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O-99 Chemotherapy for lung cancer in Scotland: Selective or scandalous?
S32 Abstract
Oral Sessions/Surgery: Resection of Locally Advanced Disease 0-97-Table:
Patients and CT characteristics
Characteristics/years % stage IV pts/N pts with NSCLC median age stage IV pts (years) % stage IV pts with CT idem, aged < 60 * idem, aged 60-74 * idem, aged >74 % pts on combination CT % pts on platinum containing CT % pts on Wane containing CT % pts on gemcitabine containing CT
by interval of 2 years
1990191 241496
1992193 241491
1994195 241514
1996/97 28/590
1998199 291561
2000/01 341654
66 11 19 10 4 56 47
65 13 28 7 1 72 71 5
66 17 29 16 2 74 74 13
65 19 25 20 2 87 86 4 15
65 25 43 19 4 71 69 11 63
67 27 43 29 4 a7 67 20 59
1990/2001 2713306 66 15 32 17 3 76 76 11 33
*p< 0.001.
lines seem to have influenced the practice of CT in the Rotterdam region. More information is needed on response, toxicity and quality of life in elderly receiving CT.
0 98 El
Treatment and survival of patients diagnosed with lung cancer in British Columbia (BC) in 1995
Sara Catherine Erridae’, Yulia D’Yachkova’, Janessa Laskin”, Greg Hislop2, Andrew J. Coldman’. Nevin Murrav’. Finbarr Sheehan’. ’ Universitv of Edinburgh, Edinburgh, UK; 2 British Columbia Cancer Agency, Vanck~er, Canada
Purpose: To analyse the treatment and survival of all patients diagnosed with lung cancer in BC in 1995. Methods: All cases registered with the BC Cancer Registry were identified and management data were obtained from the BC Medical Services Plan and the BC Cancer Agency databases. Patient and tumor characteristics were recorded, as were all lung cancer treatments delivered in first 6 months. Radiotherapy intent was defined at time of treatment by the radiation oncologist (radical/adjuvant (rRT), palliative (pRT)). Results: 2256 cases were identified; 41.4% were women and 58.6% men. The median age was 70 with range 22-100 years. 83.9% resided in an urban area and 71.2% had a journey 12 hours to a cancer centre. Pathology distribution was 21.5% squamous, 28.7% adenocarcinoma, 9.9% large-cell, 13.7% small-cell (SCLC), 9.5% others, 16.7% had no pathology. 22.1% of cases had localised disease, 19.1% regional, 26.4% metastatic, 4.6% limited-SCLC, 7.2% extensive-SCLC, 8.4% autopsy diagnosis and 12.3% the stage was unknown. In 176 cases date of diagnosis =date of death and for four cases some dates were missing. For the remaining 2076 patients, 685 (33%) received no treatment, 808 (38.9%) palliative treatment (153 chemo (C), 536 pRT, 119 C+pRT) and 563 (27.1%) potentially curative therapy (387 resection (S), 76 rRT+C, 50 rRT, 32 S+rRT, 11 S+C, 7 S+rRT+C) and 20 cases (1.0%) underwent noncurative surgery only. of the SCLC patients, 75.3% received chemotherapy (70.2% platinum-based) and 7.7% of those without-SCLC (89.7% platinumbased). 25.7% of cases received pRT to chest, RT dose median 20Gy, mean 23Gy, range 5-45Gy, the median time from diagnosis to thoracic treatment was 40 days, with a mean of 48.5 days. For the whole cohort of 2256 cases, the median survival was 6.17 (5.6-6.7) months, with l-year overall survival of 34%, 2-year 19% and 5-year 9%. The cause specific survival at l-year was 37%, e-year 18% and 5-year 13%. Conclusions: In BC, the use of curative and palliative therapy is similar to other North American series, but exceeds reported rates in the UK with, in particular, more patients undergoing resection.
