Early evaluation of a new regional pathway for tri-modality treatment in stage III-N2 NSCLC in Greater Manchester
Iyer, A. Cove-Smith, Laura Faivre-Finn, C. Woolf, David K Brown, L. Bailey, S. Grundy, S. Fullerton, D.
Iyer, A.
Cove-Smith, Laura
Faivre-Finn, C.
Woolf, David K
Brown, L.
Bailey, S.
Grundy, S.
Fullerton, D.
Citations
Altmetric:
Abstract
Introduction: The 2019 NICE guidelines on the management of
lung cancer recommended chemoradiotherapy (CRT) followed
by surgery (termed ‘tri-modality’) treatment in patients with
potentially resectable stage III-N2 NSCLC. NICE also recommends
surgery should be completed within 3-5 weeks of CRT. The Greater
Manchester (GM) Cancer Lung Pathway Board developed a new
protocol including patient selection guidance, utilising the regional
thoracic surgical centre for post-CRT imaging from brain to pelvis
with hot reporting and same day clinical consultation and rapid
access to surgical consultations. This study provides an early
evaluation of this new protocol.
Methods: A retrospective observational study of all patients
commenced on the tri-modality pathway across GM. Patient-related
data, adverse events, treatment compliance, pathway times and
treatment-related mortality (30- and 90-day) were collected.
Results: Six patients with stage III-N2 NSCLC have been referred for
tri-modality treatment since the launch of the protocol in November
2020 (see Table 1). 4/6 (66%) successfully completed tri-modality
treatment (CRT+Surgery). Two patients did not proceed with surgery
after CRT. Both were PDL1 >1% and commenced maintenance
durvalumab at 24- and 40-days post-CRT. The mean number of
days from finishing CRT to re-imaging was 5.5 days (range 3-8),
all CT scans were hot reported and all patients completed a same-day physician-led consultation. The mean number of days from re-imaging to surgical clinic was 3.3 days (range 1-9) and 29.8 days
(range 23-33) from CRT to surgery. There were no grade 4/5 adverse
events. The 30/90-day mortality was 0%. Pathological examination
confirmed complete resection (R0) and residual tumour in all cases.
Conclusion: Although based on small numbers, this initial analysis
suggests appropriate patient selection and adherence to the required
timelines through the different stages of the pathway, meeting the
NICE recommendations. Ongoing quality assurance and analysis of
long-term outcomes from the pathway is now required.
Description
Date
2022
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Iyer A, Blackhall F, Bayman N, Cove-Smith L, Faivre-Finn C, Woolf D, et al. Early evaluation of a new regional pathway for tri-modality treatment in stage III-N2 NSCLC in Greater Manchester. Vol. 165, Lung Cancer. Elsevier BV; 2022. p. S4.