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A. Othman
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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): A. Othman
- 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.
