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H. Tada



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    MO13 - SCLC I (ID 118)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Medical Oncology
    • Presentations: 1
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      MO13.08 - A pilot study of adjuvant chemotherapy with irinotecan and cisplatin for completely resected high grade pulmonary neuroendocrine carcinona (Large cell neuroendocrine carcinoma and small cell lung cancer) (ID 1562)

      11:15 - 11:20  |  Author(s): H. Tada

      • Abstract
      • Presentation
      • Slides

      Background
      Large cell neuroendocrine carcinoma (LCNEC) and small cell lung cancer (SCLC) are recognized as high grade neuroendocrine carcinoma (HGNEC) of the lung. In patients with completely resected HGNEC, platinum-based adjuvant chemotherapy may be considered. However, the optimum chemotherapy regimen has not been determined. We conducted a multicenter single-arm phase II trial to evaluate irinotecan and cisplatin in postoperative adjuvant chemotherapy for HGNEC patients.

      Methods
      Patients with completely resected stage I- IIIA HGNEC received 4 cycles of irinotecan (60 mg/m[2], day 1, 8, 15) plus cisplatin (60 mg/m[2], day 1). This regimen was repeated every 4 weeks. Other eligibility criteria included ECOG PS 0–1, age 20, and <75 years old, adequate organ function, and no prior chemotherapy or radiotherapy. Patients with UGT1A1 polymorphisms (homozygous for *6 or *28, or simultaneously heterozygous *6 and *28), associated with irinotecan-related severe toxicity, were excluded. The primary endpoint was the rate of completion of chemotherapy (defined as underwent 3 or 4 cycles), and secondary endpoints were 3-year relapse free survival (RFS), rate of 3-year survival and toxicities.

      Results
      Forty patients were enrolled between September 2007 and April 2010. Patients’ characteristics were as follows: median age (range) 65 (45-73) years; male 85%; ECOG-PS 1 60%; LCNEC 57% and SCLC 43%; stage IA/IB/IIB/IIIA 32/35/8/5%; 95% received lobectomy. The rate of completion of chemotherapy was 83% (90% C.I.; 71-90%). The rate of overall survival at 3 years was estimated at 81%, and of RFS at 3 years was 74%. The rates of overall survival and RFS at 3 years were 86% and 74% among 23 LCNEC patients, and 74%, 76% among 17 SCLC patients, respectively. Nineteen patients (48%) experienced grade 3 or 4 neutrophils, but only five patients (13%) developed febrile neutropenia. Two patients (5%) developed grade 3 diarrhea, and 4 patients (10%) had grade 3 nausea. No treatment related deaths were observed in this study. All 40 specimens were also diagnosed as HGNEC at pathological central review among 7 pathologists. There were two specimens that showed the difference in between institutional diagnosis and central pathological diagnosis.

      Conclusion
      The combination of irinotecan and cisplatin as postoperative adjuvant chemotherapy was feasible and possibly efficacious for resected HGNEC.In Japan, a randomized phase III trial is ongoing to evaluate adjuvant chemotherapy of irinotecan and cisplatin, compared with etoposide and cisplatin, for completely resected HGNEC.

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    O09 - General Thoracic Surgery (ID 100)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      O09.02 - Clinicopathological characteristics and surgical results of lung cancer patients aged up to 50 years: the Japanese Lung Cancer Registry Study 2004 (ID 83)

      16:25 - 16:35  |  Author(s): H. Tada

      • Abstract
      • Presentation
      • Slides

      Background
      Since the incidence of lung cancer death increases from 50 years-old, the surgical results of young lung cancer patients remains unclear.

      Methods
      Seven hundred and four patients with lung cancer, aged up to 50 years, were enrolled from among the 11,663 patients registered in the Japanese Lung Cancer Registry Study 2004, and their clinical data were compared with those of 10959 patients older than 50 years.

