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Y. Plata Fernández
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P1.12 - Poster Session/ Community Practice (ID 232)
- Event: WCLC 2015
- Type: Poster
- Track: Community Practice
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.12-009 - Lung Cancer in Octogenarians (ID 2535)
09:30 - 09:30 | Author(s): Y. Plata Fernández
- Abstract
Background:
Octogenarian patients with lung cancer are underestimated in the scientific literature. Since in our institution, the median age of patients with lung cancer is 71 years old, we decide to conduct a study to get specific data of our population over 80 years
Methods:
Retrospective observational cohort study of patients with lung cancer referred to Medical Oncology at our institution, during 4 years (2010-2013) and follow-up until April 2015. Inclusion criteria were age (80 years or older) and lung cancer diagnosis. The cohort was 41 patients
Results:
Our octogenarian patients were a 6.1% of our 672 patients seen in 2010-2013 interval. Of our 41 patients, 78% were male, and the median age is 81 years (80-87). Histologies are 88% NSCLC and 12% SCLC; in the NSCLC group, squamous carcinomas are most common (50%), followed by adenocarcinoma (26.8%). 51% patients were diagnosed in stages I-III, but only 3 patients were under radical treatment (2 surgery, 1 radiation therapy). 34% patients did not receive any oncologic treatment, only palliative care. Of the patients with active cancer treatment, 92% received first-line therapy. In the first-line group, 68% were under chemotherapy, 48% platinum doublet (more used schedules were carboplatin-vinorelbine, carboplatin-pemetrexed and carboplatin-paclitaxel), and 20% monotherapy (vinorelbine, pemetrexed and carboplatin) and 24% TKi (all EGFR mutated, with gefitinib and erlotinib). 26.8% (11) of patients received second-line treatment (10 erlotinib and 1 pemetrexed), and only 2 patients received 3 or more lines (1 patient up to 7 lines). 39 of 41 patients died (95%), and most patients die at home (95%). The median survival time is 11.19 months (CI 95% 7.84-14.53) and median overall survival is 8 months (CI 95% 4.51-11.48). In male patients, median survival time expected is 9.97 months, and in female patients, 14.88 months. Depending on the stage, stage IV patients had a expected survival of 9.94 months and stage I-III patients, 11.40 months, with no statistically significant diference. Depending on smoking status, survival is 8.95 months for ever-smokers, and 18.44 months for never-smokers (p-value: 0.035). Depending on therapy, survival in active cancer treatment group is 14.56 months, and in palliative care only group is 5.28 months (p-value: 0.001)
Conclusion:
In our cohort of elderly patients, with a small number of patients (a 6% of all the patients, maybe underreferred), we found some differences with our global lung cancer patients group. The ratio SCLC-NSCLC is quite similar (12-88% in elderly vs 14-86% in all our patients), but there is a different pattern according histological subtypes, with more squamous carcinomas in this cohort (44% vs 29.6%), and more EGFR mutations (24% vs 18%). We see that survival was better in patients receiving active cancer treatment plus best supportive care vs only palliative care. Factors influencing survival are smoking status (ever vs never-smokers) and sex. Although is essential a joint management with Palliative Care, in this particular group of patients, that are believed that cancer treatment is less useful, active cancer treatment is beneficial, if we always individualize decisions in each patient.
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P3.11 - Poster Session/ Palliative and Supportive Care (ID 231)
- Event: WCLC 2015
- Type: Poster
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.11-011 - Mesenchymal Thoracic Neoplasma Presenting as a Thromboembolism (ID 3192)
09:30 - 09:30 | Author(s): Y. Plata Fernández
- Abstract
Background:
In the screening of the possible etiology of pulmonary embolism rule out the presence of an occult neoplasia. Tumors more often associated with thrombotic phenomena are lung, pancreas and colon. The pulmonary artery sarcoma is a rare entity and its clinical diagnosis is complex.
Methods:
We report a case of a non-smoker 71 years old woman. In 1999 suffers first episode of thrombophlebitis. Since then presents several episodes of DVT in the lower limbs so it was anticoagulated with acenocumarol. In October 2014 she was admitted due to costalgia and fever and suspected diagnosis of pneumonia. She told a 3 months history of asthenia and progressive edema of the lower limbs. It is performed thoracic CT, with a massive pulmonary thromboembolism. The doppler sonography of lower limb show a chronic thrombosis. After clinical stabilization she was put under rivaroxaban. At 15th admission day, she starts with dyspnea with chest discomfort, and respiratory failure was found. In an urgent CT was shown a progression of the known embolism. Being a massive thrombosis refractory to treatment and progressive elevation of pulmonary pressure, surgeon was consulted, and is was performed a thromboendarterectomy and a pulmonary artery homograft replacement. In the pathology report, is reported a intermediate-grade sarcoma, suggestive of intramural primary origin and intimal type intimal grade. In January 2015 CT shows progression of local disease, and is discussed in the tumor board, considering unresectability of disesase, and it is proposed to start palliative chemotherapy
Results:
The pulmonary artery sarcoma is a rare disease, since its first description in 1923, there have been documented 200 cases. It can be classified according to their location relative to the vessel wall, or by histologic subtype. Usually located in the main pulmonary artery, diagnosis and complications arise from its intraluminal extension. Up to 50% of cases have pulmonary and mediastinal metastases at diagnosis and distant metastases in 16-19% It is an entity with very similar clinical and radiological features a thromboembolism, a fact that probably contribute to underdiagnosis. The symptoms are dyspnea (72-100%), chest pain (35-45%) and hemoptysis (15-24%), weight loss (21%), asthenia (10%) and fever (8%). The prognosis is poor, with survival reported between 6 months and 2 years (median 17 months) The treatment of choice is surgical approach, by pulmonary endarterectomy, lobectomy or pneumonectomy, with or without reconstruction of the pulmonary artery. In most cases R0 resection is not achieved. The role of radiotherapy (RT) and chemotherapy (CT) is not yet well defined. Regarding chemotherapy schedules, it have been used traditionally active drugs for the treatment of sarcomas
Conclusion:
The pulmonary artery sarcoma is a rare disease that should be suspected in patients with progressive or refractory pulmonary thromboembolism.
