poster presenting department designation abstract title...

Poster No.

Department Presenting

Author Designation Abstract Title Authors

SR-96 PMSD Sryma PB Senior Resident

Topical Nasal Xylometazoline for Flexible Bronchoscopy (VAIN): A Randomized, Double Blind, Placebo-controlled Trial

PB Sryma,Madan Karan, Mittal Saurabh, Mohan Anant,Guleria Randeep,Hadda Vijay, Tiwari Pawan

SR-97 PMSD Tejas Suri Senior Resident

A comparison of a wrist worn portable device (WatchPAT) with in-lab polysomnography for the diagnosis of obstructive sleep apnea

Suri Tejas M, Mittal Saurabh, Hadda Vijay, Madan Karan, Tiwari Pawan, Mohan Anant, Guleria Randeep

SR-105

Pulmonary Medicine

Hariharan Iyer

Senior Resident

Comparison of Sample Adequacy of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration Using 0ml, 10ml and 20ml suction pressures in malignant and benign diseases

Iyer Hariharan, Anant Mohan , Deepali Jain , Karan Madan, Vijay Hadda, PawanTiwari, Saurabh Mittal, Randeep Guleria, Garg Avneet , Bansal Shweta, Pandey R.M.

SR-106

Pulmonary Medicine

Sandip Agarwal

Senior Resident

Transdiaphragmatic pressure can be calculated using ultrasound during magnetic phrenic nerve stimulation in COPD patient

Guleria R, Agarwal S, Madan K, Hadda V, Mohan A, Khilnani GC, Pandey RM

SR-107 A , B & C

Pulmonary Medicine

Avneet Kumar Garg

Senior Resident

Abstract A: Clinico-pathological Profile of Lung Cancer Patients in India-A Tertiary Care Centre Experience Abstract B: Delays During Diagnosis and Management of Lung Cancer in India- A Prospective Observational Study Abstract C: Survival and treatment response of Lung cancer patients in India: a tertiary centre experience

A,Sahu S, Gupta A, Choudhary C, Vashistha V, IyerH, Ali A, BhallaA, JainD, KumarR, PandeyR, MadanK, Hadda V, Khilnani G.C., GuleriaR, Mohan A, ,A, Mohan A, Gupta A, Sahu S, Choudhari C, AroraS, Jain D, KumarR, Bhalla A, Pandey R, Tiwari P, MittalS, Madan K, Khilnani G.C., Hadda V, Guleria

SR-96

Title: Topical Nasal Xylometazoline for Flexible Bronchoscopy (VAIN): A Randomized,

Double Blind, Placebo-controlled Trial

PB Sryma1,Madan Karan

2, Mittal Saurabh

2, Mohan Anant

3,Guleria Randeep

3,Hadda Vijay

2,

Tiwari Pawan2

Affiliation:1Senior Resident,

2Assistant Professor,

3Professor, Department of Pulmonary

Medicine and Sleep Disorders

Presenting Author:

Name: Sryma P B

Email: [email protected]

Corresponding Author:

Name: Karan Madan


Abstract body:

Introduction: Topical nasal vasoconstrictor (such as xylometazoline) administration during

flexible bronchoscopy is thought to ease the passage of bronchoscope leading to better patient

comfort and procedural satisfaction thoughno randomized controlled trial has assessed its

clinical utility. In this randomized, double blind, placebo-controlled study, we studied the

utility of nasally administered xylometazoline in the subjects undergoing flexible

bronchoscopy.

Aims and objectives: Primary objective was to compare the operator rated ease of

bronchoscope negotiation on visual analogue scale (VAS). Secondary objectives included

assistant rated faces pain scale on nasal bronchoscope insertion, patient rated nasal pain score

(VAS), time to reach vocal cords after bronchoscope insertion (seconds), operator rated nasal

mucosal trauma (on VAS), hemodynamic changes and complications between the two groups

Materials and methods: Consecutive subjects undergoing flexible bronchoscopy were

randomized (using variable size block randomization) to receive 3 drops (into each nostril) of

either the drug Xylometazoline (0.1%) or placebo (iesaline 0.74% w/v isotonic solution) ten

minutes prior to bronchoscopy. All patients received topical anesthesia regimen including

nasal lignocaine gel (5 ml, 2%), pharyngeal lignocaine spray (4 sprays, 10%) and 1%

lignocaine solution for “spray as you go” administration. Continuous hemodynamic

monitoring was done and noted before procedure, ten minutes after drug instillation and post

procedure. The bronchoscopist, assistant and the patient were blinded to the group

assignment.

