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T. Nagayasu
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MINI 20 - Surgery (ID 137)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:G. Veronesi, R. Flores
- Coordinates: 9/08/2015, 16:45 - 18:15, 201+203
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MINI20.12 - Advancements in Bronchoplasty as Treatments for Lung Cancer: Single Institutional Review of 213 Patients (ID 1331)
17:50 - 17:55 | Author(s): T. Nagayasu
- Abstract
- Presentation
Background:
Bronchoplasty has become widely accepted as a reliable and safe lung-saving procedure for lung cancer. The purpose of this study was to evaluate the factors contributing to the outcomes of bronchoplasty for lung cancer by analyzing a single institution’s data for a 30-year period.
Methods:
In the 2416 patients who underwent lung resections for lung cancer at Nagasaki University Hospital from 1980 to 2010, there were 222 bronchoplastic procedures. After excluding patients who underwent carinoplasty, 213 patients (161 bronchoplasty and 52 broncho-angioplasty) were included. The patients were divided into two groups by the date of surgery: the 1[st] period was 1980 to 1995, and the 2[nd] period was 1996 to 2010.
Results:
Bronchoplasty and broncho-angioplasty were performed in 100 (75.8%) and 32 (24.2%) patients, respectively, in the first period and 61 (75.3%) and 20 (24.7%) patients, respectively, in the second period. Overall 90-day operative morbidity and mortality rates were 25.8 and 9.8%, respectively, in the first period and 45.7 and 2.5%, respectively, in the second period. Thirty-day mortality rates were 6.8% in the first period and 0% in the second period. Five-year survival was 41.1% (n = 132) in the first period and 61.5% (n = 81) in the second period (P = 0.0003). Comparing bronchoplasty and broncho-angioplasty, the 5-year survival was 45.6 and 26.5%, respectively, in the first period (P = 0.0048) and 60.9 and 62.1%, respectively, in the second period (P = 0. 8131). Using multivariate analysis to identify potential prognostic factors, the type of operation (broncho-angioplasty), postoperative complications and histology (non-squamous cell carcinoma) were significant factors affecting survival in the first period, but none of the factors significantly affected survival in the second period. When the rates of pN2 or N3 histological type disease were compared in each period, the rate of pN2 or N3 disease in non-squamous cell carcinoma was 51.4% in the first period and 45.5% in the second period; both were significantly higher than in squamous cell carcinoma (31.6 and 16.9%, respectively; P = 0. 0365 and 0.0073). Figure 1
Conclusion:
The present study suggests that progress in the preoperative staging system and perioperative medical management, as well as surgery, has contributed to current improvements in patients undergoing bronchoplasty and broncho-angioplasty. However, since nodal status in non-squamous cell carcinoma is not precisely evaluated before the operation, the indication for bronchoplasty should be considered carefully.
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P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.03-033 - Management of Clinical T3-4 Locally Advanced Non-Small-Cell Lung Cancer (ID 1324)
09:30 - 09:30 | Author(s): T. Nagayasu
- Abstract
Background:
Several studies of trimodality therapy for locally advanced lung cancer invvasing neighboring structures including SST were reported. They resulted in high rates of pathological complete response and better survival than previous reports. The aim of this study was to retrospectively review our experience of patients for clinical T3-T4 lung cancer.
Methods:
Between January 2000 and March 2014, 52 patients underwent surgical complete resection for locally advanced clinical T3-T4 non-small cell lung cancer. Also, we are conducting a phase II trial from 2011 to evaluate induction chemoradiotherapy using cisplatin and TS-1 combined concurrent radiotherapy (40Gy) followed by surgery would improve the survival of these patients. The extent of chest wall involvement was limited to the parietal pleura, pm1 (T3 in the same lobe) and pm2 (T4 in another lobe beyond the interlobe) were excluded in this study. Patients were divided into three groups. In the initial surgery group (IS group, n=35), patients underwent surgery without induction therapy. In the chemotherapy group (CT group, n=4), patients were received chemotherapy followed by surgery, and in chemoradiotehrapy group (CRT group, n=13), patient were received chemoradiotherapy followed by surgery.
Results:
The median age was 64 years old (range, 41-83). Patients with T3 were in 42 (chest wall : n=30, pericardium : n=5, diaphragm : n=4, main bronchus : n=3 ), and with T4 were in 10 (left atrium : n=2, carina : n=2, vertebra : n=2, esophagus : n=1, subclavian artery : n=1, superior vena cava : n=1, mediastinal fat : n=1), respectively. The histological types included 21 squamous cell carcinoma, 16 adenocarcinoma, 4 large cell carcinoma, 4 pleomorphic carcinoma, and 7 other types. All patients underwent complete resection. The 3- and 5-year overall survival rate was 61.5% and 17.5%, respectively in this series. The 3-and 5-year survival rate in patients with T3 was 65.3%, 20.8%, while that with T4 was 48.0%, 0%, respectively. There was no significant difference in survival rate between them (p=0.1454). The prognosis in the N0 disease was significant better than N1-2 disease (p=0.0073). Multivariate analysis showed N0 disease was independent factor of a favorable prognosis (p=0.046). In the CRT group, patients with T3 disease was in 9, and T4 in 4. Induction therapy was completed in all 13 candidates (100%), and 5 (38%) had a complete response, 8(62%) had a partial response in the pathological examinations. The 3-year survival rate in the CRT group was 69.2%. The prognosis in the CRT group was better than the IS plus CT group, but there was no significant difference between the group. Although there were no locoregional recurrences after surgery in the CRT group, 4 patients experienced major postoperative complications and 1 patient who underwent combined resection of both chest wall and superior vena cava with reconstruction by artificial materials died of septic shock.
Conclusion:
Multimodality therapy consisted of 2 cycle chemotherapy with concurrent 40 Gy of radiation for clinical T3-4 locally advanced lung cancer showed be feasible and good local control. However, the criteria for selecting patients should be mature, especially patients using artificial material.
