lung Cancer. NHMRC. 2004. 6Colt HG, et al. Follow-‐up and surveillance of the pa(ent with lung cancer a=er cura(ve-‐intent therapy: Diagnosis and management of lung cancer, 3rd ed: ACCP. Chest. 2013;143(5):437-‐54. 7Vansteenkiste J, et al. 2nd ESMO Consensus Conference on Lung Cancer: early-‐stage non-‐small-‐cell lung cancer consensus on diagnosis, treatment and follow-‐up. Ann Oncol. 2014;25(8):1462-‐74. 8Shead DA, et al. NCCN guidelines for pa(ents. NCCN. 2016:59-‐84.
Follow-‐up of Stage I-‐III NSCLC: Who, When and How?
S. MOHAN1, J. SHAFIQ2, N. BEYDOUN3, E. NASSER4, A. NGUYEN1 and S. VINOD5
1University of New South Wales, Sydney, NSW, Australia, 2Ingham Ins(tute, Liverpool, NSW, Australia, 3St George Hospital Cancer Care Centre, Kogarah, NSW, Australia, 4Illawarra Cancer Care Centre, Wollongong, NSW, Australia, 5Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia
RESULTS
N % Gender
Male 183 64.7 Female 100 36.3 Age at diagnosis
<60 years 36 12.7 60-‐69 years 83 29.3 70-‐79 years 89 31.4 80+ years 75 26.5 Histopathology
Large Cell Carcinoma 90 31.8 Squamous Cell Carcinoma 100 35.3 Adenocarcinoma 69 24.4 NSCLC NOS 25 8.8
ECOG
0 80 28.3 1 152 53.7 2 39 13.8 3 6 2.1 Unknown 6 2.1 Stage Stage I 79 29.7 Stage II 47 16.6 Stage III 105 53.7 IniSal Treatment Radiotherapy 160 56.5 Sequen(al Chemoradiotherapy 18 6.4 Concurrent Chemoradiotherapy 105 37.1
Table 1 – CharacterisFcs of study paFents
59%
13%
8%
4% 1% 6%
9%
Liverpool
49%
7%
18%
2% 4%
20%
Illawarra
46%
22%
14%
2% 2% 7%
7%
St George Routine RO
Routine MO
Routine Specialist
Symptomatic RO
Symptomatic MO
Symptomatic Specialist Symptomatic Hospital
17%
42% 11%
9%
6%
1%
3% 2%
9%
Liverpool
39%
28%
6% 4%
5% 2% 5% 2% 9%
Illawarra
9%
54% 11%
8%
4%
2% 3% 3%
6%
St George CXR
CT Chest
CT Abdomen
CT Pelvis
CT Brain
MRI Brain
Bone Scan
PET
Other
Figure 2 – Types of imaging done at FU by hospital
Figure 5 – Flowchart of events, method of diagnosis and subsequent treatment intent
BACKGROUND
Author Contact: Sharanya Mohan Email: [email protected]
REFERENCES
Figure 3 – No. of events (recurrence/new primary) by Fme for Stage I+II paFents
0
10
20
30
40
50
60
70
80
0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9
Time post-‐treatment (years)
Stage I+II -‐ Recurrence Stage I+II -‐ New Primary
Figure 4 – No. of events (recurrence/new primary) by Fme for Stage III paFents
0
20
40
60
80
100
120
0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9
Time post-‐treatment (years)
Stage III -‐ Recurrence Stage III -‐ New Primary
90% of Stage I&II recurrences occurred by 4.37 years 90% of Stage III recurrences occurred by 2.20 years
• Symptoma(c diagnosis of an event was associated with delivery of subsequent cura(ve treatment (p=0.049) but was not significantly associated with overall survival (p=0.862)
• No other pa(ent, tumor or ini(al treatment factors were significantly associated with subsequent cura(ve treatment (p>0.05)
Event
Recurrence (175)
Symptomatic diagnosis (85)
Palliative (70)
Curative (15)
Imaging diagnosis
(90)
Palliative (80)
Curative (10)
New Primary
(23)
Symptomatic diagnosis (16)
Palliative (3)
Curative (13)
Imaging diagnosis
(5)
Palliative (0)
Curative (5)
18% 11% 81% 100%
