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M. Tsuboi



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    P3.07 - Poster Session 3 - Surgery (ID 193)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P3.07-024 - The endo-finger technique for the localization of small pulmonary ground glass nodules under thoracoscopic surgery (ID 2089)

      09:30 - 09:30  |  Author(s): M. Tsuboi

      • Abstract

      Background
      Small pure ground glass nodules (GGNs) have sometimes been detected by high resolution computed tomography (CT). Pathologically, most of these pure GGNs are bronchioloalveolar carcinoma (BAC) or atypical adenomatous hyperplasia (AAH). In published papers, the thoracoscopic resection of the pure GGNs was reported to be difficult, because they cannot usually be palpated. Therefore, various marking techniques, such as those using a hook wire, colored collagen, barium, lipiodol and so on, have been described for the localization of pure GGNs. However, these techniques are associated with the development of several complications, such as pneumothorax, hemorrhage, and serious air embolism. Moreover, they requires a lot of time. In this study, we evaluated the localization of small pure GGNs in thoracoscopic surgery using the endo-finger technique.

      Methods
      Patients with peripheral pure GGNs that were 20 mm and less in diameter who planned to undergo resection in our institute were candidates for this study. Preoperatively, no marking technique was performed. Thoracoscopy was performed in the lateral position under single lung anesthesia. Thoracoports were placed near the GGNs based on the CT findings. One finger was inserted through the port into the pleural cavity to palpate the lung to localize the GGNs (the endo-finger technique). After the GGNs were detected, they were resected by endostaplers with adequate safety margin.

      Results
      Since January 2005, twenty patients with thirty-four GGNs were enrolled in this study. The size of the GGNs was 5 mm or less in eight lesions, 6 – 10 mm in 14 lesions, 11 – 15 mm in nine lesions and 16 – 20 mm in three lesions. The depth of the lesions from the visceral pleura ranged from 0 – 14 mm. The main reasons for the resection were a need for another ipsilateral simultaneous operation in six cases, the patients’ requests in five cases and enlargement of the GGNs during the follow-up period in three cases. All but one GGN could be detected using the endo-finger technique with two or three thoracoports, and were resected. Some of the GGNs adjacent to the visceral pleura were visualized by thoracoscopy as color changes in the visceral pleura. There was one conversion to thoracotomy in one patient who had a severe pleural adhesion due to a previous ipsilateral lobectomy of the lung. No complications occurred in association with this procedure. The pathological diagnoses of the GGNs were BAC in 23 nodules, AAH in nine, hyperplasia of the alveolar epithelium in one and an inflammatory lesion in one. The surgical margins of all of the resected specimens were pathologically negative.

      Conclusion
      The endo-finger technique is safe and useful for the localization and resection of peripheral GGNs during thoracoscopic surgery. We suggest that the preoperative marking to detect GGNs can be replaced by the endo-finger technique in some cases.

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    P3.24 - Poster Session 3 - Supportive Care (ID 160)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P3.24-042 - The use experience of crizotinib (XALKORI®) for postoperative recurrence of ALK-rearranged non-small cell lung cancer (ID 2824)

      09:30 - 09:30  |  Author(s): M. Tsuboi

      • Abstract

      Background
      Crizotinib(Xalkori®) was developed as a medicine for anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC). Multi institutes studies established its efficacy and safety for advanced lung carcinoma. After crizotinib release in Japan, there has been no report about usage of crizotinib for postoperative recurrence of lung cancer. We have four patients with postoperative recurrence of ALK-rearranged NSCLC who were treated with crizotinib. We herein report the efficacy and safety of the treatment.

      Methods
      not applicable

      Results
      Case report ALK-rearrangements were confirmed by FISH examination from surgical specimen in　all four patients. Histological diagnoses were pulmonary adenocarcinoma in all cases. Case 1. A 62-year-old man underwent the right middle and lower lobectomy (pT3N2M0) followed by adjuvant chemotherapy with platinum doublet. He had a mediastinum lymph node relapse six months after the operation. Crizotinib was administered as the 2[nd] line. A long stable disease (SD, six months) was obtained in this patient. Case 2. A 62-year-old woman underwent the right upper and middle lobectomy (pT2aN2M1a) followed by adjuvant chemotherapy with platinum doublet. She had multiple lung metastases thirty-one months after the operation. Progressive disease (PD) was detected after four courses of platinum doublet. Crizotinib was administered as the 5[th] line and partial response (PR) was obtained over 5 months. Case 3. A 63-year-old man underwent preoperative chemotherapy followed by the right upper lobectomy (ypT3N2M0). He received an adjuvant chemotherapy with platinum doublet. He developed brain metastases five months after the operation. Crizotinib was administered one month as the 4[th] line, and PR was obtained. Case 4. An 83-year-old woman underwent the left lower lobe wedge resection. (pT2aNXM1a) followed by four regimens of chemotherapy, resulting in PD. Crizotinib was administered as the 5[th] line. The side effects with increase in body weight (+4kg, Grade1), leg edema (Grade 2) and liver dysfunction (Grade 1) deveroped on the 7[th] day. Her symptoms quickly disappeared after discontinue of crizotinib. Another regimen chemotherapy was administered because she rejected restart of the crizotinib treatment.

      Conclusion
      In the efficacies of the crizotinib treatment, two cases were PR, one case was SD and one case was drop out. The crizotinib was effective in two cases which were PD with other regimen treatments. Crizotinib has possibilities of giving dramatic clinical response in ALK-rearranged NSCLC patients. In safeties of the crizotinib treatment, no adverse event was occurred in three cases and Grade 2 adverse in one case. There have been no serious complications.　Crizotinib treatments in ALK-rearranged NSCLC patients have great possibilities of having a clinical benefit. Crizotinib can also be effective and safe in postoperative recurrence of ALK-rearranged NSCLC patients. We reacknowledge an importance of molecular targeted therapy that creates dramatic clinical effects within a short time period. Further observation and accumulation of cases will be necessary to evaluate the clinical effectiveness of this treatment in postoperative recurrence of ALK-rearranged NSCLC patients.