Results: 148 subjects were randomized, 73 to placebo and 75 to xylometazoline arms.

Baseline characteristics were comparable. Operator rated ease of nasal bronchoscope

negotiation by VAS was similar in both the groups [median (IQR) 1(1-2) in both

xylometazoline and placebo groups,p 0.79]. Assistant rated pain on faces pain scale(p= 0.36),

patient rated nasal pain on procedure completion [VAS median (IQR): placebo 2 (1-2) and

mailto:[email protected]


xylometazoline 2(1-3), p= 0.28], and Operator rated nasal mucosal trauma [VAS median

(IQR) placebo 1(0-2) and xylometazoline 1(0-1), p= 0.28] were similar between the two

groups. There were no significant differences in the blood pressure, heart rate or other

complications between the two groups.

Conclusion: The addition of nasal vasoconstrictor xylometazoline did not improve the ease

of bronchoscope negotiation, nasal pain or nasal mucosal trauma in trans-nasal flexible

bronchoscopy.

Trial registry: www.clinicaltrials.gov: NCT03424889

SR-97

Title: A comparison of a wrist worn portable device (WatchPAT) with in-lab polysomnography for

the diagnosis of obstructive sleep apnea

Suri Tejas M1, Mittal Saurabh2, Hadda Vijay2, Madan Karan2, Tiwari Pawan2, Mohan Anant3, Guleria

Randeep3

Affiliation:1 Senior Resident, 2 Assistant Professor, 3 Professor, Department of Pulmonary Medicine

and Sleep Disorders, All India Institute of Medical Sciences, New Delhi

Presenting author:

Name: Dr. Tejas M Suri


Corresponding author:

Name: Dr. Saurabh Mittal


Introduction: Overnight in-lab technician attended polysomnography (PSG) is the gold standard

method for the diagnosis of obstructive sleep apnea (OSA). However, long waiting period results in

the delay in diagnosis and therapy leading to significant morbidity. Newer portable devicesare

available for the diagnosis of sleep apnea, such as WatchPAT which is based upon peripheral arterial

tonometry rather than conventional flow sensor-based technology. This device has not been well

studied in Indian subjects.

Aim: To assess the correlation of apnea hypopnea index (AHI) measured using WatchPAT and in-lab

polysomnography and to estimate the sensitivity and specificity of WatchPAT for the diagnosis of

moderate to severe obstructive sleep apnea.

Materials &Methods: We prospectively evaluated the diagnostic performance of wrist worn

portable sleep study device, the WatchPAT 200, which is a combination of oximetry, actigraphy and

peripheral arterial tonometry. Patients with suspected obstructive sleep apnea underwent

simultaneous in-lab diagnostic polysomnography and WatchPAT testing. The results from both

modalities were compared. The PSG scorer was blinded to the result of the WatchPAT study.

Results:19 patients (16 males and 3 females) were studied and had a mean (SD) age of 50.05

(±12.22) years. The mean (SD) body mass index of study subjects was 31.68 (±5.17) kg/m2. 16 out of

19 patients were found to have moderate to severe OSA by polysomnography (AHI ≥ 15). The mean

WatchPATsleep efficiency was 80.32%, whereas the mean PSG sleep efficiency was 79.83% (r=

0.366). There was a strong correlation (r=0.906) between the mean WatchPATAHI (43.08

events/hour) and the mean PSG AHI (32.7 events/hr). The sensitivity and specificity ofWatchPAT for

the diagnosis of moderate to severe OSA (AHI > 15) were both100%. The sensitivity and specificity of

WatchPAT for the diagnosis of severe OSA (AHI > 30) were 100% and 63.63% respectively.

Conclusions:WatchPAT is a very useful portable diagnostic device for the diagnosis of obstructive

sleep apnea especially for moderate to severe disease.

