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E.M. Toloza
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P2.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 213)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.03-006 - Survival Rates after Surgery for Stage-3A (N2) Non-Small Cell Lung Cancer with Induction versus Adjuvant Chemotherapy+/-Radiation Therapy (ID 3151)
09:30 - 09:30 | Author(s): E.M. Toloza
- Abstract
Background:
We compared survival of stage-3A non-small cell lung cancer (NSCLC) patients (pts) after surgery without or with induction versus adjuvant chemotherapy + radiation therapy (chemo+XRT).
Methods:
We retrospectively analyzed pts with clinical stage-3A (cStage3A) NSCLC and who had surgery without or with induction chemo+XRT or who were pathologic stage-3A (pStage3A) and had adjuvant chemo+XRT. Kaplan-Meier survival curves were compared for these 3 groups, with significant differences at p<0.05 by Chi Square test, with Log Rank (Mantel-Cox), Breslow (Generalized Wilcoxon), and Tarone-Ware pairwise comparisons.
Results:
From 1/1986 to 12/2010, there were 300 NSCLC pts who were cStage3A at surgery. Another 52 pts were not cStage3A at surgery, but were then pStage3A. Of these 352 pts, 192 had curative resection, with 56 pts having surgery alone (SURG), 43 pts having surgery after induction therapy (NEOADJ), and 93 pts having surgery then adjuvant therapy (ADJ). Kaplan-Meier survival for SURG was worse than that for either NEOADJ (p=0.03) or ADJ (p=0.005), while NEOADJ and ADJ had similar survival (p=0.90). Median survival was 18+3 mon (95%CI: 12-24 mon) for SURG, 37+6 mon (95%CI: 25-50 mon) for NEOADJ, and 41+5 mon (95%CI: 31- 51 mon) for ADJ. Survival for NEOADJ chemo-alone pts was better than for SURG pts (p=0.031), while that of NEOADJ chemo+XRT pts was similar to SURG survival (p=0.488). Survival for ADJ chemo-alone pts was better than for SURG pts (p=0.007), while that of ADJ chemo+XRT pts was similar to SURG survival (p=0.163).
Conclusion:
Stage-3A NSCLC pts have improved survival with either induction or adjuvant therapy compared to surgery alone. Patients with induction or adjuvant chemo alone, but not those with induction or adjuvant chemo+XRT, have improved survival compared to surgery alone.
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P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.02-025 - Therapeutic Lung Resection in Biliopancreatic Cancer Patients (ID 2930)
09:30 - 09:30 | Author(s): E.M. Toloza
- Abstract
Background:
Of the major malignancies, carcinoma of the pancreas and the distal biliary duct are the most lethal, primarily because the diagnosis is usually made at an advanced stage and the cancer is relatively resistant to therapy. Occasionally, pancreatic cancer presents as a relatively indolent disease and localized blood-borne lung metastases may be solitary and potentially resectable for therapy. As well, some lung lesions that develop may represent another disease unrelated to the pancreatic cancer and may be treated with surgical resection. Therefore we reviewed our experience with therapeutic lung resections in pancreatic cancer patients.
Methods:
We performed a retrospective, case-control study of treated pancreatic cancer patients who underwent subsequent therapeutic lung resections from 1998-2015. All clinical and pathologic data were gathered for comparison in patients undergoing pancreatic pulmonary metastasectomy and those undergoing lung resection for other diseases. Kaplan-Meier (KM) analyses of survivals were calculated.
Results:
25 patients with treated biliopancreatic cancer underwent lung resections with curative intent. 13 patients (mean age 60.2 ± 10.7 years) had resection of isolated biliopancreatic cancer metastases. 11 patients had 12 resections of primary lung cancers (all Stage I) and 1 patient had resection of active Cryptococcus granulomas (mean age 70.8 ± 7.0 years). A smoking history was present in 77% of metastasecomy patients and 67% of lung cancer resection patients. All never-smokers with lung cancer were females. There were no surgical complications or operative mortalities. The median times from pancreatectomy to pulmonary metastasectomy was 29 months (range 0-64), and 12.5 months (range 0-108) for the lung cancer resection group. During the study period, 11/25 (44%) patients died, although only 64% of the deaths were related to pancreatic cancer recurrence. The KM median survivals after lung resection in the pulmonary metastasectomy group was 28 months (range 3-76) and 78 months (range 2-81) in the lung cancer resection group (see Figure). Figure 1
Conclusion:
Although biliopancreatic cancers have an overall dismal prognosis with just a 12.7 month median survival, 40% present with potentially resectable disease. The lung is the primary site of recurrence after resection of the primary biliopancreatic cancer. Based on our experience, we recommend considering pulmonary metastasectomy in highly selected patients who present with no evidence of disease elsewhere. Pulmonary resection can be done safely in this patient population. Additionally, not all new lung masses in pancreatic cancer patients are metastases, and resection should be considered, whenever feasible, for often we find a second primary lung cancer.
