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A.S. Bayram
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MA06 - Locally Advanced NSCLC: Risk Groups, Biological Factors and Treatment Choices (ID 379)
- Event: WCLC 2016
- Type: Mini Oral Session
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:P. Van Houtte, M. Zemanová
- Coordinates: 12/05/2016, 16:00 - 17:30, Strauss 2
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MA06.02 - Does Pathological Staging Following Neoadjuvant Therapy (ypTNM) Reflect the Reality? (ID 3859)
16:06 - 16:12 | Author(s): A.S. Bayram
- Abstract
- Presentation
Background:
Complete histopathological response or downstaging has been reported as a good prognostic factor for locally advanced non-small cell lung cancer (NSCLC) patients who received neoadjuvant therapy and underwent surgical resection. However, it is yet to be known if the prognosis of pStage I patients is similar to that of ypStage I cases. In this study we aimed to compare the long-term survival following surgical excision between locally advanced NSCLC that have been downstaged to stage I after neoadjuvant therapy versus stage I NSCLC treated by direct surgery.
Methods:
In this is multi-centered study we retrospectively analyzed the medical data of NSCLC patients undergoing surgery (segmentectomy or more) between January 1998 and December 2014. According to the histopathological results patients with Stage 1 (T1-2aN0) disease (n=427) were included into the study. Patients were divided into two groups Group 1: patients who underwent direct surgical resection without any preoperative therapy (n=291), Group 2: Patients who had locally advanced disease (T3-4N0-1 or T1-3N2) and received neoadjuvant treatment (chemotherapy or chemoradiation) for locally advanced NSCLC (n=136). The survival rates and effecting factors were analyzed.
Results:
All but 64 patients were male with a mean age of 60y (20-87y). According to tumor type; 192(45%) patients had squamous cell carcinoma, 158(37%) adenocarcinoma and 77 (18%) patients NSCLC. Neoadjuvant treatment consisted of chemotherapy in 89 (65,4%) and chemoradiation in 47(34,5%) patients. Histopathological investigation of the resected specimen revealed stage Ib (T2aN0) in 205 patients (group 1; n=140, group 2;n= 65, p=0,95). Overall morbidity rate for all patients was 30,9% (132/427) with 1.8% mortality. Five year survival rate in all patiens was 71% (77% in group I and 57% in group 2). The difference was statistically different between the groups, p<0,001.
Conclusion:
This study showed that survival of patients after surgical excision was different in ypStage 1 compared to pStage 1. Histopathological staging does not reflect to the survival figures. Our impression is that IASLC recommendations for staging of NSCLC should be subdivided or revised according to ypTNM staging following neoadjuvant treatment.
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P1.03 - Poster Session with Presenters Present (ID 455)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.03-017 - Does PET/CT SUVmax Value Correlate with Long-Term Survival in Patients with Surgically Treated Stage I Non-Small Cell Lung Cancer (ID 5786)
14:30 - 14:30 | Author(s): A.S. Bayram
- Abstract
Background:
Positron emission tomography (PET/CT), which detects the biologic activity of tumor cells is routinely used in staging of non-small cell lung cancer (NSCLC). However, the role of PET/CT in predicting disease free long-term survival of surgically treated stage I NSCLC is not clear. In this study, we aimed to investigate prognostic value of metabolic uptake (SUVmax) of the tumor in patients with surgically treated stage I NSCLC
Methods:
Two-hundred and sixty patients who had preoperative PET/CT and pulmonary resection for stage I NSCLC between 2005 and 2015 were included into study. The patients were devided into four groups according to the SUVmax value, 0-5, group 1, 5-10 group 2, 10-15 group 3 and over 15 group 4. Lung resection, segmentectomy/lobectomy, was performed within 30 days of PET/CT in all patients. Tumor SUVmax and other potential prognostic variables were chosen for analysis in this study. Patients univariate and multivariate analyses were conducted to identify prognostic factors associated with long-term survival.
Results:
There were 53 females and 207 males with a mean age of 61,5 (range 20-84). The mean SUVmax value of the tumors in PET/CT was 10,1 (1-48). The type of the lung resection was segmentectomy in 33(12,7%) and lobectomy in 227(87,3%). Pathologic staging of the tumor was stage 1A in 156(60%), and stage 1B in 104(40%). Median follow-up time was 44 months, and overall 5-year survival rate was 81,7% and there was no statistically significant difference between the groups (p=0,3). SUVmax value of the tumor was not effected by age, gender, tumor type and location (peripheral or central)(p>0,05). However, it was found that the SUVmax value significantly increased along with tumor size (p<0,05. ). Logistic regression analysis revealed that, there is an association between perineural invasion and SUVmax value of the tumor (p=0.049).
Conclusion:
Although the previous studies revealed correlation between higher SUVmax values and impaired long term survival, this study revealed no correlation between SUVmax values and long term survival in patients with surgically treated stage I NSCLC. However, tumors with higher SUVmax values have higher chance of perineural invasion. Further studies for possible relationship between metabolic activity and histopathologic characteristics of the tumors are warranted.