SR-105

TITLE:

Comparison of Sample Adequacy of Endobronchial Ultrasound Guided Transbronchial Needle

Aspiration Using 0ml, 10ml and 20ml suction pressures in malignant and benign diseases

Authors: Dr. Iyer Hariharan1, Dr. Anant Mohan

2, Dr. Deepali Jain

3, Dr. Karan Madan

4, Dr. Vijay

Hadda4, Dr. PawanTiwari

4, Dr. Saurabh Mittal

4, Dr. RandeepGuleria

5, Dr. Garg Avneet

1, Dr Bansal

Shweta1, Dr. Pandey R.M.

6

Affiliations:

1: Senior Resident: Dept of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical

Sciences, New Delhi, India

2. Professor and Head: Dept of Pulmonary Medicine and Sleep Disorders, All India Institute of

Medical Sciences, New Delhi, India

3: Associate Professor: Dept. of Pathology, All India Institute of Medical Sciences, New Delhi, India

4. Assistant Professor: Dept of Pulmonary Medicine and Sleep Disorders, All India Institute of

Medical Sciences, New Delhi, India

5. Director: AIIMS

6: Professor and Head: Dept. of Biostatistics, All India Institute of Medical Sciences, New Delhi,

India

Presenting Author:

Name: Dr Hariharan Iyer

E Mail: [email protected]


Name: Dr Hariharan Iyer

E Mail: [email protected]



ABSTRACT BODY

INTRODUCTION:

The optimum level of suction required for best sample adequacy and diagnostic yield during

Endobronchial Ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA) is unknown. A

significant proportion of EBUS-TBNA in India is performed for presumed benign etiology. Hence,

this study aimed to compare the sample adequacy obtained by EBUS- TBNA aspirates using three

different suction pressures in lesions of malignant as well as benign etiology.

AIIMS and OBJECTIVES:

Primary:

To compare sample adequacy of EBUS TBNA aspirates obtained with 0 ml, 10 ml and 20 ml

suction pressures

Secondary:

To compare the diagnostic yield of the EBUS TBNA aspirates obtained with 0ml, 10 ml and

20 ml suction pressures

To assess the effect of various lymph node characteristics on the adequacy and diagnostic

yield of the EBUS TBNA aspirates with each of the suction pressure used

MATERIALS and METHODS:

This was a prospective Randomized non- inferiority study. Adult patients with undiagnosed

mediastinal lymphadenopathy referred for EBUS and having EBUS assessed lymph node size more

than 0.5cm (short axis) were recruited. A sample size of 300 was considered adequate for three group

parallel non- inferiority trial keeping 20 ml suction pressure as control and 10ml and 0 ml as the test

groups to compare adequacy rate amongst the three suction pressures, with non-inferiority margin of

15%.

One node per patient was sampled with either of the three suction pressures (using computer

generated randomization) and specimens were assessed by a dedicated pathologist masked to the

suction pressure applied. Primary end point was the difference in the sample adequacy achieved using

the three suction pressures.

RESULTS:

300 patients and 300 lymph nodes were studied. The overall baseline characteristics such as age,

lymph node size, lymph node echogenicity, presence of intra nodal vessels and nodal necrosis were

similar in the three groups. Of all patients, 101 patients were sampled with a suspicion of malignant

etiology and 199 patients with benign etiology.

The overall adequacy of EBUS- TBNA samples obtained with suction pressure 0 ml, 10 mland 20 ml

were 91.09%, 86.14% and 77.08% respectively.The sample adequacy in the 0 ml (No suction) group

was 14.01 % more than 20 ml suction group [one sided 95% CI:5.5 to 22.4%]. The sample adequacy

of 10 ml suction group was 9.06% more than 20 ml suction group [one sided 95% C.I. 0.01 to 18.1%].

The adequacy of EBUS- TBNA samples obtained with suction pressure 0 ml, 10 mland 20 ml was

91.2%, 75.8% and 75.8% respectively in the malignant group, and 91 %, 91.2 % and 77.8 %

respectively in the benign group.

