133 Radiological histological features and clinical outcome of lung cancer with coexistent idiopathic pulmonary fibrosis

Poster abstracts, 12th Annual British Thoracic Oncology Group Conference, 2014: Other 133 Radiological histological features and clinical outcome of lung cancer with coexistent idiopathic pulmonary fibrosis K.A. Khan1 *, P. Susan3 , L. Bourke3 , M. Maher2 , L. Crush2 , M.P. Kennedy1 , M.T. Henry1 . 1 Department of Respiratory Medicine Cork University Hospital, Ireland, 2 Department of Radiology Cork University Hospital, Ireland, 3 Department of Pathology Cork University Hospital, Ireland Introduction: The link between lung cancer and idiopathic pulmonary fibrosis remains poorly understood. The aim of this study was to understand the relationship of lung cancer to the areas of fibrosis and to evaluate the overall survival when both diseases are present concomitantly. Methods: A database was compiled of 637 patients who received a histological diagnosis of lung cancer in CUH between August 2008 and December 2011. 34 patients with established IPF on computerized tomography imaging were identified. Data from clinical notes and radiology pattern were collected and analysed. Results: There were 22 (65%) males with male to female ratio of 1.7:1. All were smokers, with a mean pack year history of 44. 94. 85% of carcinomas in these patients were non-small cell lung cancer (NSCLC). Squamous cell carcinoma (SqCL) was the predominant type in 41%. 68% of patients had usual interstitial pneumonia, 32% had idiopathic non-specific fibrosis. 76% of the lesions were located peripherally in the area of honeycombing and 64% in the lower lobes. Overall median survival was 5 months (std. error 0.729; 95% CI 3.57 to 6.42). Mean survival for patients who received surgery was longest (7.86 months), followed by those who received chemo radiotherapy (6.33 months), no intervention (6.27 months), and those who received radiotherapy alone (4.7 months) (Figure 1). Conclusion: Our findings of male predominance, peripheral distribution of lung cancer and predominant histological type of SqCL are in parallel with the reported literature. We report Survival for patients with lung cancer and IPF was lower than published figures for patients with lung cancer alone. Surgical candidates had the best survival though the survival benefit was very modest, while patients who received no intervention or radiotherapy alone fared very poorly.

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134 Effective treatment options in the management of brain metastases in lung cancer S. Cook *, R. Mendes, A. Ross, G. Hardavalla, L. Succony, D. Carnell, S.M. Janes, N. Navani. University College London Hospital, UK Introduction: Up to 40% of lung cancer patients develop brain metastases during their disease course. Although several treatment options exist, data on their utility is limited and NICE do not provide guidance on stereotactic radiosurgery or neurosurgery. Dexamethasone and WBRT are currently recommended for consideration in symptomatic patients. Aim: To compare effectiveness of the treatment options for brain metastases, i.e. steroids alone, WBRT, neurosurgical resection and stereotactic radiosurgery. Methods: Lung cancer patients diagnosed with brain metastases at a tertiary centre between 2009 and 2012 were identified and case notes were retrospectively reviewed. Data collected included demographics, performance status, histology, point in disease when brain metastases developed, number of metastases, treatment and survival time from diagnosis of lung cancer. Results: 66 patients were identified. Adenocarcinoma was the most common histology (59%), within which a quarter were positive for EGFR mutation. 6 patients remained alive with a median follow-up of 11.4 months. 1 patient was lost to follow up.

11 patients received steroids alone (group 1). WBRT was the most common treatment with 41 patients receiving this (group 2). Their median survival was lowest at 8 months. 75% had multiple brain metastases, with two thirds presenting after their lung cancer diagnosis. In contrast, of the 12 patients who received surgery (group 3), 75% had a single lesion and 11 presented with brain metastases. Their median survival was greatest at 16 months. Only 3 patients had stereotactic radiosurgery (group 4) all of whom had also undergone neurosurgical resection. Conclusion: WBRT is the most common treatment, particularly in patients with multiple brain metastases presenting later in their lung cancer illness. Surgery presently offers the best median survival. However this is likely to reflect selection bias and randomised controlled trials are urgently required in this patient group. 135 Improving lung cancer outcomes in the West of Scotland G. McDowell *, N. O’Rourke, G. Lumsden, E. Cameron. Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Scotland, UK

Figure 1. Post-intervention survival. Survival analysis of 34 patients with concomitant lung cancer and IPF did not show statistical difference (p value 0.74).

Over 38,000 new cases of lung cancer are diagnosed in the UK every year. Incidence rates of lung cancer in Scotland are amongst the highest in the world. Local incidence rates are one third higher than the Scottish average. The national lung cancer audit highlighted shortcomings between the UK and western Europe. Improving Lung Cancer Outcomes Project (ILCOP) identified reasons for these shortcomings and improved care through a