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P. Boura



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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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      P2.07-004 - Wedge Resection and Segmentectomy in Patients with Stage I Non-small Cell Lung Cancer (ID 344)

      09:30 - 09:30  |  Author(s): P. Boura

      • Abstract

      Background
      The use of resections lesser than lobectomy as definitive management of a stage I non-small cell lung carcinoma (NSCLC) is a topic that creates controversy in the global medical community. To describe the current conclusions concerning the relative indications of each type of resection in the surgical treatment of stage I NSCLC, as well as the international results from their application concerning the local recurrence, disease-free survival, and five-year survival rates.

      Methods
      Thirty four prospective and retrospective studies registered in PubMed and Scopus electronic databases during the last twenty five years were reviewed. Bibliographies and handsearching of journals were used to identify trials. Studies’ authors, citations, objectives, and results were extracted. No meta-analysis was used. Validation of results was discussed.

      Results
      Segmentectomies were superior to wedge resections in terms of local recurrence and cancer-related survival rates. Sublobar resections were superior to lobectomy concerning preservation of pulmonary parenchyma. It was recommended that high-risk patients undergo segmentectomy. Lobectomies were superior to segmentectomies only for tumors >2 cm (T2bN0M0) as regarding disease-free and overall 5-year survival. There was no significant difference for tumors <2 cm in most studies. Free surgical margins were crucial for local control rates. Systematic lymphadenectomy was mandatory regardless of type of resection. In cases of pure bronchoalveolar carcinoma, segmentectomy was recommended. Shorter hospital stay was achieved with sublobar resections.

      Conclusion
      The choice of type of resection for T1aN0M0 tumors should rely on specific patient and tumor characteristics. Patient age and tumor size are the most important factors. Further prospective randomized trials are needed to determine minimal resections in early lung cancer patients.

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    P2.10 - Poster Session 2 - Chemotherapy (ID 207)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P2.10-005 - Erlotinib (E) can be safely administered in pts > 80 years old (ID 345)

      09:30 - 09:30  |  Author(s): P. Boura

      • Abstract

      Background
      Besides chemotherapy, E is another option in NSCLC pts especially in those with EGFR mutations. Elderly pts enrolled in trials are fit without cM, but in clinical practice most suffer from cM.

      Methods
      Medical records of 1221 pts diagnosed with NSCLC between 2008-2012 were screened. We examined pts ≥75 yrs for demographics, clinical data and Tx details.

      Results
      233/1221 NSCLC pts received E at any line. 53/233 (23%) were ≥75 yrs old. Male:female ratio was 34:19 and median age 79 yrs (range 75-88). NSCLC subtypes included 31 adenoca, 8 squamous cell, 9 NOS and 5 others. 50/53 pts had cM (≥2 in 46 pts, 1 in 4pt). Main cM were cardiovascular disease (n=41), COPD (n=14), other cancer (n=10) and diabetes (n=8). 8 pts were tested for EGFR mutations (5 -ve, 3 +ve). Performance Status was satisfactory (ECOG 0-1) in 8 pts and poor (2-3) in 45pts. 8pts were treated with E 100mg and 45 pts with E 150mg (12 pts needed dose reduction). Complete follow up data were found in 46pts. Mean duration of treatment was 79 days (range 9-662). 35/46 pts experienced side effects (s.e) [rash n=29, diarrhea n=17] which led to treatment discontinuation in 12pts. Pts with abnormal creatinine clearance (n=13) were more likely to stop treatment due to s.e (6/13 versus 6/33). 17/46 pts (37%) achieved disease control (5 PR, 12 SD) and a time to progression (TTP) of 157 days (range 106-662, 95% CI 132.79-270,74) while 22/46 pts had PD as best response (TTP 49d, range 19-88, CI 44,67-64,97). 7pts were not evaluable (stopped Tx due to s.e). All EGFR+ve pts had disease control (2PR, 1SD).

      Conclusion
      E is a valuable option in elderly NSCLC patients with co-morbidities, especially if they harbor EGFR mutations. Impaired renal function might be associated with propensity to side effects and earlyTx discontinuation.