CONCLUSIONS:

Application of 0 ml (no suction) and 10 ml suction pressure during EBUS-TBNA is non-inferior to

applying 20 ml suction pressure in terms of adequacy of samples obtained.

SR-106

Transdiaphragmatic pressure can be calculated using ultrasound during

magnetic phrenic nerve stimulation in COPD patient.

Author Block: Guleria R1,Agarwal S2,Madan K3,Hadda V3,Mohan A4,Khilnani

GC5,Pandey RM6

1Director of All India Institute of Medical Sciences, New Delhi, India ,4

Pulmonary medicine and sleep disorders, Professor

and HOD ,All India Institute of Medical Sciences, New Delhi, India , 5

Pulmonary medicine and sleep disorders, Ex-Professor

and HOD , All India Institute of Medical Sciences, New Delhi, India , 3 Pulmonary medicine and sleep disorders, assistant

Professor, All India Institute of Medical Sciences, New Delhi, India, 6 Biostatistics, All India Institute of Medical Sciences,

new Delhi, India.

Presenting Author:

Name:Sandip Agarwal

Email:[email protected]


Name: Prof. RandeepGuleria


Rationale:

Diaphragm is the main inspiratory muscle and its function is compromised in

COPD.Magnetic phrenic nerve stimulation is the gold standard to assess diaphragm function

by measuring transdiaphragmatic pressure (Pdi)using esophageal and gastric balloon.

Ultrasound has been used to accurately assess diaphragm function. We evaluated whether

Pdicould be calculated using ultrasound assessment of diaphragm movement during

magnetic phrenic nerve stimulation along with spirometry in COPD patients.

Methods:

We enrolled 60 stable moderate to severe COPD patients attending pulmonary medicine

out-patient department of AIIMS,New Delhi. Patients underwent detailed pulmonary

function tests. Transdiaphragmatic pressure(Pdi) was measured by magnetic stimulation of

phrenic nerve(Magstim dual 200) using esophageal and gastric catheter (FLUXMED GRT,

M.B.Med ). Ultrasound of diaphragm was done to assess diaphragm thickness (TD). Real

time diaphragm excursion was measured with the ultrasound while stimulating phrenic

nerve by 90 mm magnetic circular coil in cervical area. Prediction equation was formulated

to predict Pdi using spirometry and ultrasound data. Equation developed using data from

the first 40 patients was validated in the next 20 patients.

Results:

Of the60 patients,58 were male and 2 were female; all 60 patients were smoker;28 had

moderate and 32 patients had severe COPD. Mean FEV1 ,FVC ,TLC ,RV/TLC were 1.44

L(56.8% predicted), 2.57L(81.3%), 6.43L(121%) and 63.42% respectively. On diaphragmatic

ultrasound mean TD at FRC(mm), TD at RV(mm), TD at TLC(mm), tidal excursion (cm) and

forced excursion (cm) was 1.60, 1.56, 2.32, 2.17, 3.22respectively.Mean twitch Pdi was 22

cm H20 (max 35 and min 15 cm H2O),mean sniff Pdi was 64.9 cm H2O (max 75 and min 35

cm H20).Sniff Pdi correlated with real time excursion(REX),TDRV, tidal excursion and twitch

Pdi correlated with real time excursion and FVC. Sniff Pdi was = 31+15.11(REX) with r2 value

of 0.62 and twitch Pdi was = 11.84+4.54( REX) with r2 value of 0.48.Using multivariate

regression analysis sniff Pdi was calculated as,10.3+13.11(TD RV) +6.19(Tidal

excursion)+10.20(REX) with r2 value of 0.76 and twitch pdiwas calculated as, 3.56

+3.98(FVC)+3.73(REX) with r2 value of 0.66.

Conclusion:

Twitch Pdi during magnetic stimulation and sniff Pdi can be calculated using ultrasound and

spirometry parameters.This is a non-invasive method and has significant utility in clinical

practice and in the ICU.

