Patterns of care in locally advanced carcinoma lung: An audit from radiation Oncologist’s perspective

Abstract

AbstractIntroductionThe standard of care in locally advanced NSCLC is concurrent chemo- radiation. This audit aims to document different treatment approaches offered in real world scenario and the resultant outcomes.MethodologyInstitute medical records during 2014–2018 were retrieved. Demographic and clinical data, different treatment offered with associated outcomes and the side effects were analysed. Various prognostic factors, disease‐free survival (DFS), and overall survival (OS) were evaluated.Results396 patients were eligible for the analysis of which 278 patients were treated with curative intent. The elderly population constituted 53% and 85.3% were male. Among allpatients, 86.7% were NSCLC and 13.3% were SCLC and 25.1% of them presented in locally advanced stage. The proportion of squamous cell and adenocarcinoma are 55.8% and 31.3% respectively. Although 71.6% of curative patients were given neoadjuvant therapy, only 53.2% could complete the scheduled number of cycles. Only 31.6% could actually receive chemo- radiotherapy. Surgical excision was done in 19.4% of patients. The compliance to concurrent and sequential chemo- radiation were 52.1% and 70.7% respectively. The median overall survival of the curative intent cohort is 17.5 months (9.3- 30.7 IQR) and the progression free survival is 9 months (4.4- 16.5 IQR). The median OS of the palliative intent cohort is 9.1 months (3.1- 15.7 IQR) and the PFS is 6.5 months (4.2- 12.7 IQR). Although, definitive chemo- radiation had lower median PFS, it provided significantly superior long-term survival outcome when compared to surgery with adjunct therapy. Median PFS, median OS, OS at 1.5 and 2- years were not significantly different. No significant differences in survival outcomes between concurrent versus sequential chemo- radiation approaches. Sequential CTRT, surgery with adjunct therapy had significantly better median PFS. Smoking, reception of intended treatment, and definitive chemo- radiation were significant prognostic factors in multivariate analysis.ConclusionCompared to global figures the outcome in the present study observed poorer outcome in terms of median PFS associated with neoadjuvant chemotherapy and concurrent chemo- radiation. Surgery may not lead to better outcomes in locally advanced NSCLC patients and the standard of care still remains definitive chemo- radiation.