Patterns of Care and Treatment Pathways for Non-Surgically Managed Early and Locally Advanced Non-Small Cell Lung Cancer Patients at Ain Shams University Clinical Oncology Department: A Retrospective and Descriptive Analysis

Background: Lung cancer is the leading cause of cancer death worldwide, but little is known about how patients with this disease are managed nationally. In our study we aim to study patterns of care and radiotherapy approaches of non-surgically managed early and locally advanced non-small cell lung cancer (NSCLC) patients in Ain Shams University Clinical Oncology Department (ASUCOD).
Patients and Methods: In this retrospective analysis we included patients who met the following criteria; age ≥18 years, non-metastatic, histologically confirmed NSCLC patients who did not undergo surgical resection with at least 6 months of follow up data. We collected data from Clinical Oncology department archive at Ain Shams University Hospital. Our primary objective was to identify the patterns of care and radiotherapy approaches for these patients in ASUCOD from January 2015 to December 2018.
Results: 86 patients met our inclusion criteria. Median age at diagnosis was 61 years. 95.3% were male and only 4.7% were female. Most of the patients were stage III; 40.7% were stage IIIA, 41.9% were stage IIIB, and 9.3% were stage IIIC, while only 8.1% were stage II. 41 patients were treated radically, 37 palliatively and 8 received supportive care. Overall median progression free survival (PFS) in our patients was 9.23 (7.4-13.6) months and median overall survival duration (OS) was 13.4 (9.6-18.0) months. In radically treated patients, 68.3% received sequential chemoradiotherapy (sCRT), 29.3% received concurrent chemoradiotherapy (cCRT), and 2.4% received definitive radiotherapy alone (RT). Median PFS and OS durations of radically treated patients were 16 months and 23.3 months, respectively. Median PFS and OS durations for palliatively treated patients were 6.1 months and 8.6 months, respectively. Paclitaxel / Carboplatin was the most common regimen used with definitive RT. Most of the patients received radiotherapy dose of 60Gy/30Fr (73.2%).
Conclusion: Most patients presenting at our centre are locally advanced and less than half of them were treated radically. Sequential chemoradiotherapy was the commonest treatment modality. There is a need to improve outcomes via early diagnosis, improving patients access to treatment particularly radiotherapy. Further studies in other local centres are needed to complete the picture nationally.