SR-107A

Clinico-pathological Profile of Lung Cancer Patients in India-A Tertiary Care

Centre Experience

Author Block: Garg1 A,Sahu1 S, Gupta1 A, Choudhary1 C, Vashistha2 V, Iyer1H, Ali1 A, Bhalla3A, Jain4D, Kumar5R,

Pandey6R, Madan1K, Hadda1 V, Khilnani1 G.C., Guleria1R, Mohan1 A 1Pulmonary medicine and sleep disorders, All India Institute of Medical Sciences, New Delhi, India, 2Hematology and

Oncology, Duke University Health System, Durham, NC, U.S.A., NC, United States, 3Radio-diagnosis, All India Institute of

Medical Sciences, New Delhi, India, 4Pathology, All India Institute of Medical Sciences, New Delhi, India, 5Nuclear

Medicine, All India Institute of Medical Sciences, New Delhi, India, 6Biostatistics, All India Institute of Medical Sciences, new Delhi, India.

Presenting Author:

Name: Avneet Garg



Name:Avneet Garg


Abstract Body:

Aiims and Objectives:

Lung cancer remains the leading cause of cancer-related death in the world. Over the past few decades,

significant changes have occurred in the demographic profile of lung cancer, possibly due to changing

smoking habits, environmental conditions or other unknown reasons. However, Indian data regarding the

changing trends in clinico-pathological profile in lung cancer has shown an inconsistent trend. We

therefore attempted to characterize the clinical characteristics of lung cancer at our centre over a period

of last 11 years.

Material and methods:

We performed an ambispective study of 1862 pathologically proven lung cancer patients over 11 years

from January 2008 to March 2018 at department of Pulmonary Medicine and Sleep disorders, AIIMS New

Delhi, including 1384 patients (74.3%) retrospectively and 478 patients (26.7%) prospectively, to study

the clinical spectrum of the lung cancer in India.

Results:

Mean age of subjects was 58 (+11.01) years, of whom 82.9% were males.. Most were smokers (76.2%)

withmedian smoking indexof500 (range, 2-3500). The smoking rates in male and female remained

unchanged over last 11 years. Performance status was ECOG 0 or 1 in 50.8%. Adenocarcinoma was most

common type (34%), followed by squamous cell carcinoma (28.6%). Adenocarcinoma showed an

increasing trend, from 9.5% in 2008 to 35.9% in 2018, SCC increased from 25.4% to 30.6%, whereas

NSCLC (NOS) decreasedfrom 33% to 14.6%. Majority of NSCLC (95%) continued to bediagnosed at

advanced stage (3 or 4); 75.2% of SCLC had extensive disease. Cough was the most common symptom

(81.3%), followed by loss of appetite and dyspnoea (65.9% and 64.9%) respectively.RUL was the most

common lobe to be involved (26.9%) followed by LUL (24.4%). Lung (including pleura) was the most

common metastatic site (47.1%) followed by bone (36.3%) and adrenal (17.8%). EGFR mutations in tissue

were present in 23.7% of adenocarcinoma, with exon 19 deletion mutationbeing most common(71.7%),

followed by exon 21 (19.7%);ALK mutations were positive in 11.5%. EGFR positive patients were

significantly younger, females and light smokers than EGFR negative. Among 1635 patients in whom

treatment details were known, 66.2% received definitive treatment for lung cancer. Chemotherapy was

the most common treatment modality (79.2%) and Carboplatin-paclitaxel was the most common regimen

administered (53.4% ). TKIs (EGFR and ALK inhibitors)were prescribed in 8.8% of all subjects as first line

therapy. The median overall survival (1803 patients) was 8.8 (IQR 3.7-19), median progression free

survival (527 patients) was 5.6 (IQR 3.1-9.4) months and median time to progression (204 patients) was

6.3 months (IQR 4.0-10.5).

Conclusion:

Our centreseems to be following the global trend with increasing incidence of adenocarcinoma. The most

likely reason for which in our study seems to be an advancement in immune-histo/cyto-chemical

techniques resulting in improved histological classification rather than changing smoking trends like in

western studies as smoking rates among male and female remain largely unchanged over last 11 years in

our study. EGFR mutation positivity and survival appears at par with most existing reports, while higher

ALK positivity was detected.Our study is the largest study till date to evaluate clinical spectrum of lung

cancer patients in India.

