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S.H. Hong



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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 2
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      P2.24-018 - Primary mediastinal Castleman' disease; Surgically curable anemia : A case report (ID 1268)

      09:30 - 09:30  |  Author(s): S.H. Hong

      • Abstract

      Background
      Castleman’s disease, an uncommon disease that causes benign lymph node hyperplasia, must be distinguished from reactive lymph node hyperplasia and malignancies. Unicentric Castleman’s disease in patients with anemia is rarely described.

      Methods
      We describe the case of a 25-year-old woman with plasma cell type of unicentric Castleman’s disease presenting as iron deficiency anemia. We report the clinical course from the initial presentation to diagnosis and surgical cure and review the literature.

      Results
      Figure 1 A 25-year-old woman was referred with abnormal chest X-ray which was found during pre-employment screening. She had no other complaints, and her previous medical history was unremarkable, as was her family medical history. No fever, acute infectious symptoms and signs, or any other abnormalities were found in the physical examination. Normocytic anemia was found based on initial blood tests (hemoglobin 7.7 g/dl, mean corpuscular volume 88.9 fl, with normal white blood cells, red blood cell distribution width, liver renal functions, and electrolytes). Further laboratory examinations (ferritin 89.0 ng/ml; serum iron 23 mg/dl; and total iron binding capacity 206 mg/dl) demonstrated that she was iron deficient. Chest X-ray and chest CT scan confirmed a mass (6x4x4 cm) at right superior and mid-mediastinum (Fig. 1). PET/CT showed paratracheal mass shows inhomogeneously high FDG uptake. In suspicion of lymphoma, diagnostic thoracoscopic surgery was planned. However, intraoperative frozen section diagnosis of a specimen was benign. Thus, the mass was completely removed and diagnosis was consistent with unicentric plasma cell type Castleman’s disease. Three months after surgery, without any medical intervention, the laboratory data had recovered to normal range (hemoglobin 14.5 g/dl). She receives regular follow ups and no recurrence has been found for 4 years since surgery.

      Conclusion
      The surgical resection would appear to be the optimal treatment modality, and constitutional symptoms may be resolved. The prognosis following complete surgical resection appears to be good.

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      P2.24-024 - Metabolic activity on [18F]-fluorodeoxyglucose-positron emission tomography/computed tomography and glucose transporter-1 expression may predict clinical outcomes in patients with limited disease of small cell lung cancer receiving concurrent chemoradiation (ID 1573)

      09:30 - 09:30  |  Author(s): S.H. Hong

      • Abstract

      Background
      Limited disease of small cell lung cancer (LD-SCLC) respond well to concurrent chemo-radiation (CCRT), but have high relapse rates and short relapse-free survival (RFS). We aimed to evaluate tumor metabolic activities measured by [18F]-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET) as a prognostic factor and analyze its relationships with markers of tumor biologic behavior.

      Methods
      Forty-one LD-SCLC patients receiving 4 cycles of EP (etoposide 120 mg/m[2], days 1–3; cisplatin 60 mg/m[2], day 1), 2 cycles of EP (etoposide 130 mg/m[2], days 1–3; cisplatin 30 mg/m[2], day 1) with concurrent mediastinal irradiation were enrolled. SUVmax of primary tumor was revised with the SUV of liver (SUVlivermax). Differences between pre- and post-treatment average SUV uptake of the primary tumor and intrathoracic lymph nodes were presented as ∆SUVliveravg. Thirty-one tumor biopsy specimens were immunostained for glucose transporter-1 (GLUT-1), Bcl-2, and hypoxia inducible factor-1α (HIF-1α).

      Results
      Objective response rates (ORRs) after CCRT were 92.7% and 87.8% on chest CT and FDG-PET, respectively. Median overall survival (OS) and RFS were 13.7 (range 4.4–54.1) months and 10.4 (range 0.97–54.1) months, respectively. In multivariate analysis, pretreatment lactate dehydrogenase (LDH) and ∆SUVliveravg correlated significantly with RFS (hazard ratio [HR] 2.8, P = 0.043 and HR 0.3, P = 0.004, respectively). Gender, pretreatment LDH, objective tumor metabolic response, and SUVlivermax correlated significantly with OS (HR 12.1, P = 0.006; HR 3.7, P = 0.037; HR 10.1, P = 0.008 and HR 0.2, P = 0.014, respectively). High GLUT-1-positivity (>75%) and pretreatment LDH levels (>400 U/L) correlated significantly with better ORR (P = 0.012) and HIF-1α immunoreactivity score (IRS, P = 0.029), respectively.

