Lung Cancer

PD 18 - Lung 5 - Poster Discussion - SBRT

1157 - Comprehensive Baseline Clinical Assessments in Stage I Non-Small Cell Lung Cancer Patients May Facilitate Treatment Allocation Between Stereotactic Body Radiation Therapy and Surgery

Wednesday, October 24
1:54 PM - 2:00 PM
Location: Room 217 C/D

Comprehensive Baseline Clinical Assessments in Stage I Non-Small Cell Lung Cancer Patients May Facilitate Treatment Allocation Between Stereotactic Body Radiation Therapy and Surgery
P. Samson1, M. C. Roach Jr2, J. D. Bradley2, L. Carpenter3, B. Kozower3, B. Meyers3, V. Puri3, and C. G. Robinson1; 1Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO, 2Washington University School of Medicine, St. Louis, MO, 3Washington University School of Medicine, Division of Cardiothoracic Surgery, St. Louis, MO

Purpose/Objective(s): Current recommendations for treatment selection in clinical Stage I non-small cell lung cancer (NSCLC) relies heavily on physiologic factors. While these factors are important in determining operability, there may be other variables that may influence allocation. We suggest that baseline functional status and quality of life (QoL) metrics may also be of value in the multidisciplinary setting.

Materials/Methods: From 2016 – 2018, all Stage I NSCLC patients receiving consultation in either radiation oncology or thoracic surgery at our institution were approached for participation in a prospective database. For those consenting, baseline comorbidities, Eastern Cooperative Oncology Group (ECOG) score, Activities of Daily Living score (ADL), Independent ADL score (IADL), timed five-meter walk test, and the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire ( EORTC QLQ-C30) was recorded. ECOG scores were dichotomized as 0 (no activity restriction) versus ≥1 (minor or major restrictions). IADL scores were dichotomized into 8 (complete independence) versus ≤8 (dependence in at least one category). For the EORTC QLQ-C30 assessment, scores range from 0-100, with larger values indicating a higher baseline QoL.

Results: 140 Stage I NSCLC patients received complete baseline assessments (SBRT =85, surgery=55). Compared to surgery patients, SBRT patients were older (70.7 years versus 67.1, p=0.009), more likely to have a Charlson-Deyo cormorbidity score of ≥3 (51.8% versus 36.4%, p=0.02), had lower FEV1 percent predicted values (58.5% versus 85.6%, p<0.001) and DLCO percent predicted values (49.0% versus 75.6%, p<0.001). In addition to these standard metrics, SBRT patients were more likely to have an ECOG score ≥1 (76.5% versus 15.1%, p<0.001), be dependent in at least one ADL (13.1% versus 3.6%, p=0.05), and at least one IADL (25.3% versus 7.4%, p=0.008). The median time for completion of the 5-meter walk test was 5.6 seconds, and a higher proportion of SBRT patients’ walk tests were above the median compared to surgical patients (66.2% versus 26.0%, p<0.001). Finally, SBRT patients had lower baseline self-reported global health QoL scores (66.6 versus 79.5 for surgical patients, p<0.001). Variables independently associated with receiving SBRT versus surgical resection included decreasing FEV1% percent predicted (per percent decrease OR 0.95, 95%CI 0.92 – 0.98) and ECOG score ≥1 (OR 9.3, 95% CI 2.7 – 32.5). With the inclusion of functional status metrics, age and comorbidity status were not independently associated with receipt of SBRT.

Conclusion: Capturing Stage I NSCLC patients’ baseline functional status metrics prospectively further quantifies current patterns of treatment allocation. Continuing to assess these factors may facilitate multidisciplinary discussions and shared decision making. Post-treatment follow-up will be needed to evaluate if these baseline assessments are associated with short- and long-term outcomes.

Author Disclosure: P. Samson: Employee; Washington Univeristy. Data management committee chair; member of PLG; ImproveCareNow. M.C. Roach: Travel Expenses; BTG, Varian, Elekta. J.D. Bradley: None. B. Kozower: None. B. Meyers: None. V. Puri: None. C.G. Robinson: Research Grant; Varian Medical Systems, Elekta. Speaker's Bureau; Varian Medical Systems, DFINE. Advisory Board; Radialogica. Stock Options; Radialogica.

Pamela Samson, MD

Disclosure:
Employment
Barnes Jewish hospital: Resident physician: Employee; Washington Univeristy: Assistant professor: Employee

Leadership
ImproveCareNow: Data management committee chair; member of PLG

Presentation(s):

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