Table 1. Year wise distribution of various pathologic types of lung cancer

Year Squamo

us cell

carcino

ma

Adeno-

carcinoma

NSCLC

(NOS)

Poorly

differenti

ated

carcinoma

SCC Other

s

2008

(n=63)

16 (25.4) 6 (9.5) 21 (33.3) 10 (15.9) 10(15.9) 0 (0)

2009

(n=48)

11 (22.9) 5 (10.4) 18 (37.5) 7 (14.6)

7 (14.6)

0 (0)

2010

(n=67)

13 (19.4) 10 (14.9) 25 (37.3) 4 (6.0) 15 (22.4) 0 (0)

2011

(n=70)

21 (30) 15 (21.4) 22 (31.4) 2 (2.9) 10 (14.3) 0 (0)

2012

(n=103)

26 (25.2) 37 (35.9)

16 (15.6) 9 (8.7)

14 (13.6) 1 (1.0)

2013

(n=154)

41 (26.6) 57 (37.0)

18 (11.7) 3 (1.9)

33 (21.4) 2 (1.4)

2014

(n=233)

75 (32.2) 79 (34.0) 25 (10.7) 8 (3.4) 40 (17.2) 6

(2.5)

2015

(n=286)

83 (29.0)

89 (31.1)

26 (9.1)

16 (5.6) 59 (20.6) 13

(4.6)

2016

(n=359)

101

(28.1)

162 (45.1) 23 (6.4)

9 (2.6)

51 (14.2) 13

(3.6)

2017

(n=376)

115

(30.6)

137 (36.4) 39 (10.4) 15 (4.0) 54 (14.4) 16(4.

2)

2018

(n=103)

30 (29.1) 37 (35.9) 15 (14.6) 7 (6.8) 7 (6.8) 7 (6.8)

Figure 1.Comparison of Epidemiology and histopathology between various Indian studies

Author

(reference)

Place, year Total Male:

Female

Mean

age

(years)

Smokers

(%)

SCC

(%)

ADC

(%)

SCC:ADC SCLC

Kaur H et al Chandigarh,

2017

1301 4.6:1 58.6 76.9 36.4 36.4 1 19.2

Jindal and

Behera

Chandigarh,

1990

1009 4.5:1 51 63 34.3 25.9 1.3 25.9

Prasad et al Lucknow,

2009

799 4.75:1 80.4 47.3 18.2 2.6 13.7

Sheena Sheikh

et al

Kashmir,

2010

783 6.98:1 57.8 68.1 71.3 2.6 27.9 20.8

Navneet Singh

et al

Chandigarh,

2012

654 5:1 58.2 76.9 38.1 27.5 1.38 20.5

Dey et al Kolkata,

2012

607 4.1:1 57.9 67.2 35.1 30.8 1.1 16.5

Noronha et al Mumbai,

2012

489 3.5:1 56 52 26.2 43.8 8

Mandal et al Manipur,

2013

466 1.09:1 58.5 73 49.1 30.8 1.6 14.8

Malik et al New Delhi,

2013

434 4.6:1 55 67.9 32.1 37.1 0.86 14.7

Prasad et al Lucknow,

2004

400 4.3:1 57 71 46.5 18.5 2.5 18.2

Mohan et al New Delhi,

2016

397 7.4:1 57.8 79 25.1 24.1 1.04 14.6

NA Khan et al Kashmir,

2006

321 11.3:1 88.4 77.3 5.3 14.5 17.1

Gupta et al Rajasthan,

1998

279 6.1:1 57 81.6 42 20 2.1 14

Krishnamurthy

et al

Tamil Nadu,

2012

258 3.5:1 56 60.5 15.8 42.6 13.2

Rawat et al Uttarakhand,

2009

203 8.2:1 56.4 81.77 44.83 19.38 2.2 16.75

PK Sharma et

al

Himachal

Pradesh,

2012

105 10.6:1 62.7 89.5 37.1 36.2 1.02

Baburao et al Bangalore,

2015

96 3:1 69.7 47.9 28.1 1.7

SR-107B

Delays During Diagnosis and Management of Lung Cancer in India- A

Prospective Observational Study

Author Block: Garg1 A, Mohan1 A, Gupta1 A, Sahu1 S, Choudhari1 C, Arora1S, Jain2 D, Kumar3R, Bhalla4 A, Pandey5 R,

Tiwari1 P, Mittal1S, Madan1 K, Khilnani1 G.C., Hadda1 V, Guleria1 R 1Pulmonary medicine and sleep disorders, All India Institute of Medical Sciences, New Delhi, India, 2Pathology, All India

Institute of Medical Sciences, New Delhi, India, 3Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India, 4Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India, 5Biostatistics, All India Institute of Medical Sciences, New Delhi, India.

