Timing of treatment in small-cell lung cancer

Bhandari, Shruti; Pham, Danh; Pinkston, Christina; Oechsli, Malgorzata; Kloecker, Goetz

doi:10.1007/s12032-019-1271-3

Cited by 9 publications

(7 citation statements)

References 6 publications

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“…Anggondowati et al [ 17 ] distinguished according to disease progression, reporting median waiting times of 18 days for patients with metastases, 28 days for patients in the early stages and 27 days for patients in locally advanced stages. In patients with stages I–IV SCLC, the median of the medians of diagnosis to treatment was 7.5 days, while Bhandari et al [ 18 ] found a mean of 18 days in these patients.…”

Section: Resultsmentioning

confidence: 99%

“…For the diagnosis-to-treatment time, nine studies reported improved survival when the waiting time was shorter, three studies found no association between waiting time and survival or mortality, and nine studies reported improved survival when the waiting time was longer; in these studies the results obtained were justified by indicating that patients in more advanced stages, or who are older or with worse health are referred and treated more quickly than those in earlier stages, whose diagnosis may require more tests that delay the time to treatment, and in whom, despite being treated more quickly, due to the disease severity, the poor prognosis is not altered. In addition, the studies clarified that, despite these results, the timely treatment of patients with early-stage SCLC should be emphasized to prevent a worsening in staging, which has a large impact on survival [ 18 , 22 ].…”

Section: Resultsmentioning

confidence: 99%

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Clinical impact of delays in the management of lung cancer patients in the last decade: systematic review

et al. 2022

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Introduction Due to the importance of lung cancer early treatment because of its severity and extent worldwide a systematic literature review was conducted about the impact of delays in waiting times on the disease prognosis. Materials and Methods We conducted a systematic search of observational studies (2010-2020) including adult patients diagnosed with lung cancer and reporting healthcare timelines and their clinical consequences. Results We included 38 articles containing data on waiting times and prognosis; only 31 articles linked this forecast to a specific waiting time. We identified 41 healthcare time intervals and found medians of 6-121 days from diagnosis to treatment and 4-19.5 days from primary care to specialist visit: 37.5% of the intervals indicated better prognosis with longer waiting times. Conclusions All articles emphasized that waiting times must be reduced to achieve good management and prognosis of lung cancer. Further prospective studies are needed on the relationship between waiting times and prognosis of lung cancer.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical impact of delays in the management of lung cancer patients in the last decade: systematic review

et al. 2022

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“…Small cell carcinoma is an aggressive tumour with rapid volume doubling time, therefore eligible patients identified to have small cell lung carcinoma with ROSE can be referred onwards to a medical oncologist on the same day as their EBUS procedure. This avoids delays in deciding arrangements for treatment delivery whilst waiting for a final cytological report and sector MDT discussion 7,13,14 …”

Section: Discussionmentioning

confidence: 99%

Impact of rapid on‐site evaluation in expediting the fast investigative lung cancer pathway

Fowell,

Khan

2023

Cytopathology

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ObjectiveEBUS‐TBNA is a method of acquiring tissue samples from intrathoracic lymph nodes and central intrathoracic tumours in patients suspected of having lung cancer. Rapid on‐site evaluation (ROSE) denotes assessing tissue samples during EBUS (or bronchoscopy), providing instant feedback on sample adequacy and provisional cytomorphological diagnosis. Sector multidisciplinary team (MDT) discussion can then make informed treatment decisions, with confirmatory immunohistochemistry being finalised before provision of final treatment. Currently, impact of ROSE on length of time patients spend on the lung cancer diagnostic pathway remains unclear.MethodsWe retrospectively evaluated the impact of ROSE on the length of time between patients' EBUS/bronchoscopy procedures and discussion at sector MDT, referred to as time to treatment decision (TTD), at our institution. Additionally, we assessed impact of ROSE on number of passes (number of times nodes/masses were sampled) per procedure.ResultsThe mean TTD was 77.9% shorter (p = 0.001) with ROSE present than when absent. Patients who received ROSE spend 34.3% less time (p = 0.028) on lung cancer diagnostic pathway overall. There was a significant reduction in number of passes in non‐malignant nodes with ROSE present (2.23) than when absent (3.14) (p < 0.001). With ROSE present there was a significantly greater number of passes at malignant sites (5.07) than non‐malignant sites (2.23) (p < 0.001).ConclusionsThese findings support conclusions made in our institution's previous study, that utilisation of ROSE reduces TTD. ROSE also allows safe advancement through nodes with low suspicion of malignant involvement, focusing time on sampling nodes/masses of greater suspicion.

