Author of

• 11001

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11041

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    P1.24-040 - Management of solid lung malignancy by CT-guided percutaneous catheter ablation --- Does adjuvant chemotherapy help? (ID 2978)

    09:30 - 09:30  |  Author(s): P. Andrew
    • Abstract

    Background
    With a burgeoning population of elderly patients with lung cancer deemed non-surgical, increasing utilization of minimally-invasive techniques such as CT-guided percutaneous catheter ablation is occurring for the management of solid tumors. However, it is unknown whether a strategy of ablation plus adjuvant chemotherapy improves locoregional and survival outcomes in aged patients with solid lung malignancy. The aim of this study was to compare local tumor recurrence and survival outcomes of ablation plus adjuvant chemotherapy versus ablation alone for management of primary and metastatic solid lung tumors in patients unsuitable for lung resection.

    Methods
    Searched PubMed, the Cochrane Library, EMBASE, and CANCERLIT databases from January 2000 to December 2012. Blinded duplicate screening was used to extract data from captured clinical studies involving patients with non-surgical solid lung tumors, both primary and/or metastatic. Population was deemed non-surgical, with solid lung tumors, both primary and/or metastatic. Generated aggregate effect estimates from constituent studies for three outcomes (e.g., local tumor progression [LTP], overall survival [OS], and disease-free survival [DFS]) with comparison of pooled fixed effect analyses concerning ablation plus adjuvant chemotherapy versus ablation alone. Data were analyzed using dedicated meta-analysis statistical software (BioStat Inc., NJ, USA).

    Results
    Ablation + chemotherapy group: 684 patients and 1,314 lung tumors. Ablation only group: 1,874 patients and 2,604 lung tumors. Histology was NSCLC >> mets from colorectal cancer > sarcoma > renal > other. Ablation + chemotherapy versus ablation alone: LTP of 15% over median follow-up of 31 months [range 12 to 59] versus 19% over median follow-up of 21 months [range 12 to 29]; odds ratio (OR) 0.73 (95% CI: 0.61-0.86, p<0.05) at 12 month follow-up. OS was 89% versus 78%, respectively, at 12 month follow-up; OR 1.52 (95% CI: 1.16-2.00, p=0.003). DFS was 90% versus 82%, respectively, at 12 month follow-up; OR 3.18 (95% CI: 2.04-4.96, p<0.05). Forrest plots for the outcomes of LTP, OS, and DFS are shown. Sensitivity analyses were robust, publication bias relatively narrow, and Q statistic <21; p>0.13 for all outcomes.Figure 1

    Conclusion
    A strategy of CT-guided percutaneous catheter ablation plus adjuvant chemotherapy delivers the benefit of retarding LTP, and expectedly lengthens both OS and DFS. Elderly patients with solid lung tumors who are most likely to benefit from this strategy would be non-surgical candidates with relatively good performance status who could tolerate both catheter ablation and chemotherapy.

• 11794

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  P2.12 - Poster Session 2 - NSCLC Early Stage (ID 205)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11800

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    P2.12-006 - Factors impacting the management of solid lung tumors by percutaneous radiofrequency ablation in non-surgical patients (ID 1136)

    09:30 - 09:30  |  Author(s): P. Andrew
    • Abstract

    Background
    By 2010, the estimated number of percutaneous radiofrequency ablation (RFA) procedures to treat solid thoracic malignancies approached 150,000 per annum. But limited data exists regarding factors that impact local recurrence following RFA of solid lung tumors in non-surgical patients. The objective of this meta-analysis was to compare pooled estimate data of LTP for small (<3cm diameter) versus large (≥3cm diameter) solid lung tumors following CT-guided percutaneous RFA. Moreover, sensitivity analyses were used to consider whether lung lobular site (RUL, RML, RLL, LUL, lingula, and LLL), histology (primary versus metastatic), and adjuvant chemotherapy modified local tumor recurrence.

    Methods
    Study design: Based on meta-analysis. Evidence was gathered from PubMed, the Cochrane Library, EMBASE, and CANCERLIT databases from January 2000 to December 2012; additional interrogation of abstracts from scientific meetings, bibliographies of identified studies, and clinical trial registries [e.g., clinicaltrials.gov] was undertaken in an effort to identify all available evidence. Blinded duplicate screening was used to extract data from captured clinical studies involving patients with non-surgical solid lung tumors, both primary and/or metastatic. Aggregate effect estimates from constituent studies for single outcome (local tumor progression; [LTP]) was the basis for comparing pooled estimates. Population: non-surgical patients with solid lung tumors, either primary and/or metastatic. Intervention: RFA +/- PAC. Comparators: small (<3cm diameter) versus large (≥3cm diameter) tumors. Outcomes: LTP at 1 year follow-up; sensitivity analyses for tumor location in lung lobules, tumor histology, and post ablation chemotherapy (PAC).

    Results
    Pooled estimate analysis involved 87 small tumors versus 96 large tumors; 106 primary versus 48 metastatic. LTP 6% for small tumors versus 19% for large tumors following percutaneous RFA at 1 year follow-up; odds ratio (OR) 4.7 (95% CI: 1.5-14.9, p=0.009). Tumor location and histology did not significantly perturb LTP (p>0.1). RFA plus PAC yielded LTP of 15% over median follow-up of 31 months [range 12 to 59]) whereas RFA alone yielded 19% over median follow-up of 21 months [range 12 to 29]); OR 0.73 (95% CI: 0.61-0.86, p<0.05) at 1 year follow-up.

    Conclusion
    RFA is a relatively new tool for local control of solid lung tumors. To our knowledge, our meta-analysis is the first to purposely demonstrate factors that impact the management of solid lung tumors by percutaneous RFA in non-surgical patients. Our pooled analysis revealed that locoregional control of lung malignancy by percutaneous RFA is most effective for tumors <3cm in diameter, is independent of lung lobular site and tumor histology, but is optimized with a therapeutic strategy of RFA plus PAC. Patients most likely to benefit from a RFA plus PAC strategy would be non-surgical candidates with solid lung tumors that have a relatively good performance status and could tolerate RFA plus PAC.