known subtype and 999 (25.9%) had no histology or cytology to confirm the diagnosis. In the group with NSCLC, 170 (8.2%) received CT with intent recorded as palliation in 120 (75.9%). In 72 (65.3%) pts, CT was started between 0.5 and 3 months from diagnosis. Mustine was one of the administered agents in 28 (16.5%) pts. Only 4 pts received concomitant CT and radiotherapy. There was a statistically significant variation in pts’ likelihood of receiving CT depending on age ~70 and Health Board of residence (HB). Pts who received CT had improved median survival - 9.1 versus 4.8 months - but this may partially be explained by pt selection. For pts with SCLC, 425 (62.7%) received CT although this fell to 16.7% for one HB. Although 337 (79.3%) pts received combination CT nationally, this ranged from 23.1% to 99% by HB. Only 33 (7.8%) pts with SCLC were treated within a clinical trial compared with 38 (22.4%) of NSCLC pts. Conclusion: In this audit, performed prior to release of the Scottish Intercollegiate Guidelines Network (SIGN) lung cancer treatment advice, the underuse of CT for NSCLC is demonstrated. Old fashioned drugs were still being prescribed. A clinical trial in advanced NSCLC was ongoing where single agent CT was being compared with best supportive care, but this is unlikely to have reduced significantly the number of pts who would otherwise have received CT. There was huge regional variation in CT availability. Since this represented practice only seven years ago, one can but hope that there has been a radical change in favour of CT availability for Scottish pts with lung cancer.
TUESDAY, 12 AUGUST 2003
Surgery: Disease L-0
100
Resection
The Risk of Right Pneumonectomy: Bronchopleural Fistula
for Lung Cancer in Scotland: Selective or
Marianne C. Nicolson’ , Catherine Thomson”, David Brewste?, David Dunlop4, Anna Grego?, Robert Milroy4. ‘Scottish Lung Cancer Group, Aberdeen, Scot/and; 2 Scottish Lung Cancer Group, Sheffield, England: 3 Scottish Lung Cancer Group, Edinburgh, Scot/and; 4 Scottish Lung Cancer Group, Glasgow, Scofland
Introduction:
It is well known that patients (pts) in the US and mainland Europe have a higher chance of receiving chemotherapy (CT) for their lung cancer than do those pts who live in the UK. In this audit of lung cancer treatment in Scotland, we investigated the absolute numbers and characteristics of those pts receiving CT, the drugs prescribed, regional variations and outcomes. Method: Retrospective casenote review was carried out for the 3855 pts resident in Scotland who in 1995 had a new diagnosis of lung cancer and for whom records were available. CT had to be delivered by six months from diagnosis for the treatment to be included in the audit. Results: Of the 3855 pts, 2071 (53.7%) had non-small cell lung cancer (NSCLC), 678 (17.6%) small cell lung cancer (SCLC), 107 (2.8%) were of un-
the Role of
the morbidity and mortality of right versus left pneuin our institution. Method: Retrospective chart review of all pneumonectomies performed during the period 1990-2000, excluding pleuropneumonectomy for mesothelioma, completion pneumonectomy, carinal and donor pneumonectomy. Meta-analysis of relevant literature. Results: There were 187 pneumonectomies: 119 left, 68 right. Our primary study endpoint was in hospital death. There were 11 deaths: 4/l 19 (3.3%) left, 7/68 (10.3%) right: p=O.lO. When the cause of death was examined, we found that 5 deaths were attributable to bronchopleural fistula (BPF) and its subsequent complications. There was a higher risk of BPF on the right 9/68 (13.2%) vs. left: 6/l 19 (5.0%) p=O.O5. The mortality associated with BPF was l/6 (16%) left vs. 4/9 (44%) right. Other causes of death were (one each of) ARDS, pulmonary embolus, pneumonia, coagulopathy, acute myocardial infarction and ventricular fibrillation. Because of a previous report of increased mortality in right pneumonectomy after induction therapy, mortality was reanalyzed excluding 31 patients who had received preoperative induction therapy. With these patients excluded (one death each from ARDS, pneumonia and Ml), there were 8 deaths: 3 left (3.0%) and 5 right (10.6%), p=O.ll. Right pneumonectomies were more likely to require an intrapericardial or other extended dissection (p=O.O03), the bronchus was more often closed by hand suturing, (p
Chemotherapy Scandalous?
