Author of

• 11595

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

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

  • 11604

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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): M. Takahama
    • 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.

• 12701

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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
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12720

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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): M. Takahama
    • 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.

• 12853

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

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

  • 12872

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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): M. Takahama
    • 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.