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L. Ladegaard



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    MO22 - Advanced Disease and Outcomes (ID 103)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      MO22.03 - Postoperative Rehabilitation and Follow-up - a randomized study. (ID 2422)

      10:40 - 10:45  |  Author(s): L. Ladegaard

      • Abstract
      • Presentation
      • Slides

      Background
      The importance of postoperative follow-up and rehabilitation after lung cancer surgery remains a controversial topic. Previous studies have showed that follow-up programs did not influence survival but at that time there was little focus on the effects of rehabilitation. Introduction of new diagnostic procedures, improvements in treatment modalities and increasing awareness on quality of life after treatment has changed guidelines and recommendations for follow-up programs. There is little evidence for these recommendations which prompted us to conduct a randomized study to evaluate the effect of an intense follow-up program on survival and quality of life for patients undergoing surgery for lung cancer (NSCLC).

      Methods
      Between January 2003 and April 2008 a total 197 NSCLC patients were included in the study after undergoing surgical resection (wedge, lobectomy or pneumonectomy) through a posterolateral thoracotomy. Adjuvant chemotherapy was offered to stage Ib - IIIa. Postoperatively patients were randomized to either active rehabilitation and follow-up (POREFU, N=103) or passive follow-up (Standard, N=94). Patients in the POREFU group had intensive follow-up in the form of annual clinical evaluation, chest X-ray, chest CT, bronchoscopy and EBUS (Endobronchial Ultrasound) for 5 years. In the POREFU group patients were also evaluated by a nurse and a physiotherapist after 6 weeks, 6 months and at annual controls. When indicated, interventions were established to correct patient symptoms. Patients in the standard treatment group were offered a chest X-ray one year after surgery and a clinical examination by their family doctors upon request. Quality of life in both groups was assessed after 6 weeks, 6 months, 12 months and 2, 3, 4 and 5 years evaluating EORTC QLQ-C30/LC13. All survivors were followed for 5 years.

      Results
      Figure 1There was no significant difference in survival between the two groups (Kaplan Meier plot). There was a significant difference between the two groups in favour of active follow-up regarding Global health status as well as “Physical”, “Role” and “Emotional” functioning and POREFU patients had significant less pain and fatigue. There was no statistical significant improvement of other symptoms or functional issues.

      Conclusion
      This randomized trial shows that a follow-up program with an additional focus on rehabilitation and intervention towards reported symptoms in patients operated for NSCLC significantly improves quality of life but has no effect on overall survival.

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    P2.08 - Poster Session 2 - Radiotherapy (ID 198)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Radiation Oncology + Radiotherapy
    • Presentations: 1
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      P2.08-018 - Interobserver Variability in Target Volume Delineations in Postoperative Radiotherapy for NSCLC. (ID 2298)

      09:30 - 09:30  |  Author(s): L. Ladegaard

      • Abstract

      Background
      The aim of this study is to determine the interobserver variability between thoracic surgeons and radiation oncologists in defining and delineating target volume for postoperative radiotherapy for patients with non small cell lung cancer (NSCLC). These patients were offered postoperative RT due to microscopic non-radical operation.

      Methods
      Between 2002 and 2010, 48 NSCLC patients were offered postoperative radiotherapy at Department of Oncology, Odense University Hospital due to microscopic non-radical operation. Two thoracic surgeons (S1 and S2) and two clinical oncologists (O1 and O2) were retrospectively asked to delineate clinical target volume (CTV) on the 3D CT scanning used for radiotherapy planning in each patient. Instruction were given to include the non-radical site on basis of surgical-, pathological-, and radiological reports. The delineation was done independently by each physician. There are no local guidelines for delineation postoperative volume after non radical microscopic operation. The spatial volume discrepancy between the different physicians was the end-point.

      Results
      The mean volumes were very different between the physicians: S1 20.5 (SD 17.4) cm[3], S2 21.5 (28.1) cm[3], O1 14.4 (20.5) cm[3], and O2 32.9 (SD 35.6) cm[3]. A large spatial volume discrepancy between the different physicians was observed as well. Mean discrepancies were O1-O2 18.5 (SD 25.3) cm[3 ](p<0.0001), O1-S1 6.1 (SD 21.4) cm[3] (p=0.06), S1-S2 1.3 (SD 22.9) cm[3] (p=0.7). Mean Soerensen-Dice index O1-O2 0.27 (SD 0.19), O1-S1 0.27 (SD 0.16), S1-S2 0.29 (SD 0.18). There was a reasonable overlap in 25 patients (52%) between all 4 physicians. In another 9 cases (19%) 3 physicians had a reasonable overlap and one “outlier”. Figure 1 illustrates one case with reasonable overlap, and another case with one “outlier”.

      Conclusion
      Figure 1 Several conclusions can be drawn from this study. At first it is very challenging to define postoperative volume, when there is no gross tumor volume as is the case when RT it is due to microscopic non-radical operation. Secondly, it is important to have guidelines in order to define the approximate size of the CTV, this in context of the large difference in the size of the volume between the oncologists. Thirdly, surgeon and oncologist should delineate the postoperative target volume in collaboration to ensure the correct conclusion is drawn on the basis of operation and pathological reports, in order to hit the right target and reduce irradiated volume.