P1.08-076 Recurrence Patterns in Lung Cancer Patients Treated with Protocol Based Multimodality Treatment at a Tertiary Care Cancer Center in India

Abstract

Wide disparity has been reported in lung cancer survival between high income countries (HIC) and low-middle income countries (LMIC). The aim of present study is to analyze treatment outcomes and relapse patterns following protocol based multimodality management including quality control surgery in lung cancer patients from a tertiary care cancer center in India (LMIC). A retrospective analysis of computerized prospective clinical database of lung cancer patients treated consecutively during January 2006 to June 2015, in the department of Surgical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India was performed. The AJCC/ TNM (2010) staging system was referred for staging purpose. All patients were offered protocol based trimodality therapy (Surgery + Systemic therapy + Radiotherapy). Clinical spectrums, Follow up patterns, compliance to treatment and relapse patterns were analyzed. A total of 136 patients underwent surgery during this period. Mean age at presentation was 53.16 years (SD 13.56) with male predominance (78%). Cough (58%) and Hemoptysis (42%) were most common presenting symptoms. Majority operated upfront (70%) and 126 (92.6%) underwent curative resection. Most common procedure was lobectomy (52%) however 42 patients (30%) underwent pneumonectomy due to advanced stage. Most common histology was squamous cell carcinoma (45%) followed by adenocarcinoma (36%). Most common stage was IIIA (30%) followed by IIB (27%). Median duration of surgery and hospital stay was 180 minutes and 7 days respectively. One patient developed post-operative pneumonia and succumbed to it while 15 others developed major postoperative morbidity which was managed conservatively. Total of 30% received adjuvant chemotherapy and 11% received adjuvant radiotherapy. After median follow up of 7.26 months 16 (11.75%) patients had documented recurrences. Out of 16 patients 3 had isolated loco-regional, 4 had loco-regional with systemic and 9 had systemic recurrence. Among systemic recurrences five had multiple visceral, bone and brain in three each followed by contralateral lung in two patients. Majority of lung cancer patients presents in advanced stage. With good protocol based approach including quality-controlled surgery excellent outcomes can be achieved which are comparable to western world even in resource constrained low middle income countries like India.