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“…Importantly, our analysis suggests that the timing of concurrent chemotherapy in relation to the start of RT may influence the impact of fractionation schedule on survival in early-stage SCLC. Early administration of concurrent chemoradiation in this setting has been associated with improved locoregional control and survival in a number of studies, although some recent limited data has called this benefit into question (14,(39)(40)(41)(42)(43). Interestingly, our analysis demonstrated worsened OS with HFRT compared to standard RT among those who underwent early concurrent chemoradiation, but improved OS with HFRT compared to standard RT among those who underwent non-early concurrent chemoradiation, although neither of these findings quite reached statistical significance in our matched sensitivity analyses.…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated vs. standard radiotherapy for locally advanced limited-stage small cell lung cancer

Saeed¹,

Jin²,

Sasse³

et al. 2022

J Thorac Dis

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Background: Hypofractionated radiotherapy in locally advanced limited-stage small cell lung cancer is preferred in many Western countries but not used regularly in the United States. We examined practice patterns and overall survival with definitive hypofractionated radiotherapy and chemotherapy vs. standard radiotherapy in this setting. Methods: We included patients in the National Cancer Database with unresected primary stage II-III small cell lung cancer in 2008-2016 who underwent chemotherapy within six months of either hypofractionated radiotherapy (40-45 Gy/15 fractions) or standard radiotherapy (45 Gy/30 fractions or 60-70 Gy /30-35 fractions) in this retrospective cohort study. Patient characteristics were assessed with univariable and multivariable logistic regression. Kaplan-Meier estimator, log-rank test, and multivariable Cox regression were used to evaluate overall survival. Propensity score matching (PSM) was performed as a sensitivity analysis. Early concurrent chemotherapy consisted of radiotherapy and chemotherapy initiated within 30 days of each other.Results: Seven thousand and one hundred forty-three patients were included: 97.9% received standard radiotherapy and 2.1% hypofractionated radiotherapy. Multivariable analysis on the whole cohort yielded comparable overall survival (HR for hypofractionated radiotherapy 1.09, CI: 0.90-1.32, P=0.37). On PSM (N=292), median overall survival was similar between standard radiotherapy [22.9 months (95% CI: 18.2-30.4)] vs. hypofractionated radiotherapy [21.2 months (CI: 16.3-24.7); P=0.13]. Overall survival was shorter with hypofractionated radiotherapy in the early concurrent chemotherapy subset (15.8 vs. 22.1 months, P=0.007) and longer with hypofractionated radiotherapy in the non-early concurrent chemotherapy subset (29.5 vs. 18.5 months, P=0.027).Conclusions: Overall survival with hypofractionated radiotherapy appears similar to standard radiotherapy in locally advanced limited-stage small cell lung cancer. Chemotherapy timing may modify the effect of fractionation on overall survival, though larger numbers must confirm. Hypofractionated radiotherapy may be considered in those unable to receive early concurrent chemotherapy.

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Timing of treatment in small-cell lung cancer

Cited by 9 publications

References 6 publications

Clinical impact of delays in the management of lung cancer patients in the last decade: systematic review

Clinical impact of delays in the management of lung cancer patients in the last decade: systematic review

Impact of rapid on‐site evaluation in expediting the fast investigative lung cancer pathway

Hypofractionated vs. standard radiotherapy for locally advanced limited-stage small cell lung cancer

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