      Results
      In the young/old groups, pneumonectomy was performed in 5.7%/3.2%; adjuvant therapies were given preoperatively in 10.4%/4.7% (p<0.001) and postoperatively in 31.4%/24.5% (p<0.001). The proportions of patients with p-stage IIIA and adenocarcinoma histology were higher in the young group. The 5-year overall survival rate (5Y-OS) was 94.8%/86.2% for p-stage IA (p<0.001), 87.0%/73.2% for p-stage IB (p=0.001), 61.0%/61.6% for p-stage IIA (p=0.595), 71.0%/48.4% for p-stage IIB (p=0.003), 49.6%/39.4% for p-stage IIIA (p=0.020), and 80.0%/24.8% for p-stage IIIB (p=0.012); it was 83.5%/80.7% for females (p=0.106) and 75.1%/62.3% for males (p<0.001) in the young/old groups. The postoperative survival was significantly better with all operative procedures in the young group. The 5Y-OS after recurrence was better in the young group (17.9%, p=0.016). In the young group, the 5Y-OS was better in females (83.5%) than in males (75.1%, p=0.002), and for patients with adenocarcinoma (80.3%) than for those with squamous cell carcinoma (68.5%, p=0.013). Age up to 50 years was identified as an independent prognostic factor on multivariate analysis. Figure 1

      Conclusion
      The postoperative survival in lung cancer patients aged up to 50 years was better than that in patients older than 50 years.

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

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    P2.07 - Poster Session 2 - Surgery (ID 190)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P2.07-009 - What is an appropriate treatment strategy for superior sulcus tumors? (ID 1057)

      09:30 - 09:30  |  Author(s): H. Tada

      • Abstract

      Background
      Superior sulcus tumors (SST) comprise a subgroup of non-small-cell lung cancers that arise near the pulmonary apex or superior sulcus. They generally invade the chest wall and brachial plexus, and occasionally the subclavian vessels. Induction chemoradiation therapy followed by surgery is the recommended treatment for SST. However, surgical approaches for SST remain controversial, partly because of their infrequent use. Several approaches to resecting these tumors have been described, depending on the precise localization and involvement of the surrounding organs. These include posterolateral thoracotomy, hemi-clamshell and transmanubrial osteomuscular-sparing approaches. It is necessary to establish the appropriate multimodality therapy for SST, including the optimal surgical approaches.

      Methods
      We retrospectively analyzed the clinical courses of patients with SST treated with surgery at our institution. A total of 2765 patients with non-small-cell lung cancer were treated surgically at Osaka City General Hospital, Japan, from January 1995 to December 2012. Among these, 34 patients with SST were investigated in this study.

      Results
      The mean age of the patients was 62 years (range, 42–90 years). There were 32 men and two women. Seventeen patients had squamous cell carcinoma, 12 had adenocarcinoma, and five patients had tumors of other histological types. There were 21 patients with stage 2B, 10 with stage 3A, and three patients with stage 3B disease. Two patients received induction chemotherapy, and 22 patients received induction chemoradiotherapy. Posterolateral thoracotomy was performed in 11 patients and anterior thoracotomy (hemi-clamshell, transmanubrial osteomuscular-sparing approaches) in 22 patients. A combination of anterior and lateral thoracotomies was applied in one patient. Pulmonary lobectomy was performed in 25 patients, segmentectomy in one patient, and pulmonary partial resection in nine patients. The resected surrounding organs, other than the chest wall, were the subclavian artery in two patients, the superior vena cava in two, and the aortic arch and vertebral body in two patients each. The median follow-up period was 16 months (range, 3–154 months). Postoperative 1-, 3- and 5-year survival rates were 72%, 46%, and 34%, respectively. Investigation of clinicopathological factors with potential impacts on postoperative outcome identified pathological nodal extension as the only significant factor indicating poor prognosis (p < 0.01). Tumor markers, surgical approach, type of pulmonary resection, and type of resected surrounding organ had no effect on postoperative outcome. No viable tumor was observed in seven of 22 patients treated with induction chemoradiotherapy, and the postoperative 5-year survival rate in these seven patients was 86%. Recurrent disease was observed in 17 patients during the postoperative follow-up period. Local recurrence was observed in five patients and recurrence in distant organs was observed in 13 patients.

