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T. Kilani
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P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.02-028 - Surgical Resection for Sarcomatoid Carcinoma of the Lung (ID 1576)
09:30 - 09:30 | Author(s): T. Kilani
- Abstract
Background:
Sarcomatoid carcinoma of the lung is not very common. It consists of poorly differentiated non-small cell carcinomas with sarcoma or sarcoma-like differentiation component. The World Health Organization lists five subtypes representing an overall continuum of epithelial and mesenchymal differentiation: pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma, and pulmonary blastoma. The diagnosis is pathological and requires a good sampling of the tumor. The purpose of this study was to assess the surgical management of primary sarcomatoid carcinomas of the lung which could benefit from surgery with curative intent.
Methods:
We retrospectively reviewed the 38 cases of primary sarcomatoid carcinoma, which were managed between 2000 and 2012, in the thoracic surgery department of our Hospital. All the included patients had surgical resection.
Results:
There were 33 males and 5 females with a mean age of 59.7 years (42-81). The main symptoms were respiratory. Imaging features showed a pulmonary mass invading pleura or the thoracic wall in 14 cases. The diagnosis was confirmed in all cases on histological examination of the resected tumor. According to the pathological results there were 23 pleomorphic carcinomas, 7 giant cell carcinomas, 1 spindle cell carcinoma, 5 carcinosarcomas and 2 blastomas. Associated treatments were split as follows: neoadjuvant (four cases) or adjuvant (six cases) chemotherapy, and radiotherapy (ten cases). Lobectomy (26 cases) or bilobectomy (2 cases) was performed in 28 patients and pneumonectomy in 9 patients. Chest wall enlargement with costal resection was associated in 5 cases. One patient had a conservative resection (segmentectomy) because of a history of contralateral adenocarcinoma for which he had a lobectomy (2 years earlier). The tumors were classified as: T1 in 2 cases, T2 in 16, T3 in 16 and T4 in 4. The different stages were: Ia (n=2), Ib (n=8), IIa (n=1), IIb (n=13), IIIa (n=8), IIIb (n=2) and IV (n=4). The margins of the resected parenchyma showed tumoral involvement in 1 case. The median survival of our patients was 9 months. Two patients died in the early postoperative course.
Conclusion:
Sarcomatoid carcinomas are rare, aggressive tumors which require early diagnosis and management. Surgery whenever performed can be beneficial for these tumors which are of bad prognosis compared to other NSCLC.
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P2.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 210)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.02-031 - Surgical Management of Bronchial Carcinoid Tumors: A Monocentric Tunisian Experience (ID 1584)
09:30 - 09:30 | Author(s): T. Kilani
- Abstract
Background:
Bronchial carcinoids are rare and account among well differentiated neuroendocrine tumors, with low-grade malignancy. They are divided in two different groups: typical and atypical carcinoids. They have almost a better prognosis than other lung malignancies; however atypical carcinoids are more aggressive. Surgery remains the gold standard with the same requirements as other malignancies, although conservative techniques with broncho-plastic surgery for typical carcinoids are well established. However, their management has to be multidisciplinary, The purpose of this study was to assess the surgical management of primary broncho-pulmonary carcinoid tumors.
Methods:
We reviewed retrospectively 137 cases managed in our thoracic surgery department for bronchial carcinoid tumors during a twenty-three-year period, between 1992 and 2014.