Advanced
Gail Darlinq’, Adel Abdurahman’, Qi-Long Yis, Michael Johnston4, Thomas Waddells, Shaf Keshavjee’, Andrew Pierres, Robert Ginsberg5. ’ University of Toronto, Toronto General Hospital, Toronto, Canada; 2 University of Toronto, Toronto, Canada; 3 PMH, UHN, Toronto, Canada: 4 Toronto Genera/ Hospital/University Health Network, Toron to, Canada; 5 Division of Thoracic Surgery, Toronto Genera/ Hospital, Toronto, Canada
Purpose: To compare
0 99 El
of Locally
Oral Sessions/Surgery: Resection of Locally Advanced Disease 0-97-Table:
Patients and CT characteristics
Characteristics/years % stage IV pts/N pts with NSCLC median age stage IV pts (years) % stage IV pts with CT idem, aged < 60 * idem, aged 60-74 * idem, aged >74 % pts on combination CT % pts on platinum containing CT % pts on Wane containing CT % pts on gemcitabine containing CT
by interval of 2 years
1990191 241496
1992193 241491
1994195 241514
1996/97 28/590
1998199 291561
2000/01 341654
66 11 19 10 4 56 47
65 13 28 7 1 72 71 5
66 17 29 16 2 74 74 13
65 19 25 20 2 87 86 4 15
65 25 43 19 4 71 69 11 63
67 27 43 29 4 a7 67 20 59
1990/2001 2713306 66 15 32 17 3 76 76 11 33
*p< 0.001.
lines seem to have influenced the practice of CT in the Rotterdam region. More information is needed on response, toxicity and quality of life in elderly receiving CT.
0 98 El
Treatment and survival of patients diagnosed with lung cancer in British Columbia (BC) in 1995
Sara Catherine Erridae’, Yulia D’Yachkova’, Janessa Laskin”, Greg Hislop2, Andrew J. Coldman’. Nevin Murrav’. Finbarr Sheehan’. ’ Universitv of Edinburgh, Edinburgh, UK; 2 British Columbia Cancer Agency, Vanck~er, Canada
Purpose: To analyse the treatment and survival of all patients diagnosed with lung cancer in BC in 1995. Methods: All cases registered with the BC Cancer Registry were identified and management data were obtained from the BC Medical Services Plan and the BC Cancer Agency databases. Patient and tumor characteristics were recorded, as were all lung cancer treatments delivered in first 6 months. Radiotherapy intent was defined at time of treatment by the radiation oncologist (radical/adjuvant (rRT), palliative (pRT)). Results: 2256 cases were identified; 41.4% were women and 58.6% men. The median age was 70 with range 22-100 years. 83.9% resided in an urban area and 71.2% had a journey 12 hours to a cancer centre. Pathology distribution was 21.5% squamous, 28.7% adenocarcinoma, 9.9% large-cell, 13.7% small-cell (SCLC), 9.5% others, 16.7% had no pathology. 22.1% of cases had localised disease, 19.1% regional, 26.4% metastatic, 4.6% limited-SCLC, 7.2% extensive-SCLC, 8.4% autopsy diagnosis and 12.3% the stage was unknown. In 176 cases date of diagnosis =date of death and for four cases some dates were missing. For the remaining 2076 patients, 685 (33%) received no treatment, 808 (38.9%) palliative treatment (153 chemo (C), 536 pRT, 119 C+pRT) and 563 (27.1%) potentially curative therapy (387 resection (S), 76 rRT+C, 50 rRT, 32 S+rRT, 11 S+C, 7 S+rRT+C) and 20 cases (1.0%) underwent noncurative surgery only. of the SCLC patients, 75.3% received chemotherapy (70.2% platinum-based) and 7.7% of those without-SCLC (89.7% platinumbased). 25.7% of cases received pRT to chest, RT dose median 20Gy, mean 23Gy, range 5-45Gy, the median time from diagnosis to thoracic treatment was 40 days, with a mean of 48.5 days. For the whole cohort of 2256 cases, the median survival was 6.17 (5.6-6.7) months, with l-year overall survival of 34%, 2-year 19% and 5-year 9%. The cause specific survival at l-year was 37%, e-year 18% and 5-year 13%. Conclusions: In BC, the use of curative and palliative therapy is similar to other North American series, but exceeds reported rates in the UK with, in particular, more patients undergoing resection.