Presenting Author:

Name: Avneet Garg



Name: Avneet Garg


Abstract Body:


The majority of lung cancers (>80%) are diagnosed at an advanced stage.This may, in part, be due to

a long lag period between the onset of symptoms and establishment of a diagnosis and finally,

initiation of treatment. The reasons for this lag period are yet uncertain and may be multi-factorial.

There is scarce Indian dataevaluating delays in the diagnosis and management of lung cancer

patients.


A prospective evaluation of proven lung cancer patients between 1stJanuary 2008 and 31stJanuary

2018 was completed to quantify various timelines during the course of management and establish

reasons for delay, if any. Timelines were defined as the time intervals between symptom onset, first

physician visit, referral to our facility, definitive diagnostic investigation, date of confirmed diagnosis

and date of treatment. Various factors affecting various time-lines were determined by univariate

and multivariate analysis.

Results:

418 patients were included for analysis,with majority having advanced stage (96.2% stage 3 or 4

NSCLC and 80.8% extensive stage SCLC).Of these, 252 patients (60.2%) received definitive treatment.

Among the various time intervals, it took a median of 30 days (IQR 20-90 days) for a patient to visit a

physician for first time, 50 days (IQR 20-120 days) to be referred for our centre, 13 days (IQR 6-21

days) to undergo definitive diagnostic investigation, 9 days (IQR 6-13 days) for a pathologist to

report and despatch the diagnosis, and 25 days (IQR 13.5-35 days) to initiate chemotherapy after

obtaining definitive diagnosis.Among the various factors affecting different time intervals; poor

educational status [upto primary level education:45 days (20-90) vs above primary level:30 days (15-

60); p=0.03] and loss of weight [LOW absent: 30 days (15-85.5) vs LOA present: 32 days(20-90);

p=0.018] were independently associated with longer delay between symptom onset to first

physician visit on multivariate analysis.Administration of anti-tuberculosis treatment (ATT) was the

only independent factor that affectedthe delay between first physician visit and referral to AIIMS

[median time in those who did not receive ATT:45 days (range, 20-100) vs those who received

ATT:60 days (range,30-180); p=0.002]. Advanced disease stage(77 days for stage 1, 2 vs 28.5 days

for stage 3, 4; p value .005) and presence of EGFR (27 days vs 14 days, p value .001) and ALK

mutations (26.3 days vs 14.5 days; p value.018) remained independent factors for lesser time delays

between diagnosis and treatment on multivariate analysis. Various time delays did not affect the

overall survival.

Conclusion:

Majority of patients present with advanced stage in India. Poor education status and inappropriate

institution of ATT appear to be the major reasonsfor delay during lung cancer diagnosis and

management in our setup. Unlike western data, various delays did not affect overall survival

probably due to the fact that most of patients presented at advanced stage of lung cancer.

Keywords: Lung cancer, India. Time delays

SR-107C

Figure 1: Various time intervals during diagnosis and management of lung cancer

Survival and treatment response of Lung cancer patients in India: a tertiary

centre experience

Mohan A, M.D.1, Garg A, M.D. DM

1 , Sahu S, D.N.B.

1, Gupta A, M.D.

1,Choudhari C, M.D.

1, Vashistha V, M.D.

2, Bhalla A,

M.D.3, Jain D, M.D.

4, Pandey R.M.

5, Kumar

, R, M.D.

6, Madan K, M.D., DM

1,Hadda V, M.D.

1,Khilnani G.C., M.D.

