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Multi-modality radical intent treatment in synchronous oligometastatic non-small cell lung cancer: how many patients complete the full treatment regime recommended by the MDT?
Cheng, A. Craig, C. Summers, Yvonne J Taylor, Paul Califano, Raffaele Cove-Smith, Laura Woolf, David K Duerden, R. Sharman, A. Lyons, J.
Cheng, A.
Craig, C.
Summers, Yvonne J
Taylor, Paul
Califano, Raffaele
Cove-Smith, Laura
Woolf, David K
Duerden, R.
Sharman, A.
Lyons, J.
Citations
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Abstract
Introduction: Management of oligometastatic disease in non-small
cell lung cancer (NSCLC) identified at initial diagnosis (synchronous)
often provokes treatment dilemmas within multi-disciplinary
teams (MDTs). Suitable patients are sometimes considered for
multi-modality radical-intent treatment including systemic therapy
and local treatment to both the metastasis and the primary tumour.
We sought to assess how many patients complete all components
of this multi-modality treatment when recommended in our MDT
as a surrogate marker of appropriate patient selection and practice. Methods: A retrospective review of our electronic lung cancer MDT
database at Wythenshawe Hospital, South Manchester, between
April 2016 and April 2018. Synchronous oligometastatic NSCLC cases
were defined as a single metastasis in a single organ. We recorded
patient demographics, performance status, TNM staging, pathology,
and site of oligometastasis. MDT recommended treatment was
compared to treatment completed.
Results: 1754 individual MDT cases were identified. Synchronous
oligometastatic NSCLC was found in 26 (1.5%) patients (Table 1).
Thirteen patients (50%) with a single metastasis were recommended
to have multi-modality treatment. The remaining patients were
recommended for palliative systemic therapy (31%, 8/26) and best
supportive care (19%, 5/26). Of the 13 patients recommended for
multi-modality treatment, 12 were offered chemotherapy prior
to local therapies to the primary tumour and metastatic site. The
exception was the treatment of a brain metastasis first prior to
systemic therapy. 13 (69%) managed to complete their entire
treatment pathway. Failure to complete the treatment regime was
commonly due to rapid disease progression.
Conclusion: Synchronous oligometastatic NSCLC represents a small
fraction of our MDT discussions (1.5%). Our MDT recommends multimodality
radical-intent treatment in half of these cases and twothirds
of patients complete the full treatment course suggesting
appropriate patient selection. Our standard practice appears to be
systemic therapy first followed by local treatment to the metastatic
site and primary tumour.
Description
Date
2019
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Cheng A, Craig C, Summers Y, Taylor P, Califano R, Cove-Smith L, et al. Multi-modality radical intent treatment in synchronous oligometastatic non-small cell lung cancer: how many patients complete the full treatment regime recommended by the MDT? Lung Cancer. 2019;127:S35-S6.