      Conclusion
      Patients with node-positive SST have a poor prognosis, and surgical indications should be investigated fully in these patients. Induction chemoradiotherapy is necessary to treat SST. The major sites of recurrence are in distant organs, and the type of pulmonary resection does not affect postoperative outcome. Partial resection may be an acceptable option in patients with no detectable viable tumor after induction chemoradiotherapy.

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    P2.22 - Poster Session 2 - Epidemiology, Etiology (ID 167)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P2.22-001 - Japanese Nation Wide Lung Cancer Registries conducted by the Japanese Joint Committee of Lung Cancer Registry (JJCLCR) (ID 66)

      09:30 - 09:30  |  Author(s): H. Tada

      • Abstract

      Background
      The Japanese Joint Committee of Lung Cancer Registry (JJCLCR) is jointly established by the Japan Lung Cancer Society, the Japanese Respiratory Society, the Japanese Association for Chest Surgery and the Japan Society for Respiratory Endoscopy, conducting Japanese nation-wide registries of lung cancer patients

      Methods
      In 1999, 2004 and 2009, registries were conducted for surgical patients in 1994, 1999 and 2004, respectively. In 2002, both surgical and non-surgical (non-biased) patients in 2002 were registered with a follow up period of 3 years or more. In 2012, a registry has been conducted for non-surgical patients in 2012 with a follow up period of 3 years. In 2016, surgical patients in 2010 will be registered. These registries were observationally assessed.

      Results
      Registries for surgical cases in 1994, 1999 and 2004 which were conducted in 1999, 2004 and 2009 revealed the trend of increase in mean age, rates of female, the aged, small sized lesion, adenocarcinoma and stage I, and that of decrease in the rate of perioperative death. Furthermore proposals for TNM classification were stated as peer reviewed papers- invasion to visceral pleura, chest wall and fat tissue in the mediastinum for T factor. In addition, status of N2 disease were assessed resulting in that highly selected cases (3.8%) were subjected to surgery or surgery-included multimodal therapy with a 5-year survival rate of 30.1% in cN2/pN2-Stage IIIA and it was better than previous registries. Registry for surgical and non-surgical patients in 2002 revealed that stage-specific prognosis was within a range similar to other reports and stage, gender, surgery and performance status were independent prognostic indicator of both non-small and small cell lung cancer. Registry of non-surgical cases in 2012 was conducted and greater than 8,000 cases were registered. In this study, status of usage of FDG-PET scan for staging, EGFR gene mutation and individual therapy were, and prognosis of patients will be registered. In up-coming registry for surgical cases in 2010 which will be performed in 2016, new parameters- the size of tumor regarding non-invasive regions in adenocarcinoma (ground grass opacity in computed tomography), quantitative assessment of lymph node metastasis (the number of metastasized lymph node) as a prognostic indicator, which may be assessed as factors of TNM classification in the future. Besides, the TNM classification will be revised in 2016 according to the proposal from IASLC staging project, to which the JJCLCR offered data of 47,306 cases (approximately 25% of whole world wide cases) from the recent 4 registries.

      Conclusion
      The JJCLCR conducted nation-wide lung cancer registry in Japan, revealing the condition of the treatment of lung cancer and contributing to the TNM staging program.

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    P3.12 - Poster Session 3 - NSCLC Early Stage (ID 206)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.12-019 - Feasibility and efficacy of radical local therapy for Oligo-Recurrence of NSCLC (ID 3227)

      09:30 - 09:30  |  Author(s): H. Tada

      • Abstract

      Background
      Oligo-Recurrence (< 5 metastatic lesions) of surgically resected Non-Small Cell Lung Cancer (NSCLC) patient was stage IV disease, but long term survival was expected. Radical local therapy may be able to cure a subset of these patients, but clinical data has been insufficient.The purpose of this study is to evaluate the efficacy and toxicity of local therapy (include surgery (OP) and radiation therapy (RT)) according to the recurrence site.

