P1.16-39 Oncology Emergencies in Patients with Lung Cancer: Experience of One Hospital

Abstract

Oncological emergencies (OE) are common conditions associated with significant morbidity and mortality. Individuals with malignancy may present with a cancer-related emergency; for many, this will be their initial manifestation of cancer (about 23%). Patients with lung cancer are the type of cancer patient who are most often admitted to emergency departments due to OE. The aim of this study was to characterize the OE like superior vena cava syndrome and metastatic spinal cord compression (MSCC) in patients with lung cancer, at our hospital. a retrospective review was undertaken to assess the number and the outcomes of patients admitted from 2015 to 2018 with lung cancer who had superior vena cava syndrome and MSCC. in this 4-year period there were 455 new patients with the diagnosis of lung cancer, and 31 had an OE: n= 15 (48%) had superior vena cava syndrome and n = 16 (52%) had MSCC. The median age was 66 years old and 90% were man. The histological diagnostics was adenocarcinoma in 48% (n=14), small cell lung cancer in 34% (n=10) and squamous cell carcinoma in 18% (n=4). In 61% (n=19) of the patients the OE was the first manifestation of cancer, and lead to the diagnosis. In the others, the median time between the diagnosis and the emergency was 6 months (0-56 month). Of this, 36% (n=4) were in the first-line chemotherapy, 36% (n=4) in the second-line chemotherapy and 18% (n=2) in the third-line chemotherapy. MSCC was the most frequent OE with 46% (n=16) of the patients, followed by superior vena cava syndrome (43%; n=15). 63% of the patients with MSCC, when the diagnosis was performed had lost the ability to walk; 50% had paraparesis, 25% paraplegia and only one presented with sphincter incontinence. 69% (n=11) of the patients with MSCC were treated with radiotherapy; 44% (n=7) underwent surgery and/or radiotherapy; 13% (n=2) were treated with steroids in combination with radiotherapy. 14 patients who were presented with superior vena cava syndrome (93%) were treated with radiotherapy. After the OE only 13 patients (37%; n=8 (62%) in superior vena cava syndrome and n=5 (38%) in MSCC) initiated or restarted systemic treatment for lung cancer. In this group disease progression was observed in a median time of 2 month after OE (0-31 months). Only 2 patients with MSCC who had lost the ability to walk regain it. 71% (n=21) of patients were dead 3 months after the OE. Only 4 patients (25%) with MSCC and 6 (40%) with superior vena cava syndrome were alive after 3 months of OE. OE causes severe morbidity and compromised survival and can be the initial manifestation of lung cancer. We need to be aware of this situation because the OE have the potential to progress rapidly; therefore, prompt, accurate diagnosis and institution of appropriate treatment are essential to achieve favorable outcomes.