P1.07-049 Limited Stage Small Cell Lung Cancer: Patterns of Care and Outcomes of a Single Institution over 15 Years

Abstract

The past two decades have seen an increase in survival of patients with limited stage small cell lung cancer (SCLC). This retrospective audit analyzed patterns of care, toxicity and survival for all patients with limited stage SCLC diagnosed and treated at Prince of Wales hospital over 15 years. Our results were compared with the literature to assess this single institution’s performance and outcomes, and explore what factors may most be influencing these results. We identified 120 patients diagnosed with SCLC at Prince of Wales Hospital between 2000 and 2014 from the departmental electronic patient information system (Mosaiq). Eligibility criteria were: age >18 years, histopathologically confirmed diagnosis of SCLC, limited stage according to the two-stage Veterans’ Affairs Lung Study Group staging criteria (2016), and treatment with either curative or palliative intent. Median progression free survival (PFS), cancer specific survival (CSS) and overall survival (OS) were estimated using the Kaplan-Meier method and log-rank test (IBM SPSS version 23.0). Thirty-two patients fulfilled the eligibility criteria. The median age of patients was 66.5 years; 19 (59%) patients were female and 50% had an Eastern Cooperative Oncology Group (ECOG) score of 0. Median PFS, CSS and OS were 12.6, 22.1 and 18.0 months respectively, comparable with published literature. Ten patients (31%) received prophylactic cranial irradiation (PCI) as a component of their therapy. Of the 10 patients who received PCI, none had brain recurrence, while 36.4% of the non-PCI group developed brain metastases. Patients receiving PCI demonstrated a trend toward improved PFS compared to patients not receiving PCI (18.3 months versus 10.5 months, p=0.057). This trend was also seen in OS in this group (25.4 months versus 15.5 months, p=0.072). The median time from date of diagnosis to start of chemotherapy was 21 days, and there was correlation between time to chemotherapy and OS (p=0.037) and PFS (p=0.045). Twenty-six of the 32 patients underwent a combination of chemotherapy and radiotherapy. Seventeen patients (65%) received concurrent chemoradiotherapy, and 9 (35%) received sequential chemoradiotherapy, with no significant difference in survival or toxicity between these two regimens. Survival outcomes from this single institution are comparable with current literature. The use of PCI in appropriate patients can prevent cerebral metastases, improve PFS and ultimately OS. The time to initiation of chemotherapy may also have a significant impact on outcomes.