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L. Wang



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    MO25 - NSCLC - Combined Modality Therapy II (ID 112)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Mesothelioma
    • Presentations: 1
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      MO25.04 - Phase II study comparing Cisplatin/Etoposide and weekly Paclitaxol/Carboplatin regimens with concurrent thoracic radiotherapy in patients with locally advanced non-small cell lung cancer (ID 67)

      10:45 - 10:50  |  Author(s): L. Wang

      • Abstract
      • Presentation
      • Slides

      Background
      To evaluate the effect and safety of concurrent thoracic radiotherapy (TRT) with Cisplatin/Etoposide (PE) compared with weekly Paclitaxol/Carboplatin (PC) regimens in patients with stage III non-small cell lung cancer (NSCLC).

      Methods
      Patients with stage III NSCLC were randomly assigned to receive PE regimen (PE arm) cisplatin 50mg/m[2] d1, 8, 29 and 36, etoposide 50mg/m[2] d1-5 and 29-33 concurrent with TRT 60Gy, or PC regimen (PC arm) carboplatin (AUC=2) and paclitaxol 45mg/m[2] concurrent with TRT 60Gy.

      Results
      156 patients were registered. Eventually, 149 were assigned to PE arm (73) and PC (76). The median follow-up time was 38 months. The median survival time (MST) was 20 months. The 2-year overall survival (OS) and 3-year OS were 39.8% and 32.9%. The 2-year progress free survival (PFS) and 3-year PFS were 24.8% and 22.4%. The MST of PE arm and PC arm were 22 months and 20 months, and the median progress free time were 13 months and 11months, respectively. The 2-year OS of PE arm and PC arm were 44.9% and 35%, the 3-year OS were 40% and 26.2% (p=0.323), respectively. The 2-year PFS of PE arm and PC arm were 27.7% and 22.1%, 3-year PFS were 24.5% and 20.5% (p=0.449), respectively. The incidence of Great 3/4 bone marrow depression of PE arm and PC arm were 34.2% and 23.7% (p=0.29). The incidence of Great 2 or greater radiation pneumonitis of PE arm and PC arm were 19.2% and 26.3% (p=0.059).

      Conclusion
      For stage III NSCLC, concurrent TRT with PE regimen has improved PFS and OS comparing with PC regimen without significant difference. Concurrent PE regimen has a lower incidence of Great 2 or greater radiation pneumonitis.

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    P1.09 - Poster Session 1 - Combined Modality (ID 212)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P1.09-022 - A Multicenter, Randomized, Open-label, Phase II Trial of Erlotinibversus Etoposideplus Cisplatinwith Concurrent Radiotherapy in UnresectableStage III Non-smallCell Lung Cancer (NSCLC) with Activating Mutation of Epidermal Growth Factor Receptor (EGFR) in Exon 19 or 21(RECEL, ML28545, NCT01714908) (ID 1553)

      09:30 - 09:30  |  Author(s): L. Wang

      • Abstract

      Background
      The standard treatment for unresectable stage IIIA/IIIB NSCLC patients with good PS is concurrent chemo-radiotherapy. However, local tumor control remains suboptimal and distant metastases remain the major failure. Moreover, the treatment related toxicities limit application. EGFR-targeting agents including tyrosine kinase inhibitor (TKI)such as erlotinibwere demonstrated to sensitize tumor cells to radiation by a variety of mechanisms in preclinical studies. Subsequently, Phase I/II studies forcombination of TKI with radiotherapy in different cancer types have been conducted. Based on those findings, the RECEL study is comparing efficacy and tolerability of erlotinib versus etoposide plus cisplatin with concurrent radiotherapy in unresectablestage III NSCLC with activating mutation of epidermal growth factor receptor (EGFR) in exon 19 or 21.

      Methods
      The study was designed as a prospective, open-labeled, randomized, multicenter phase II clinical trial.Patients aged between 18 and 75 with ECOG PS 0–1IIIA/IIIB NSCLCconfirmed by histopathology or cytology and clinically unresectablewith activating mutation ofEGFR in exon 19 (loss) or 21 (L858R point mutation)will be enrolled (n=100). The enrolled patientswould be randomly assigned (1:1) into two arms: erlotinibarm(erlotinib 150mg/day taken orally for up to 2 years which begin on day 1 of radiation) or EP chemotherapy arm(etoposide50mg/m[2]I.V. on days 1-5 and days29-33,cisplatin50mg/m[2]I.V. after etoposideon days 1,8,29,36. 28-day schedule for 2 cycleswhich begin on day 1 of radiation).Concurrent radiotherapy in both arms is prescribed at 200cGy/day, 5 days/week for a total of 30-33 fractions, total dose of 6000-6600cGy. Duration of the recruitment will be 36 months. Patients will receive long-term follow-up including chest and upper-abdominal CT scan every 3months, brain MRI every 6 months and bone scan every 12 months. Primary endpoint is progress free survival (PFS). Secondary endpoints areobjective response rate(ORR), local control rate (LCR), overall survival (OS), quality of life (QoL) and safety.Biomarker profile will be the exploratory research.