known subtype and 999 (25.9%) had no histology or cytology to confirm the diagnosis. In the group with NSCLC, 170 (8.2%) received CT with intent recorded as palliation in 120 (75.9%). In 72 (65.3%) pts, CT was started between 0.5 and 3 months from diagnosis. Mustine was one of the administered agents in 28 (16.5%) pts. Only 4 pts received concomitant CT and radiotherapy. There was a statistically significant variation in pts’ likelihood of receiving CT depending on age ~70 and Health Board of residence (HB). Pts who received CT had improved median survival - 9.1 versus 4.8 months - but this may partially be explained by pt selection. For pts with SCLC, 425 (62.7%) received CT although this fell to 16.7% for one HB. Although 337 (79.3%) pts received combination CT nationally, this ranged from 23.1% to 99% by HB. Only 33 (7.8%) pts with SCLC were treated within a clinical trial compared with 38 (22.4%) of NSCLC pts. Conclusion: In this audit, performed prior to release of the Scottish Intercollegiate Guidelines Network (SIGN) lung cancer treatment advice, the underuse of CT for NSCLC is demonstrated. Old fashioned drugs were still being prescribed. A clinical trial in advanced NSCLC was ongoing where single agent CT was being compared with best supportive care, but this is unlikely to have reduced significantly the number of pts who would otherwise have received CT. There was huge regional variation in CT availability. Since this represented practice only seven years ago, one can but hope that there has been a radical change in favour of CT availability for Scottish pts with lung cancer.
TUESDAY, 12 AUGUST 2003
Surgery: Disease L-0
100
Resection
The Risk of Right Pneumonectomy: Bronchopleural Fistula
for Lung Cancer in Scotland: Selective or
Marianne C. Nicolson’ , Catherine Thomson”, David Brewste?, David Dunlop4, Anna Grego?, Robert Milroy4. ‘Scottish Lung Cancer Group, Aberdeen, Scot/and; 2 Scottish Lung Cancer Group, Sheffield, England: 3 Scottish Lung Cancer Group, Edinburgh, Scot/and; 4 Scottish Lung Cancer Group, Glasgow, Scofland
Introduction:
It is well known that patients (pts) in the US and mainland Europe have a higher chance of receiving chemotherapy (CT) for their lung cancer than do those pts who live in the UK. In this audit of lung cancer treatment in Scotland, we investigated the absolute numbers and characteristics of those pts receiving CT, the drugs prescribed, regional variations and outcomes. Method: Retrospective casenote review was carried out for the 3855 pts resident in Scotland who in 1995 had a new diagnosis of lung cancer and for whom records were available. CT had to be delivered by six months from diagnosis for the treatment to be included in the audit. Results: Of the 3855 pts, 2071 (53.7%) had non-small cell lung cancer (NSCLC), 678 (17.6%) small cell lung cancer (SCLC), 107 (2.8%) were of un-
the Role of
the morbidity and mortality of right versus left pneuin our institution. Method: Retrospective chart review of all pneumonectomies performed during the period 1990-2000, excluding pleuropneumonectomy for mesothelioma, completion pneumonectomy, carinal and donor pneumonectomy. Meta-analysis of relevant literature. Results: There were 187 pneumonectomies: 119 left, 68 right. Our primary study endpoint was in hospital death. There were 11 deaths: 4/l 19 (3.3%) left, 7/68 (10.3%) right: p=O.lO. When the cause of death was examined, we found that 5 deaths were attributable to bronchopleural fistula (BPF) and its subsequent complications. There was a higher risk of BPF on the right 9/68 (13.2%) vs. left: 6/l 19 (5.0%) p=O.O5. The mortality associated with BPF was l/6 (16%) left vs. 4/9 (44%) right. Other causes of death were (one each of) ARDS, pulmonary embolus, pneumonia, coagulopathy, acute myocardial infarction and ventricular fibrillation. Because of a previous report of increased mortality in right pneumonectomy after induction therapy, mortality was reanalyzed excluding 31 patients who had received preoperative induction therapy. With these patients excluded (one death each from ARDS, pneumonia and Ml), there were 8 deaths: 3 left (3.0%) and 5 right (10.6%), p=O.ll. Right pneumonectomies were more likely to require an intrapericardial or other extended dissection (p=O.O03), the bronchus was more often closed by hand suturing, (p
Chemotherapy Scandalous?
Advanced
Gail Darlinq’, Adel Abdurahman’, Qi-Long Yis, Michael Johnston4, Thomas Waddells, Shaf Keshavjee’, Andrew Pierres, Robert Ginsberg5. ’ University of Toronto, Toronto General Hospital, Toronto, Canada; 2 University of Toronto, Toronto, Canada; 3 PMH, UHN, Toronto, Canada: 4 Toronto Genera/ Hospital/University Health Network, Toron to, Canada; 5 Division of Thoracic Surgery, Toronto Genera/ Hospital, Toronto, Canada
Purpose: To compare
0 99 El
of Locally