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S. Hillinger



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    OA22 - Novel Trials and Biomarkers in Malignant Pleural Mesothelioma (ID 403)

    • Event: WCLC 2016
    • Type: Oral Session
    • Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
    • Presentations: 1
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      OA22.07 - Correlation of CT Scan Based Tumor Volume Measurement to Actual Resected Tumor Volume - A New T-Factor? (ID 5958)

      15:15 - 15:25  |  Author(s): S. Hillinger

      • Abstract
      • Presentation
      • Slides

      Background:
      Tumor volume has been reported to be a valuable prognosticator for malignant pleural mesothelioma (MPM) survival. We wanted to assess the precision of CT scan based preoperatively measured tumor volume when correlated to the actual resected tumor weight and tumor volume after pleurectomy/decortication.

      Methods:
      From 10/2012 – 06/2016 the tumor weight of surgery specimens was measured in 32 patients undergoing macroscopic complete resection by (extended) pleurectomy/decortication ((e)P/D). The median tumor weight of all patients was (n=32) 443g (95-783g). In all patients tumor volume was measured in the CT or PET-CT scans performed before surgery as described previously (Frauenfelder 2011). Tumor volume of the resected specimen was additionally measured in 21 patients. Relations between tumor weight, tumor volume at surgery, CT-volume, cT stage and pT stage were analyzed using Spearman rank correlation.

      Results:
      Median time between CT scan and surgery was 18 days (range 1-48). The analysis revealed a moderate correlation between CT tumor volume and weight (p=0.001, correlation coefficient 0.58, CT volume and tumor volume at surgery showed strong correlation (p=0.001, correlation coefficient 0.65). No significant correlation was observed between cT stage and tumor weight (p=0.1, correlation coefficient 0.31), but a moderate correlation between cT stage and CT volume (p=0.001, correlation coefficient 0.58) as well as specimen volume (p=0.008, correlation coefficient 0.58). There was a moderate correlation of tumor weight with pT stage (p=0.02, correlation coefficient 0.42), but no correlation of CT volume (p=0.1, correlation coefficient 0.31) as well as specimen volume with the pT stage (p=0.2, correlation coefficient 0.32). Figure 1



      Conclusion:
      The correlation between preoperatively assessed CT tumor volume and volume of the resected specimen showed a strong correlation. To assess the prognostic role of CT measured tumor volume a correlation to prognosis has to be performed before implementation as a new T-factor.

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    P1.05 - Poster Session with Presenters Present (ID 457)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 1
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      P1.05-057 - Prediction of Early Recurrence in Patients with Stage I and II Non-Small Cell Lung Cancer Using FDG PET Quantification (ID 4872)

      14:30 - 14:30  |  Author(s): S. Hillinger

      • Abstract

      Background:
      Although surgical resection remains the optimal treatment for early-stage NSCLC, up to 50% of patients with stage I and II relapse and die within 5 years after curative resection. Therefore prognostic markers are important as these patients might benefit from adjuvant therapy. The goal of this study was to evaluate established PET quantification metrics including: maximal standard uptake volume (SUV~max~), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) as prognostic markers for early recurrence and overall survival in resected early stage lung cancer.

      Methods:
      Between January 2003 and December 2010 182 surgically resected patients with stage I-II NSCLC who underwent 18 F FDG PET/CT less than one month prior to surgery have been evaluated. All patients had at least 5 years of follow-up. Cox proportional hazard model was used to determine the association between variables and survival respectively time to recurrence. For the multivariate analysis the following variables have been included: tumor size on CT, age tumor stage, histology, SUV~max~, TLG (for TLG~42%~ (threshold at 42% SUV~max~) and TLG~2.5 ~(cut-off at SUV 2.5) and MTV~42%~ and MTV~2.5~). To identify high-risk patients we used survival trees.

      Results:
      133 patients were included, 71 with adeno carcinoma, 62 with squamous cell carcinoma. TLG~2.5~ and MTV~2.5~ values have been a significant prognostic factor for recurrence (P<0.0001). Patients with a MTV2.5 above 42 cm[3] had a mean recurrence time of 0.8±0.9 years, while patients with MTV2.5 ≤ 42 cm[3 ]recurred within 2.8±1.3 years. Using the survival tree models TLG~42%~ has been the first choice variable for discriminating high risk patients for DOD (dead of disease) independent from histological type, whereas MTV~2.5~ has been the first choice for DOD in adeno carcinoma patients.

      Conclusion:
      TLG and MTV may be useful prognostic variables in stage I-II NSCLC depending on the tumor type. Using a cut-off at 42 cm[3 ]for early stage adenocarcinoma patients a high risk of recurrence within one year might be identified and adjuvant therapy following surgical resection could improve outcome for those patients.