Author of

• 10912

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  P1.17 - Poster Session 1 - Bronchoscopy, Endoscopy (ID 182)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Pulmonology + Endoscopy/Pulmonary
  • Presentations: 2
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10918

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    P1.17-006 - Early Bronchoscopic Interventional Strategy in Highly at Risk Morbid Ageing Cohort (ID 2322)

    09:30 - 09:30  |  Author(s): I. Smesseim
    • Abstract

    Background
    We retrospectively reviewed our longitudinal data (1992 - 2012) with regard to early interventional techniques using advancements of non- and minimally invasive techniques (NiMiT) as alternatives for early intervention in squamous carcinogenesis in highly at risk -including frail elderly individuals. >50% lung cancer develops in >70 years age cohort and cancer and ageing are becoming an important health care issue in our society.

    Methods
    So far, 159 surgically non-resectable candidates with various comorbidities (Previous LC/ENT primaries, COPD, etc.) have been closely monitored using autofluorescence bronchoscopy for suspicious endobronchial lesions (e.g. dysplasia, carcinoma in situ and microinvasive squamous cancer). End points were the development of squamous cancer and its outcome with the use NiMiT (Chest 2001;120:1327; Respiration 2004;71:391

    Results
    Patient characteristics and outcome are shown in the table. Cohort analyses of age ≤70 years versus over, showed a significant longer time of survival in the elderly cohort (35.9 vs 18.5 months; p = 0.01). Lung cancer specific mortality was low ,respectively 15% and 22%. Table: Longitudinal carcinogenesis study in cohorts highly at risk to develop (subsequent) squamous cancer primaries and its outcome.

    Age cohort (years) n patients	<70 112	>70 47	p-value
    Gender - Male - Female	93 (83%) 19 (17%)	39 (83%) 8 (17%)	NS
    Mean age years (range)	60(42-70)	74(70-83)
    Indication for close surveillance: - Previous LC /ENT cancer - Suspicion occult lung cancer	55 (49%) 57 (51%)	19 (40%) 28 (60%)	NS
    Mean pack-years smoked (range)	44(4-120)	49(20-137)	NS
    COPD Non-COPD Unknown	72 (64%) 32 (29%) 8 (7%)	29 (62%) 10 (21%) 8 (17%)	NS
    Interval to (subsequent) primaries (months)	69(0-198)	54(1-184)	NS
    Acquiring (subsequent) squamous ca. Recurrences of previous primaries	41 (37%) 4 (4%)	12 (26%) 2 (4%)	NS NS
    Death due to lung cancer Other causes	25 (22%) 31 (28%)	7 (15%) 17 (36%)	NS NS
    Survival after curative treatment (months)	19 (0-110)	36 (0-106)	0,01

    Conclusion
    In contrast to the undocumented belief about less aggressive cancer, the need for less aggressive treatment, potential toxicities in the co-morbid elderly and their expected shorter life span, the outcome shows that early interventional strategy is warranted. LC mortality is relatively low despite the highly negative selection bias, especially in the frail – ageing – subcohort. This warrants further studies to increase the cost-effectiveness of NiMiT in our ageing population.

  • 10920

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    P1.17-008 - Results of a close surveillance strategy for subjects with pre-invasive endobronchial squamous lesions (ID 2678)

    09:30 - 09:30  |  Author(s): I. Smesseim
    • Abstract

    Background
    The dismal overall 5-year survival of non-small cell lung cancer (NSCLC) patients is mainly due to advanced stage of disease at time of initial diagnosis in most and the inability to cure metastatic disease in all patients. In contrast, the prognoses of in situ mucosal and small parenchymal lesions are excellent. Early detection strategies might result in the identification of early-stage, (pre-)invasive lesions that are still eligible for curative treatment. The present study was set out to characterize the risk of lung cancer development in a cohort of high-risk subjects harboring pre-invasive endobronchial lesions and to assess the results of surveillance using autofluorescence bronchoscopy (AFB) and computed tomography (CT) scan.

    Methods
    Between November 1995 and December 2012, one hundred and sixty-four at risk individuals with pre-invasive endobronchial lesions were monitored by repeated AFB and CT. During the course of surveillance, progression of lesions to cancer (in situ), recurrences and second primary cancers were treated with different modalities (e.g. endobronchial techniques, surgery, radiotherapy), depending on tumor stage and location. Log-rank tests were performed to examine the relation between baseline characteristics and progression-free and overall survival (PFS and OS, respectively). Cox regression was used for multivariate survival analysis.

    Results
    Demographical and clinical variables of the cohort are shown (Table). At inclusion, 80 individuals were identified with one or more high-grade pre-invasive lesions (severe dysplasia or CIS; HGD), whereas 84 subjects were identified solely with lower grade pre-invasive lesions (LGD). During close surveillance (median follow-up (FU) of 30 months, range 4-152), sixty-one lung cancers were detected (26 CT-detected, 35 AFB-detected cancers) in 55 individuals within a median time to event of 16.5 months. Mean PFS was similar between individuals with radiographically occult lesions vs. FU after surgery for early-stage NSCLC/ENT ca (122.3 vs. 126.9 months, p=0.237) and COPD vs. non-COPD (118.8 vs. 136.8 months, p=0.162). There was a relatively large difference in PFS between LGD and HGD groups (142.6 vs. 93.7 months, p=0.057). Independent risk determinants for OS were indication for surveillance (FU after surgery for early-stage NSCLC/ENT ca vs. radiographically occult lesions, p=0.008) and COPD-status (COPD vs. non-COPD, p<0.001).

    		Referral for radiographically occult lesion	Follow-up after surgery for early-stage NSCLC / ENT ca
    	total
    individuals, n	164	92	72
    Gender
    male	134	72	62
    female	30	20	10
    Age at baseline
    years, mean (range)	64.2 (42-83)	64.8 (42-81)	64.0 (43-82)
    Smoking status
    current smoker	75	44	31
    former smoker	74	36	38
    unknown	15	12	3
    Smoking history
    Pack-years, mean (range)	45 (4-137)	45 (4-120)	40 (15-137)
    COPD-status
    COPD	100	56	44
    non-COPD	45	22	23
    unknown	19	14	5
    AF Bronchoscopies
    Number, mean (range)	7 (1-27)	5 (2-27)	6 (1-18)
    CT-scans
    Number, mean (range)	3 (0-20)	2 (0-20)	3 (0-18)
    No. of detected lung cancers
    During surveillance period	61	29	32
    Parenchymal cancer	21	12	9
    Site-specific lesion progression	24	13	11
    Interval cancer	10	4	6
    Recurrences previous primaries	6	0	6
    Patient outcome
    alive	80	56	24
    died of lung cancer	33	13	20
    died of other/unknown cause	51	23	28

    Conclusion
    Our findings demonstrate that individuals with pre-invasive endobronchial lesions are at high risk of developing (second primary) lung cancers. Combined surveillance using AFB in addition to CT screening facilitated early detection and early (endobronchial) intervention in most patients. Future clinical trials are warranted to determine whether the current approach improves patient outcome.