Results:
There were 64 men and 73 women (sex-ratio: 0.87), with a mean age of 44.2 years. One hundred and twenty-one patients had typical carcinoids and 16 patients had atypical carcinoids. Respiratory symptoms were the chief complaint in 98.42%. CT showed a proximal obstructive mass in 52% of the cases, with lung consolidation or atelectasis in 77.2%. Bronchoscopy showed an endo-bronchial tumor in 82.67% of the cases. Anatomical resection had been achieved among 119 patients (86.9%) (Pneumonectomy: 24 cases, bilobectomy: 27 cases, lobectomy: 68), with extended resection to the left atrium in 2 cases and to the adjacent upper lobe in 1 case. Conservative resection was performed in 18 patients (13.1%) with typical carcinoid tumor (bronchotomy and resection of the tumor: 3 cases, anatomical segmentectomy: 3 cases, sleeve lobectomy: 12 cases). Lymph node metastases were present in 12.6% of the cases. The postoperative course was uneventful in 89.05% of the cases and complicated in 10.94%, with atelectasis being the most reported in 5 cases. One patient was readmitted and reoperated two months after surgery for post operative empyema. 2 patients deceased in the post operative course (1.4%). Follow-up revealed recurrence in one patient with a typical carcinoid and distant metastasis in 4 others (2 atypical and 2 typical carcinoids). The 5-year survival rate was 45% for atypical carcinoid vs 95% for typical carcinoid. Reported prognostic factors for typical carcinoids were sex (male), the size of the tumor and lymph nodes involvement.
Conclusion:
Carcinoids are rare malignant tumors, almost with a favorable outcome after surgery, given that their resection is complete, with a thorough lymph node dissection. However, local recurrence and metastases can occur with both typical and atypical carcinoid tumors, justifying the need for early diagnosis and long-term follow-up. Survival rates in our series were largely influenced by the pathological type, distant metastasis and mediastinal lymph node involvement.
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P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.02-021 - Lung Cancer Surgery: A 30 Years Monocentric Experience in Tunisia (ID 2892)
09:30 - 09:30 | Author(s): T. Kilani
- Abstract
Background:
The results of lung cancer surgical treatment depend on several factors inherent to the tumour, the patient and the socio-economic context in which the disease is managed. Few studies have described the results of surgery for lung cancer in emerging countries, particularly in Africa. The objective of this study was to report a large monocentric experience of a North African country.
Methods:
The results of lung cancer surgical treatment depend on several factors inherent to the tumour, the patient and the socio-economic context in which the disease is managed. Few studies have described the results of surgery for lung cancer in emerging countries, particularly in Africa. The objective of this study was to report a large monocentric experience of a North African country.
Results:
There were 1485 males and 196 females (sex ratio 7.57) with a mean age of 58 (range 10-91). Clinical findings were dominated by thoracic symptoms and 176 (10.4%) were asymptomatic. Imaging findings showed a peripheral mass in 883 cases (52.5%). The mean tumour size was 5.3 cm (range, 1 – 20 cm). 48 patients received induction therapy (this treatment was not prescribed before 2009). Lobectomy or bilobectomy was performed in 1036 patients (61.6%) and pneumonectomy in 448 patients (26.6%), thoracotomy was exploratory in 153 cases (9.1%), the rate of exploratory thoracotomy has fallen at 4.5% in the last 10 years (2003 to 2012). The histology diagnoses were: squamous cell carcinoma (n=693), adenocarcinoma (n=622), carcinoid tumour (n=135). Different stages were: IA (n=167), IB (n=523), IIA (n=56), IIB (n=393), IIIA (n=244), IIIB (n=188) and IV (n=109). There were 4 operative deaths. 69 died within 1 month of surgical complications. Post operative course was uneventful in 1203 patients (71.5%) and the most frequent post operative complication was persistent air leak. Post operative mortality was 4.3% (within 30 days PO), 3.47% for lobectomies and 6.25% for pneumonectomy. Adjuvant therapy was performed in 157 patients. The median survival time was 45 months with a maximum of 276 months. The overall 5-year survival rate was at 30% and it was at 67%, 41%, 44%, 24%, 17%, 3% and 13% respectively for stages IA, IB, IIA, IIB, IIIA, IIIB and IV. Survival was influenced by sex; age over 70 years, tumour size, nodal status, tumour stage and surgical procedure. By cons, post operative radiotherapy and neoadjuvant chemotherapy did not significantly improve the prognosis of our patients.
Conclusion:
Our 30 years experience initiated in 1985 of surgery for lung cancer demonstrated that major thoracic surgery is feasible with good early results and low mortality and morbidity rates. Survival rates are lower than those of the world literature; this may be related to the more advanced stages of our series and the lack to a complete assessment of the patients: number of patients did not have CTscan in the beginning of the series, and nowadays we don’t yet have PET scan in our country.
