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N. Mandel



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    P2.16 - Poster Session 2 - Other Thoracic Malignancies (ID 187)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Thymoma & Other Thoracic Malignancies
    • Presentations: 1
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      P2.16-002 - Long-term Treatment Results in Soft Tissue Sarcomas of The Thoracic Wall Treated by Pre-or-Postoperative Radiotherapy in a Multidisciplinary Approach-<br /> Results of the CTF Sarcoma Group (ID 1842)

      09:30 - 09:30  |  Author(s): N. Mandel

      • Abstract

      Background
      To evaluate the long term treatment results and the prognostic factors among patients with soft tissue sarcoma of the thoracic wall who were treated with pre-or postoperative radiotherapy

      Methods
      Forty two cases were referred to our clinic between December 1980- December 2007 with the diagnosis of soft tissue sarcoma of the thoracic wall, and 13 of them were excluded from further evaluation due to the absence of radiotherapy indication or the predilection of the patients to receive radiotherapy at another center. The mean age was 44 (14-85) and 15 of them were male and 11 female. Malignant fibrous histiocytoma was the most common histopathology (27.6%). 7 patients had well differentiated, 6 had moderately differentiated and 13 had poorly differentiated tumor. Tumor size varied between 1- 25 cm (mean 7.8 cm). Twenty one of the patients admitted to our clinic after primary surgery, 5 after local recurrence. Seventeen of the cases had marginal and 9 had wide local resection. The surgical margin was positive in 11 of the patients. Four cases received postoperative radiotherapy with a mean dose of 60 Gy (50-66 Gy) and 22 received preoperative radiotherapy with a mean dose of 46 Gy. adjuvant chemotherapy with Doxorubicin, Ifosfamide and Holoxan was given to 6 patients.

      Results
      Mean follow-up time was 97 (9-309 months) months. Nine patients (34.6%) developed local recurrence with a median time to recurrence of 20 months (2-53 months). the surgical margin was positive in 6 of them. All patients with recurrent disease had undergone surgery. And 4 of them were treated with chemotherapy, 1 of them received external radiotherapy, and 1 patient received brachytherapy afterwards. 11 (42.3%) patients developed distant metastasis after a median of 40 months (4-92 months). The most common metastases sites were the lungs (38.5%) and the bones (3.8%). Three cases developed both local and distant metastasis. Five-year local control (LC), disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS) rates were 62%, 38%, 69%, and 76% respectively. Chemotherapy was given to all cases developing distant metastasis. Seventeen cases died due to disease progression, 2 patients died due to cardiac disorders. On univariate analysis, although LC was approximately twice worse for the patients with positive surgical margin, the difference was not significant. 5-year DFS and DSS rates were significantly worse for the patients with poorly differentiated tumors than well and moderately differentiated tumors (0%, 66% and 60%, 92% respectively. DFS was significantly better for the patients who received chemotherapy (p=0.01) and there was a trend for DSS (p=0.09). On multivariate analysis, no factor affected the results significantly.

      Conclusion
      In our series, high grade found to be the most important factor affecting prognosis. Although we couldn’t show statistically, it seems that radiotherapy helped to achieve better LC, even in margin positive patients. In addition to this, while a definitive conclusion is not possible due to the small number of cases, chemotherapy improved the treatment results.. Thoracic wall sarcomas should be approached in a multidisciplinary manner as with sarcomas in other regions.

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    P3.19 - Poster Session 3 - Imaging (ID 181)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P3.19-017 - 18F-FDG-PET-CT imaging in malignant mesothelioma (ID 2833)

      09:30 - 09:30  |  Author(s): N. Mandel

      • Abstract

      Background
      Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor with a complex growth pattern. Imaging plays a crucial role in diagnosis and management. The diagnosis of MPM is based on histology using essentially immunohistochemistry on pleural biopsies. Occasional long-term survival results are probably due to the biologic characteristics of the disease. 18F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)-computed tomography (CT) (FDG PET-CT) has become an invaluable tool for the diagnosis, staging, and prognosis of this severe disease as it combines both anatomic and functional information in a single imaging procedure, allowing for improved management of this disease.

      Methods
      From April 20011 and May 2013, eight patients with histologically proven MPM underwent integrated FDG PET and computed tomography (CT) scanning. These were analyzed: mean age was 53.6 years (range: 40-66) and histologic MPM subtypes were epithelioid (7 patients) and biphasic (1 patients). We observed a significant correlation between high SUV(max) and high-grade disease. There were 75 % male patients and 25% female patients. PET-CT images showed intense abnormal FDG uptake (SUVmax>8.0) in the pleural lesions of all 8 MPM patients at delayed phase, while it showed abnormal FDG uptake in all (100%) patients at early phase. In all patients, the values of SUVmax at delayed phase were higher than those at the early phase. PET-CT also indicated metastasis in the lymph node in 4 patients (50%) and in the peritoneal lesions in one patient (12.5%) with MPM. The results showed that 18F-FDG PET-CT at delayed phase is very useful for the diagnosis of pleural diseases and high uptake of 18F-FDG PET-CT may be a predictive factor of prognosis in MPM patients.

      Results
      MPM has a limited response to conventional chemotherapy and radiotherapy, thus early diagnosis of MPM is extremely critical. In these group patients, PET-CT showed all lesions with high sensitivity (%100). CT scans have limited accuracy in the differentiation between benign and malignant pleural disease. Also CT tends to underestimate early chest wall invasion and peritoneal involvement and has well-known limitations in the evaluation of lymph node metastases. Several studies have reported that 18-fluorodeoxyglucose (FDG) PET-CT plays an important role in the assessment of thoracic malignancy such as lung cancer. With a small patients experience, we suggest that PET-CT is useful as an aid for diagnosis and prognosis of MPM. PET-CT provides useful information concerning the extension of the lesions to thoracic and abdominal walls not fully evaluated by the initial conventional cross-sectional imaging. PET/CT also allows an accurate therapeutic monitoring of the disease.

      Conclusion
      Our results showed (even with a limited group of patients experience), PET/CT seems to be superior to convantional imaging modalities in identifying more extensive disease involvement, and detecting unexpected occult distant metastases.