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N. O'Rourke
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ORAL 26 - Clinical Trials 2 (ID 127)
- Event: WCLC 2015
- Type: Oral Session
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:A. Scherpereel, C. Thomas
- Coordinates: 9/08/2015, 10:45 - 12:15, 702+704+706
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ORAL26.05 - Symptom Study of Radiotherapy in Mesothelioma (SYSTEMS), a Phase II Study (ID 390)
11:28 - 11:39 | Author(s): N. O'Rourke
- Abstract
- Presentation
Background:
There is little evidence to support the use of radiotherapy in treating pain in malignant pleural mesothelioma (MPM), however it is widely used. The aim of the present study was to assess the role of radiotherapy in palliating pain in MPM.
Methods:
A multi-centre, single arm, phase II study was conducted in the UK. Eligible patients met the following criteria: a diagnosis of MPM; worst pain score of > 4/10; performance status 0-2; CT scan within eight weeks of radiotherapy; due to receive radiotherapy for pain. Patients who had received anti-cancer therapy in the previous 6 weeks were ineligible. The following key assessments were performed at study baseline: pain (Brief Pain Inventory), Quality of Life (EORTC QLQ-C30) and inflammation (CRP). Following this, all patients were treated with 20 Gray in five fractions to the area of tumour felt to be responsible for the pain. The primary endpoint was a 30% drop in the BPI score five weeks after radiotherapy. Patients were followed up for 12 weeks after radiotherapy.
Results:
Forty patients were recruited between June 2012 and December 2013. Mean age was 71 with a male to female ratio of 7 : 1. Histological diagnosis was present in 85% of patients; 52.5% epithelioid, 25% sarcomatoid, 7.5% biphasic and 15% unspecified. The mean response to radiotherapy at five weeks was 35% (95% CI 20.6-51.7%). 37 patients started radiotherapy and 35 patients completed the full course. Fourteen patients had received prior chemotherapy. No association between baseline CRP and response was observed (p=0.958). Only one patient had a radiological response on CT with stable disease seen in a further 13 patients. There was no significant change in quality of life (QoL) score at any timepoint (p=0.680 week 1, p=0.765 week 5, p=0.384 week 12).
Conclusion:
Radiotherapy provides effective pain relief in a proportion of patients with MPM and should be considered for all patients with MPM related pain. Randomised dose escalation studies are now warranted and funding has been secured for such a study, SYSTEMS 2.
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P1.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 206)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.01-030 - Curable Bulky T4 Right Lower Lobe Tumours Invading Diaphragm and Liver: A Distinct Entity? (ID 1694)
09:30 - 09:30 | Author(s): N. O'Rourke
- Abstract
Background:
One third of patients with non-small cell lung cancer present with unresectable stage III disease. The median survival for all stage III(A and B) tumours with optimal chemoradiation in published series ranges 17-24 months. Using platinum doublet neoadjuvant chemotherapy as primary treatment the expected response rate is modest at 30-40%. In patients presenting with bulky T4 tumours with direct extension to diaphragm and beyond into liver, the expected outlook would be extremely poor. We report here a series of four such cases over a five year period in our practice which challenge our understanding of this disease
Methods:
Our regional lung cancer network presents all new patients at multidisciplinary tumour meetings to agree staging and management plan. We record data on all new patients registered with demographic data, performance status, results of staging and pathology investigations, treatment proposed, treatment delivered and outcomes in terms of progression free and overall survival.
Results:
Between January 2009 and end 2013 we recorded four cases of bulky right lower lobe lung cancers which showed radiological evidence of invasion into diaphragm (1 case) or beyond to liver (3 cases). There were 2 men and 2 women with ages 34, 51, 52 and 68. Three had squamous carcinoma and in one tumour was poorly differentiated, no subtype. Two were staged radiologically T4N2 and two were T4N0 but both with gross visible extension into liver. All patients were fit and received induction chemotherapy (2 carboplatin/paclitaxel and 2 cisplatin/vinorelbine). All had extraordinary responses to chemotherapy and proceeded to microscopically complete surgical resection. One patient had no viable tumour at operation including within the necessary liver resection. Another had only necrosis in the liver but small area viable residual tumour at right hilum and proceeded to post-op radiotherapy. All are alive with no evidence of recurrence with follow-up ranging 22, 34, 64 and 71 months
Conclusion:
This series although small is remarkable for the exquisite chemosensitivity of locally very advanced squamous cancers which have been apparently cured by neoadjuvant chemotherapy and surgical resection. We are undertaking additional pathological analysis of these specimens to determine whether there is a linking characteristic.
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P1.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 233)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.04-026 - Lung Cancer Patients Who 'Relapse' After Primary Treatment May Have Different Pathology or No Malignancy (ID 1699)
09:30 - 09:30 | Author(s): N. O'Rourke
- Abstract
Background:
In the evolving era of genetic sequencing of lung tumours and targeted agents, there is impetus to repeat biopsies of previously treated lung cancers when there is clinical and radiological evidence of relapse, justified on the basis that genetic status of the tumour may change over time. In our centre, even prior to genetic subtyping of lung cancers we have operated a policy of confirming relapse histologically and we present here the value of this strategy. This audit describes the outcome of repeat biopsies in the lung cancer population of Greater Glasgow over a five year period.
Methods:
The regional pathology database was interrogated for all patients with previous diagnosis of lung cancer who had repeat biopsy between February 2009 and March 2014. Inclusion criteria were those whose initial diagnostic biopsy was six months or more previously and included were CT guided biopsies, bronchoscopic brushings or washings, transbronchial or endobronchial guided biopsies, mediastinoscopies, surgical resections and cytology of pleural fluid. We excluded from our analysis those who were having lung biopsy due to metastasis from extra thoracic primary sites. We collated data on patient demographics, time between initial diagnosis and second biopsy, first and second pathology, stage and treatment at first presentation and again at second, whether second biopsy was a different site, and whether pathology was identical on second biopsy/similar (more or less well differentiated but same subtype of lung cancer)/ not malignant or different pathology.
Results:
103 patients fulfilled our inclusion criteria: 41 men, 62 women; age range 35-85y with initial stage of disease: 55 I, 18 II, 25 III, 4 IV and 1 small cell. 91 had primary treatment with curative intent: 66 surgery, 25 radical radiotherapy +/- chemo. 11 had chemo alone, 1 observation only as first treatment. Time to second biopsy ranged 6-52 months (median 17). 70 patients (70%) had identical or similar pathology at second presentation. 13 had different pathology: 2 patients with initial NSCLC developed a second tumour which was SCLC, 1 previously treated SCLC developed a second tumour which was NSCLC, 1 resected carcinoid developed subsequent adenocarcinoma and one adenocarcinoma developed subsequent carcinoid. 8 patients had change of NSCLC subtype at second presentation. The remaining 20 patients had no malignancy on second biopsy: these had had prior radiotherapy or surgery all with radiological/clinical suspicion of recurrence. Of the 103 patients 42 are still alive.
Conclusion:
Although lung cancer carries a high risk of relapse following primary therapy our results demonstrate that clinical or radiological suspicion of recurrence cannot justify treatment without confirmatory biopsy. One third of our cohort either had no malignancy or a second pathology.