      Methods
      We retrospectively reviewed surgically resected patients of NSCLC at our institution between 1994 and 2009, and extracted patients who received local therapy after recurrence. Efficacy and toxicity were compared between OP and RT. Significant differences among treatment groups were compared using the X[2]-test and survival curves were constructed using the Kaplan-Meier method and log-rank test.

      Results
      Of the 1975 patients who underwent surgery during this period, and 421 cases were relapsed. Two hundred sixty patients were oligo-recurrence case and were received local therapy (OP: 48/ RT: 143). Primary lesion had been controlled in all cases. Recurrence sites were lung: 55 (21/ 34), Brain: 52 (3/49), Mediastinal and neck LN: 49 (7/38), Born: 33(3/30) and Adrenal gland: 7 (3/4). RT for brain metastasis was r-knife: 38 and Whole brain irradiation: 11. There were no serious adverse events in both treatments. Performance status was not spoiled in both treatment groups. Overall median survival time (MST) after recurrence was 17 months (mo.) (OP: 27/RT: 11), 3-year survival rate was 22% (29%/19%). Twenty patients (OP 6/RT 6) were survived over 5 years. MST according to the recurrence site was, lung: 23 mo. (27/11), Brain 18 mo. (16/18), mediastinal and neck LN 14 mo. (12/14), born 12 mo. (17/11) and adrenal gland 26 mo. (22/47). There was no statistically significant difference in survival for overall patients, according to the recurrence site, and also treatment modality.

      Conclusion
      Local therapy for oligo-recurrence NSCLC could be safety performed. Overall survival data was not extremely superior to other Stage IV disease in this data. However, according to the recurrence site, MST of lung and adrenal gland were over 20 months. There was no significant difference between treatment modality. To confirm the true efficacy of radical local therapy for these patients, prospective study must be needed.

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    P3.24 - Poster Session 3 - Supportive Care (ID 160)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P3.24-019 - Local management of NSCLC with operable primary lesion and synchronous solitary brain metastasis (ID 1223)

      09:30 - 09:30  |  Author(s): H. Tada

      • Abstract

      Background
      The treatment for non small cell lung cancer (NSCLC) with operable primary lesion and solitary brain metastasis has not formed but the combined local therapy with surgical pulmonary resection of primary lesion and curative neurosurgical intervention of solitary brain metastatic site is becoming a standard option for such patients. The purpose of this study is to assess the efficacy and safety of the combined local therapy for NSCLC with operable primary lesion and solitary brain metastasis.

      Methods
      Within 1781 NSCLC patients underwent surgical resection from December 1993 to December 2010 at Osaka City General Hospital, 11 cases with synchronous (within 1 month of the primary NSCLC diagnosis) solitary brain metastasis and treated with curative neurosurgical intervention were identified. We retrospectively reviewed these cases and analyzed the treatment, pathology, prognosis and prognostic characteristics. Overall survival was recorded from the date of lung surgery until the last follow-up observation.

      Results
      The study group consisted of 7 male and 4 female. The median age at the time of pulmonary resection was 57 years (range, 39-76 years). The histological subgroup was adenocarcinoma in 10 cases and large cell carcinoma in 1 case. Neurological symptoms as the initial symptom were recognized in 3 cases. Type of pulmonary resection for primary lesion were lobectomy in 10 patients and sleeve lobectomy in 1 patient, and lymphatic extension was pN0 in 7 patients and N1-2 in 4 patients. All patients received gamma knife stereotactic radiosurgery (GKSRS) for management of the solitary brain metastasis and curative neurosurgical resection was performed in 1 patient before GKSRS. Both pulmonary resection and neurological intervention caused no serious adverse events. Of 11 patients, 7 patients had died of disease and 4 patients (3 with pN0 and 1 with pN1) were alive and with disease. The median overall survival time was 14 months and the 3-year overall survival rate was 36.4%.

      Conclusion
      The aggressive combined local therapy with pulmonary resection and neurological intervention for NSCLC patients with operable primary lesion and synchronous solitary brain metastasis should be considered effective and safe for selected patients. The multicentre prospective randomized studies are required to clarify the effectiveness and optimal method of this local treatment for such patients.