P2.01-92 “All-In-One” Window: A New Way of Looking at Chest CT Studies in Thoracic Oncology

Abstract

Background: I-O Optimise is a new pan-European data platform developed to enable real-world insights into the management of thoracic malignancies. As part of this initiative, the current analysis reports the characteristics and treatment patterns for adult patients diagnosed with stage IIIB or IV NSCLC at Leeds Teaching Hospitals Trust (LTHT), hosting one of the largest integrated cancer centres in the UK. Method: Retrospective cohort study using longitudinal data already collected from electronic medical records at LTHT, including all adult patients diagnosed with stage IIIB-IV NSCLC between January 2007 and August 2017. Minimum follow-up was 6 months. Distinct lines of therapy (LoT) were identified using a clinically-verified algorithm based on the name and date of systemic anti-cancer therapy (SACT) administered and the gap between two treatments. Result: Overall, 2119 patients were included. Mean age at diagnosis was 71.4 ± 11.2 years. Nearly one-third (32.7%) were clinically diagnosed without pathological confirmation (TABLE) and very few of these patients have SACT administration recorded. Following diagnosis, 648 patients (30.6%) received 1 LoT, 223 (10.5%) 2 LoT and 60 (2.8%) 3 LoT. Proportions of patients treated decreased with age (73.5% [25/34] aged 18-44 years; 52.7% [267/507] aged 45-64 years; 29.8% [310/1040] aged 65-79 years; 8.6% [46/538] aged 80+ years) and performance score (58.5% [387/ 662] PS0-1; 38.2% [158/414] PS2; 6.1% [52/848] PS3-4). Between the periods 2007-2011 and 2012-2017, increased proportions were treated (28.2% [263/933] and 32.5% [385/1186] respectively). Patient characteristics of the treated cohort and regimens administered for 1 st and 2 nd LoT are shown (TABLE). Conclusion: Around 70% of this real-world cohort did not receive any SACT, and the administration of treatment was strongly associated with age and performance status. The changing availability of treatment options over time (including the emergence of immunotherapy) and survival outcomes by LoT will be presented in more detail for the cohort described.Background: Historically, CT studies are always viewed in several window settings, optimized to evaluate specific anatomic structures and regions (mediastinal, lung, bone and vascular window). A newly developed image processing technique fuses these conventional windows into a single "all-in-one" window. This new window is specifically designed for comparison and follow-up of CT studies in oncology. The purpose of this study is to compare lesion detection on this "all-in-one" window versus conventional window settings. Method: In this retrospective study, 50 consecutive thoracic oncology chest CT examinations, containing 417 documented lesions and features, were reviewed by 6 radiologists, subdivided into 2 groups of 3 radiologists each, with similar levels of expertise in each group (experienced, junior and radiology resident). All scans were reviewed in conventional window settings (as in routine daily practice), by one group and in the "all-inone" window by the other...

Lesion measurement on a combined “all-in-one” window for chest CT: effect on intra- and interobserver variability

“…It is with this in mind that we decided to explore the possibilities of the AIO-window in this patient population. It has been previously shown that lesion detection on a single AIO-window is at least as good as on multiple conventional window settings [8]. However, lesion management measurement and characterization are equally important parameters in the diagnosis and follow-up of oncology patients.…”

“…To minimize bias on recognition of lesion morphology (in particular for lung parenchymal lesions), measurements were first performed on the AIO-window and subsequently on conventional window settings. Some readers were familiar with the AIO-window from the previous clinical study on lesion detection [8]. There was however a one-year time interval between both studies, making visual image recall less important.…”

“…In the imaging evaluation process of (thoracic) oncology studies, lesion detection, lesion measurement and lesion characterization are crucial elements. Previous research has shown that lesion detection on a single AIO-window is at least as good as on multiple conventional window settings [8]. CT measurements are essential in tumor imaging and determining response to therapy.…”