1, Guleria R,

M.D, DM1

1 All India Institute of Medical Sciences, Department of Pulmonary Medicine and Sleep Disorders, Delhi, India,

2 Duke

University Health System, Department of Hematology and Oncology, Durham, NC, U.S.A., 3 All India Institute of Medical

Sciences, Department of Radiology, Delhi, India., 4

All India Institute of Medical Sciences, Department of Pathology, Delhi,

India, 5

All India Institute of Medical Sciences, Department of Biostatistics, Delhi, India, 6

All India Institute of Medical

Sciences, Department of Nuclear Medicine, Delhi, India

Presenting Author:

Name: Avneet Garg



Name: Avneet Garg


Abstarct Body:


Inspite of several therapeutic advancements in lung cancer, response to treatment and survival

remains generally poor and highly variable in different parts of the world. However, limited data

exists regarding treatment response and outcomes in lung cancer patients in India.


We performed an ambispective study of 1803proven lung cancer patients over 11 years from

1stJanuary 2008 to 31st January 2018 at a tertiary care referral facility in North India. Treatment

response and survival was assessed in terms of objective response rate (ORR), disease control rate

(DCR), time to progression (TTP), progression free survival (PFS) and overall survival (OS).

Results:


Among all patients enrolled during the above period, 60.0% received treatment, out of which 79.2%

received chemotherapy, 8.8%targeted therapy (TKIs), 15.3% radiotherapy and2.9% underwent

surgery. ORR and DCRafterfour cycles of first line doublet chemotherapy or 3 months of TKIswas

54.8% and 73.3% respectively (409 patients). TKIs achieved significantly better ORR compared to

standard chemotherapy in NSCLC (68.7% vs 53,8%; p=0.05), whereas diagnosis of well differentiated

carcinoma and non-smoking status was associated with significantly better DCR. (74.4% vs 46.1%,

p=0.02and 84.5% vs 69.9%, p=0.002respectively). The median TTP (204 patients) was 6.3 months

(IQR 4.0-10.5). The factors that were associated with significantly prolonged TTP on multivariate

analysis included: non-metastatic NSCLC [6.7 vs 5.8 months, HR 1.55 (1.09-2.19), p=0.013], non-

smoking status (7.1 vs 5.5 months, HR 1.47 (1.08-2.01), p=0.014]and treatment with TKIs(9.1 vs

5.9months, HR 0.64 (.04-0.94),p=0.024]. The median PFS (527 patients) was 5.6 months (IQR 3.1-9.4)

and young age (6.3 vs 5.0 months, HR 1.27 (1.07-1.52), p=0.005), good performance status (6.4 vs

4.7 months, HR 1.45 (1.2-1.7),p=<0.001) and non-metastatic disease NSCLC (6.7 vs 4.7 months, HR

1.6 (1.29-1.97),p=<0.001) were independent predictors of better PFS on multivariate analysis. The

median OS(1803 patients) was 8.8 months (IQR 3.7-19);non-smoking status [14.4 vs 8.0 months, HR

1.67 (1.4-2.0),p<0.001], non-metastatic NSCLC stage [11.3 vs 8.23 months, HR 1.27 (1.08-

1.5),p=0.003]and good performance status(14.3 vs 6.1 months,HR 1.67 (1.4-2.0),p=<.001) had

significantly better OS on multivariate analysis.

Conclusion:

In our study, various factors were identified that affected survival outcomes including age, smoking

status, metastatic disease, performance status and differentiation of tumour. Treatment with

targeted therapy resulted in significantly better ORR and TTP, although did not affect the PFS and OS

significantly.

Keywords: Lung cancer, India

Figure 1: Kaplan-Meier curve for Time to progression (TTP) and overall survival (OS)

Table 1: Factors affecting ORR and DCR among the treated patients

Factor/ variable Sub-group n ORR (%) DCR (%)

Chemotherapy regimen

in NSCLC

Conventional chemotherapy

TKIs (EGFR TKIs / ALK

inhibitors)

262

48

53.8

68.7

p=0.05

73.7

83.3

p=0.15

Pathological subtypes Well differentiated carcinoma

Poorly differentiated

carcinoma

387

13

55.3

30.8

p=0.08

74.4

46.1

p=0.02

Smoking status No

Yes

116

275

63.8

51.2

p=0.02

84.5

69.9

p=0.002

poster presenting department designation abstract title...

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