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P1.08 - Poster Session with Presenters Present (ID 460)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.08-059 - Timing of Surgery after Induction Chemoradiation Therapy for Locally Advanced NSCLC (ID 5695)
14:30 - 14:30 | Author(s): A.S. Bayram
- Abstract
Background:
The timing of surgery after induction chemoradiotherapy (ChRT) for locally Advanced NSCLC is accepted crucial because of technical difficulties, morbidity and related mortality. Although six to eight weeks’ time interval between induction ChRT and surgery is advocated, precise analysis of the optimal waiting time that maximizes oncologic benefits of ChRT has not been established. We aimed to review our results of pulmonary resections performed after induction ChRT and to determine the effects of time interval on postoperative morbidity, mortality and long term survival.
Methods:
We retrospectively reviewed our records for patients undergoing induction ChRT between 1996 and 2015. Timing of treatment was defined as the difference between the last date of radiotherapy and the date of lung resection. The dose of radiotherapy varied from 45Gy to 66Gy. The patients were divided into two groups, surgery less than eight weeks (Group 1) and more than eight weeks (Group 2) following induction ChRT. Type of resection, postoperative complications, 90-days mortality and long-term survival were analyzed. The impact of surgical timing on outcomes was studied through univariable and multivariable analyses.
Results:
One hundred and forty-two patients were included into study. The mean time interval between ChRT and surgery was 92.3 days (21-900 days). Sixty-five lung resections were performed less than eight and 77 more than eight weeks. Pulmonary resections were classified as pneumonectomy in 20 patients, lobectomy in 122 patients (of whom, 55 underwent extended resections, chest wall, sleeve etc.). Final pathological examination revealed complete response in 43 (30.3%) of the patients. Major morbidity was observed in 42.2% of the patients [43% (28 of 65pts) in group 1 and 41.5% (32 of 77pts) in group 2, p=0.85]. The overall 90-day mortality rate was 6.3% [7.7% in group 1 and 5.2% in group 2, p=0.54]. The mortality rate after pneumonectomy was 5% (1/20) and 6.5% (8/122) after lobectomy. The 5-year survival rate was 61% vs 47% (p = 0.16). Multivariate analysis showed that timing of surgery after ChRT was not significantly associated with an increased morbidity and mortality that was also not effected by the dose of radiotherapy.
Conclusion:
These findings indicate that lobectomy or pneumonectomy can be safely performed eight weeks or more after induction ChRT without affecting surgical morbidity and mortality. Pulmonary resection may be performed safely even one year after ChRT.
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P2.04 - Poster Session with Presenters Present (ID 466)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.04-024 - Thymic Epithelial Tumors and Radiotherapy Results (ID 3702)
14:30 - 14:30 | Author(s): A.S. Bayram
- Abstract
Background:
Thymic epithelial tumors (TET) treated with radiotherapy (RT) was evaluated for treatment outcomes and prognostic factors on survival.
Methods:
Between October 1995 and December 2013, 31 patients were treated. The median age was 44 (range: 19-83). There were 25 thymoma, 4 thymic carcinoma (TC) and 2 thymic neuroendocrin carcinoma (NEC). The incidence were found 13%, 39%, 39% and 9% for Masaoka stage I-II-III and IV, and 3%, 16%, 61%, 13% and 6%, for WHO type A-AB-B-C and NEC, respectively. Eighteen patients (58%) underwent R0 resection. Median RT dose was 5400 cGy (range: 1620-6596). Seven patients received a median of 6 cycles (range: 1-6) cisplatin-based adjuvant and 4 patients received weekly 60-70 mg/m2 paclitaxel or 2-3 cycles standart chemotherapy concurrently. According to prognostic risk stratification including Masaoka staging and WHO classification, cases were divided to good (n: 10), moderate (n: 9) and poor (n: 12) risk groups. Survival was calculated from diagnosis.
Results:
In January 2016, 22 cases lived with median 51.5 months (range: 2-170.5) follow-up. Recurrences were observed 9 (29%) of patients median 29.5 months (range: 6.5-105). Local control, mean overall (OS) and disease-free survival (DFS) rates for all patients, were 86%, 119 months (range: 94-144) and 116 months (range: 89-144), respectively. Local control were 100%, 89% and 75% for good, moderate and poor risk groups, respectively (p=0.08). There were a significant differences for Masaoka stage (I-II vs III-IV, p = 0.001, p <0.001), R0 resection (present vs absent, p = 0.06, p = 0.05), histology (thymoma vs TC, p = 0.02, p = 0.01) and prognostic risk groups (good vs moderate vs poor, p = 0.003, p = 0.004) in terms of OS and DFS, respectively.
Conclusion:
In our study, prognostic risk stratification was seen to be an important predictor for survival. The patients with TC was stage III-IV at diagnosis in moderate and poor risk groups indirectly and survival rates was found to be less than thymoma.