      Conclusion
      ∆SUVliveravg and GLUT-1, with respect to tumor glucose metabolism, might predict RFS and ORR, respectively, in definitive CCRT-treated LD-SCLC patients.

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    P3.10 - Poster Session 3 - Chemotherapy (ID 210)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.10-025 - Taxane-Platinum Induction Chemotherapy in Locoregionally Advanced Non-Small-Cell Lung Cancer: Outcomes and Prognostic Factors (ID 1546)

      09:30 - 09:30  |  Author(s): S.H. Hong

      • Abstract

      Background
      Induction chemotherapy (IC) in locoregionally advanced non-small-cell lung cancer (LA-NSCLC) has shown survival benefit. This retrospective study aimed to assess clinical outcomes and to identify prognostic factors in the LA-NSCLC patients who received taxane-platinum IC (TP-IC).

      Methods
      We reviewed medical charts, imaging studies, and pathologic reports in 51 LA-NSCLC pts who were treated with TP-IC between January 2003 and June 2012 at Seoul St. Mary’s Hospital and St. Vincent’s Hospital.

      Results
      Mean age at diagnosis was 63.1 years (range, 43-77). Forty-two pts (82.4%) were male. ECOG performance status was 0 in 17 pts (33.3%) and 1 in 34 (66.7%). Histology was squamous cell in 30 pts (58.8%), adenocarcinoma in 20 (39.2%), and large cell in 1. Thirty-four pts (66.7%) had stage IIIA disease, 13 (25.5%) IIIB and 4 (7.8%) IIB. All pts were treated with docetaxel 75 mg/m[2] or paclitaxel 175 mg/m[2], and cisplatin 75 mg/m[2] or carboplatin AUC 5 on day 1 every 3 weeks. Forty-four pts (86.3%) received docetaxel-cisplatin IC, 4 (7.8%) docetaxel-carboplatin, and 3 (15.7%) paclitaxel-cisplatin. The median number of IC cycles was 3 (range, 2-4). Mean relative dose intensity was 90.4% (±10.8) and RDI ≥90% was achieved in 31 pts (60.8%). During TP-IC, asthenia (88.1%), anorexia (89.1%), neutropenia (84.4%), alopecia (80.4%), nausea (71.7%) and myalgia (57.1%) were frequent. Most common grade 3/4 toxicity was neutropenia (80%) and febrile neutropenia occurred in 3 pts (5.9%). All toxicities were manageable with supportive care with no treatment-related death. Tumor response was assessed according to the RECIST and PERCIST criteria. According to RECIST, 3 pts (5.9%) achieved complete responses (CR), 32 (62.7%) partial responses (PR), 14 (27.5%) stable diseases (SD), and 2 (3.9%) progressive disease (PD). In addition, response evaluation by PERCIST was available in 38 pts, 5 pts (13.2%) achieved CR, 26 (68.4%) PR, 5 (13.2%) SD, and 2 (5.3%) PD. Thirty-one pts (60.8%) underwent surgery, 12 (23.5%) concurrent chemo-radiation (CCRT), 2 (4.3%) radiotherapy alone, 5 (9.8%) 2[nd] line chemotherapy or best supportive care and 1 lost follow-up. In 31 pts undergone surgical resection, 27 (87.1%) achieved R0 resection while 30-day postoperative death was reported in 2 pts. Median relapse-free survival (RFS) and overall survival (OS) were 10.7 months (95% CI, 8.1-13.2 months) and 25.5 months (95% CI, 20.4-30.6 months), respectively. The pts. with MD histology and objective metabolic response (CR+PR) by PERCIST showed significant longer RFS with HR of 6.27 (P=.002) and 3.23 (P=.04), respectively.

      Conclusion
      The TP-IC in LA-NSCLC showed remarkable tumor regression activity, leading to high R0 resection rate. MD histology and tumor response (CR+PR) by PET (PERCIST) were significant prognostic factors for RFS. Further study is ongoing to identify molecular markers affecting clinical outcomes.