P2.03a-071 Adjuvant Chemotherapy Following Resection of NSCLC: An Audit of 5 Years of Practice and Outcomes in South West Wales: Topic: Clinical Trials

Abstract

A number of meta-analyses have shown post-operative chemotherapy is beneficial following curative surgery for NSCLC, with the LACE meta-analysis demonstrating a 5 year survival improvement of 5.4%. NICE guidance states that cisplatin based combination chemotherapy should be offered to all patients of good PS with T1-3, N1-2, M0 disease, and should be considered in T2-3 N0 disease if > 4cm. The primary outcome of this audit was to review 5 years of practice; to assess adherence to guidelines in offering post-operative chemotherapy, and overall survival. Data was collected retrospectively from electronic records of patients who underwent surgery for lung cancer across Abertawe Bro Morganwg University Health Board and Hywel Dda Health Board between 2009 and 2014 Data collected included; demographics, date of diagnostic CT scan, date and type of surgery, histology, pathological stage, PET SUV max of primary tumor, date adjuvant chemotherapy started, regimen received, date of recurrence and overall survival. SPSS and Excel software was used to collate results and statistical analysis. Of the 281 patients, 241 had a histological diagnosis of NSCLC. Median age was 69 years. By stage; 31.9% IA, 40.3% IB, 9.2% IIA, 10.1% IIB, 7.5% IIIA, 0.4% IIIB, 0.4% IV. 88.8% underwent lobectomy, 4.9% excision of segment and 2.9% pneumonectomy. 62.5% of patients with stage IIA, IIB or IIIA disease had adjuvant chemotherapy (n=40/64), 70% of these received a cisplatin based combination (cisplatin/vinorelbine), 84% completed 4 cycles of treatment. 9.45% stage IA patients underwent chemotherapy which is not in accordance with guidance. The mean time from diagnostic CT to surgery was 109 days, and from surgery to post-operative chemotherapy 62 days. The one year overall survival (OS) was 89.6%, 80.1% and 82.6%, and the three year OS was 70.7%, 59% and 32.4%, for stage I, II and III respectively. 213 (88.4%) patients underwent PET scan with mean maximum SUV of 12.1 (range 1.0-76.3). There was no statistically significant relationship between SUV max and OS. Our data shows good compliance with national guidance in offering postoperative chemotherapy, and survival rates better than published UK survival data.