      Results
      Till June 2013, 24 patients were screened for EGFR mutation, and 4patient has been enrolled.

      Conclusion
      Concurrent erlotinib with radiation therapy might be a promising treatment strategy.

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    P1.15 - Poster Session 1 - Thymoma (ID 189)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Thymoma & Other Thoracic Malignancies
    • Presentations: 1
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      P1.15-002 - Results and Prognostic Features of Recurrent Thymoma (ID 3020)

      09:30 - 09:30  |  Author(s): L. Wang

      • Abstract

      Background
      This study sought to analyse the results and prognosis of recurrent thymoma.

      Methods
      Between 1991 and 2012, 32 patients who developed recurrence after radical resection of thymoma were reviewed.

      Results
      The initial Masaoka staging was stage I, 3; stage II, 14; stage III, 10; stage IVa, 4;and stage IVb, 1. World Health Organization tumor type: A and AB, 5; B1, 7; B2, 6; B3, 12; and unknown, 2. Among the 32 patients, relapses were found in the following sites: pleura (20 cases), tumor bed (10),non-tumor bed in mediastinum (one), lung (seven), chest wall (six), lymph node metastasis (four) , abdominal node metastasis (one),liver (one), pleural effusion (four), and overlapped recurrence (14).The patterns of recurrence: local recurrence, 6; regional recurrence, 8; distant recurrence, 5; local and regional recurrence, 6; regional and distant recurrence, 4; local, regional and distant recurrence, 3. The median recurrence interval was 42 months (range, 5–193 months). The median follow-up time after recurrence was 49.5 months (range, 1-136months). Overall 5-year survival after recurrence was 65.5%. 7 patients with relapse in the thorax are still alive after re-resection, with a median survival time of 26 months (range, 6-95 months). The perioperative mortality was 0% and the morbidity was 14%. 4 patients with local relapse were given radiotherapy (RT) alone, with a median survival of 60 months (range, 51-107months) and one was dead of progressive disease, probably due to lower reirradiation dose (50Gy), compared to others with radical radiation dose (60Gy). In patients with regional and/or distant relapse, 6 patients received chemotherapy, and had 37.5% of overall 5-year survival. 5 patients without re-treatment had 50% of overall 1-year survival, with median survival 3 months (range,1-20months). After re-treatment, 9 patients had re-relapse, and the re-relapse free survival rate was 63% at 5 years, with a median re-relapse free survival of 53 months (range, 11-69months). 1 of 15 patients with RT had radiation pneumonitis and recovered after management. In univariate analysis, age (<55y, ≥55y; p=0.009), patterns of relapse (p=0.042), and recurrence-free interval (<20months, ≥20months; p=0.038) were prognostic factors.

      Conclusion
      Reoperation for resectable thymoma recurrences is associated with better outcome and relative safety, and it should be recommended. In patients with local recurrence of thymoma, RT may get comparable survival to re-operation. RT/CT probably is the treatment of choice when re-resection is not feasible. Younger age, local and regional recurrence, and longer relapse-free interval are associated with positive prognosis.

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    P2.15 - Poster Session 2 - Thymoma (ID 191)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Thymoma & Other Thoracic Malignancies
    • Presentations: 2
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      P2.15-001 - Predictors of long-term survivals in patients with Masaoka stage III thymomas (ID 44)

      09:30 - 09:30  |  Author(s): L. Wang

      • Abstract

      Background
      To analyse long-term survival rates, reccurence rates and prognostic factors of patients with Masaoka stage Ⅲ thymomas.

      Methods
      A total of 111 patients with stage Ⅲ thymoma treated in our hospital between September 1965 and December 2010 were retrospectively analysed. Sixty-eight patients(61.3%) were with complete resection, while 23 patients(20.7%)with incomplete resection and 20 patients(18%)with pure biopsy(18 patients wih thoracic exploration surgery and 2 patients with CT-guidied fine needle puncture biopsy). Fifty-six patients with complete resection(50.5%)and 10 patients with incomplete resection(9%) had postoperative radiation. Twenty patients with pure biopsy received post or preoperative radiation or chemotherapy with or without surgery.

