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F. Psarros



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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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      P2.07-003 - Sampling vs. systematic full lymphatic dissection in surgical treatment of non-small cell lung cancer (ID 340)

      09:30 - 09:30  |  Author(s): F. Psarros

      • Abstract

      Background
      The extent of mediastinal lymph node assessment during surgery for non-small cell cancer remains controversial. Different techniques are used, ranging from simple visual inspection of the unopened mediastinum to an extended bilateral lymph node dissection. Furthermore, there are different terms to define these techniques: Sampling is the removal of one or more lymph nodes guided by preoperative finding. Systematic (full) nodal dissection is the removal of all mediastinal tissue containing the lymph nodes systematically within anatomical landmarks.

      Methods
      A Medline search was conducted to identify articles in English, addressing the role of mediastinal lymph nodes resection in the treatment of NSCLC

      Results
      Opinions favoring full lymphatic dissection include complete resection, improved nodal staging and better local control due to resection of undetected micrometastasis. Arguments against routine full lymphatic dissection are increased morbidity, increased operative time and lack of evidence of improved survival. For complete resection of non-small cell lung cancer a systematic nodal dissection is recommended for many authors, as the standard approach during surgery: it ascertains both adequate nodal staging and completeness of resection.

      Conclusion
      Whether extending the lymph node dissection influences survival or recurrence rate remains to be determined. There are valuable arguments in favor of not only an improved local control but also an improved long-term survival. However, the impact of lymph node dissection in long-term survival should be further assessed by large-scale multicenter randomized trials.

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    P3.10 - Poster Session 3 - Chemotherapy (ID 210)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.10-004 - Jaw Osteonecrosis in lung cancer patients: a retrospective analysis (ID 305)

      09:30 - 09:30  |  Author(s): F. Psarros

      • Abstract

      Background
      Lung cancer patients may develop oral complications related to conventional chemotherapy or targeted and antiresorptive agents. Early diagnosis of those complications, within a multidisciplinary team, can lead to effective treatment and the maintenance of patient’s quality of life. The aim of the current study is to present our 4-year experience (2009-2012) in the treatment and prevention of oral complications in lung cancer patients.

      Methods
      Forty three patients (21 women, 22 men, mean age 62.6 years) were included in the analysis. Thirty patients received active chemotherapy treatment; 9/30 (30%) received conventional chemotherapy in combination with targeted therapy, 11/30 (36.7%) targeted therapy and 10/30 (33.3%) conventional chemotherapy. Twenty-one patients received i.v. bisphosphonates (zoledronate 76.2%). Eleven patients received bishosphonates combined with bevacizumab; 4 of them had interrupted bevacizumab at the time of referral. Oral clinical and radiographic evaluation, using periapical and panoramic x-rays were performed. Dental scan was performed in 2 patients. Oral hygiene instructions were introduced and patients were educated about the importance of the maintenance of optimal oral health.

      Results
      Thirty three patients were referred by their medical oncologist (25 patients, 58.1%, by the SOTIRIA Hospital), 1 was referred by his dentist and 10 were self referred. Twelve patients (27.9%) presented with jaw osteonecrosis (Stage 0: 6, 50%, Stage I: 4, 33.3%, Stage II: 2, 16.7%); of those 4 received bevacizumab concurrently with zoledronic acid, 2 received the same combination in the past, 5 received zoledronate alone and 1 received zoledronate followed by denosumab. Six patients were diagnosed with oral candidiasis, 4 with herpes infection, and 2 with necrotizing ulcerative gingivitis. Nine patients had dental problems, while 5 patients were introduced to the Unit for preventive measures. Jaw osteonecrosis was treated with long term antibiotics, while local ozone oil was applied in 3 patients. Three dental extractions were performed in one patient with osteonecrosis stage 0. Today, 6 patients with osteonecrosis remain in partial remission, 3 are in complete remission, 2 were lost of follow up and 1 worsened. Of the 3 dental extractions, 2 healed and one led to osteonecrosis stage I. Patients with dental problems were further referred to their family dentists.

      Conclusion
      Osteonecrosis of the jaw, in the present series, was the most common oral complication. The dental oncology expert within in the multidisciplinary team contributed to the diagnosis of oral pathoses and of the osteonecrosis at the early Stage 0.

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    P3.23 - Poster Session 3 - Tobacco Control, Prevention and Chemoprevention (ID 164)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P3.23-001 - The clinical significance of smoking cessation in patients with cancer (ID 342)

      09:30 - 09:30  |  Author(s): F. Psarros

      • Abstract

      Background
      Despite the established causal relationship between tobacco smoking and cancer many cancer patients continue to smoke after diagnosis. This partly reflects the ignorance of the beneficial effects of smoking cessation even after diagnosis. The aim of the study is to demonstrate the effect of continuing or quitting smoking in patients with diagnosed cancer.

      Methods
      This study is based on a review of medical databases (Pub Med CENTRAL, MEDLINE, Cochrane Library) of the last thirty years. All articles included in the present analysis were in English.

      Results
      In patients with early stage lung cancer, continued smoking after diagnosis is associated with an increased risk of all cause mortality and decreased survival. Research has demonstrated significant difference in actuarial overall survival favoring the non-smoking group among patients with lung cancer. In patients with oral cancer smoking cessation or reduction leads to a significant reduction in mortality. There is also evidence that tobacco smoking exacerbates and prolongs radiotherapy induced complications.Of particular importance is the evidence that continued smoking is associated with adverse effects during anticancer treatment. Smoking increases tumor progression and resistance to chemotherapy due to nicotine-induced resistance to apoptosis by modulating mitochondrial signaling. Continuing smoking is also related with inferior outcomes during treatment with novel targeted therapies such as erlotinib. Continuing smoking in gastric and lung cancer patients is also associated with an increased risk of developing second primary tumors. Quitting smoking after lung cancer diagnosis is associated with better performance status while persistent smokers have worse overall quality of life. Patients who continued to smoke despite being diagnosed with cancer report more severe pain than never smokers and a greater interference from pain.

      Conclusion
      Continuing smoking after cancer diagnosis is related with reduced treatment efficacy and reduced survival, risk for more secondary malignancies and deterioration in quality of life.