      Results
      The median follow-up time was 66 months(5-540). The total overall survival (OS) rates、disease free survival(DFS)rates and disease specific survival (DSS) rates at 5 and 10 year were 75.3%、60.8%、81.9% and 54.7%、41.3%、67.1%, respectively. Postoperative radiotherapy did not improve OS、DFS、DSS compared to surgery alone (p=0.316, p=0.729 and p=0.601). The OS at 5 and 10 year among the patients with complete resection、incomplete resection and pure biopsy were 88%、59%、56.7% and 69.3%、30.6%、47.3%, repectively (p=0.002). The DFS at 5 and 10 year among the patients with complete resection、incomplete resection and pure biopsy were 73.9%、40.1%、41.2% and51.5%、26.7%、30.9%, repectively (p=0.003). The DSS at 5 and 10 year were 93.9%、69.2%、59.7% and 78.9%、46.2%、59.7%, respectively (p=0.004). The total failure rate was 36% (40/111), including 30.6% locoregional recurrence and 9% distant metastasis (including multisite failure). Local recurrent rates in patients with postoperative radiotherapy was lower than patients with surgery alone (9.4% and 19.2%), but the result was not statistically significant (p=0.173). On multivariate analysis, resection completeness (p=0.000) and lung involvement (p=0.024) were independent prognostic factors for DFS, and resection completeness (p=0.002)、age (p=0.028) and myasthenia gravis (p=0.038) were independent prognostic factors for DSS.

      Conclusion
      Patients with completely resected Masaoka stage III thymoma had a better survival and lower recurrence rates than patients with tumor incompletely resected. The role of postoperative radiation needs further investigation. Resection completeness and lung involvement were prognostic factors for DFS, and resection completeness、age and myasthenia gravis were prognostic factors for DSS.

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      P2.15-002 - Patterns and Predictors of Recurrence after radical resection of Thymoma (ID 3022)

      09:30 - 09:30  |  Author(s): L. Wang

      • Abstract

      Background
      Even after complete resection, recurrence of thymoma is not uncommon, but the recurrent patterns remain controversial. This study sought to define the patterns and predictors of relapse after complete resection of thymoma.

      Methods
      A single-institution retrospective study was performed of 331 patients who underwent radical resection of thymoma from 1991 through 2012.

      Results
      After a median follow-up of 59 months (range, 3-256), the recurrence rates was 6.9% (23/331). Overall 5- and 10-year survival rates were 92.3% and 84.9%. Cancer specific survival rates were 95% and 89.4% at 5 and 10 years, respectively. Recurrence-free survival rates were 93.6% and 87.2% at 5 and 10 years, respectively. Among the 23 patients, relapses were found in the following sites: pleura (thirteen cases), tumor bed (six), lung (six), chest wall (four), lymph node metastasis (two) , abdominal node metastasis (one),liver (one), pleural effusion (three), and over-lapped recurrence (nine). According to the definition of the International Thymic Malignancy Interest Group, 10 (43.5%) patients had local recurrence, 15 (65.2%) had regional recurrence, 10 (43.5%) had distant recurrence (six lung, one liver, one abdominal node metastasis, and two lymph node metastasis), and 9 (39.1%) had over-lapped recurrence. The difference in survival after recurrence between lung and regional relapse was statistically significant (p=0.027), but it was insignificant between lung and distant relapse (p=0.808). Recurrence rates correlated with the initial Masaoka stage: I, 1.0% (2/196); II, 9.7% (9/93) ; III, 24.2% (8/33); IVa, 42.9% (3/7); and IVb, 100% (1/1). The difference in recurrence between Masaoka stage I and II was stastically significant (p=0.000). And they also correlated with World Health Organization tumor type: A and AB, 3.2% ( 5/154 ); B1, 6% ( 4/67 ); B2, 6% ( 3/50 ); and B3, 22.7% ( 10/44). Tumor size demonstrated a step-up of recurrence at 8 cm (<8 cm, 62.8%; ≥8 cm, 37.2%; P=0.007). In multivariate analysis, Masaoka stage (p=0.005), tumor size (p=0.033), and WHO histology (p=0.046) were predictive of recurrence.

      Conclusion
      Pleura are the most common recurrent sites. Recurrence in the lung had poorer survival than the regional relapse, it should be included in the distant recurrence. Regional recurrence is the most common pattern of relapse, but local and distant recurrences are not infrequently observed. Advanced Masaoka stage, larger tumor size, and Type B3 were risk factors of recurrence.