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N. Alevizopoulos
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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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P1.03-031 - Gynecological Malignancies and Imaging Patterns. An Interesting Case Report and Literature Surveillance (ID 5508)
14:30 - 14:30 | Author(s): N. Alevizopoulos
- Abstract
Background:
Gynecologic malignancies are a heterogeneous group of common neoplasms in women. Thoracic abnormal findings exhibit various imaging patterns and are usually associated with locally invasive primary neoplasms with intra-abdominal spread. It is not rare, thoracic involvement occurring years post first diagnosis or as an isolated finding in patients without evidence of intra-abdominal neoplastic involvement. Thoracic metastases from gynecologic carcinomas typically manifest as pulmonary nodules and lymphadenopathy. Ovarian cancer often presents small pleural effusions and subtle pleural nodules whereas metastatic lung lesions, lymph nodes, and pleura are thought to present calcification or mimicking granulomatous disease. Metastases from fallopian tube carcinomas have imaging features identical to ovarian cancers. Most cervical cancers are of squamous histology, and while solid pulmonary metastases are more common, the cavitary metastatic lesions occur more often. Metastatic choriocarcinoma to lung characteristically exhibits solid pulmonary nodules. There are also reported pulmonary metastases from gynecologic malignancies with characteristic features such as cavitation (as awaited in squamous cell cervical cancer) and the "halo" sign (in hemorrhagic metastatic choriocarcinoma lesions) at computed tomography.
Methods:
We report a case with a mass in left paratracheal area invading the lung hinting primary lung cancer.
Results:
The patient ,female ,36 years old with previous medical history of resected cervical cancer , underwent endoscopy with aim to have trasnsbronchial aspiration but unfortunately the samples taken were consistent of inflammation infiltration. Thus she underwent thoracotomy due to high SUV (12) uptake points at PET CT with intention to exclude lung cancer. She had the mass removed with all the surrounding lung parenchyma but unfortunately the final histologic report documented metastatic infiltration from cervical cancer in competence with her previous medical history 6 years ago(Ib stage with radiotherapy only treated in adjuvant basis).She recovered well and was initiated chemotherapy for the gynecological malignancy stated She is now 2 years later alive, with no residual disease The basic is that malignancies are always suspected to be primary originated but the medical previous history should not be ignored ,even the imaging tests tend to resemble to other entities
Conclusion:
Therefore, radiologists should consider the presence of locoregional disease in combination with elevated tumor marker levels when interpreting imaging studies and all previous medical history of the patient’s malignancy to exclude metastatic disease.
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P1.06 - Poster Session with Presenters Present (ID 458)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.06-029 - Epidemiologic, Clinical Characteristics and Therapeutic Strategy of Elderly NSCLC Patients Treated in a Single Institution (ID 5379)
14:30 - 14:30 | Author(s): N. Alevizopoulos
- Abstract
Background:
In NSCLC pts 40% are ≥ 70y with poor PS and increased comorbidities(cbs). The aim of this retrospective study is to present all data in 208 NSCLC pts stage IIIB and IV admitted in our unit between 1/2007- 3/2016.
Methods:
Group A(young old):51%,70-75years(y),Group B(old):49%,75-87y.Median PS:2(0-3). Histology: Adenocarcinoma(AC) 43%, Squamous carcinoma(SCC) 31%, Adenosquamous CC 10%, Large CC 5% and Large Neuroendocrine 11%. Metastasis: Liver 79%, Bones: 72%, Adrenal: 37%, Lung: 35%, Brain: 23% of pts. Cbs included: hypertension, diabetes,heart disease, dyslipidemia, COPD, hypothyroidism, osteoporosis, Parkinson and dementia in 81, 68, 56, 56, 52, 42, 14 and 6% of pts .In Group B had ≥3 comorbidities more often (59% vs 42%), p<0.05).Symptoms at presentation No of pts (%) N=208 Group A% N= 106 Group B N = 102 p Haemoptysis 163 (78%) 78(74%) 85(83%) 0.05 Cough 69(33%) 35(33%) 34(33%) NS Dyspnoea 60(29%) 22(21%) 38(37%) x<0.01 Chest discomfort 46(22%) 17(16%) 29(28%) 0.01 Cervical lymphadenopathy 38(18%) 18(17%) 20(19%) NS SVCS 27(13%) 12(11%) 15(15%) NS Pancoast tumors 9(4%) 4(4%) 5(5%) NS
Results:
Four pts(4.5%) mutated received TKI ± chemo(CT) (Paclitaxel,Carboplatin,Bevacizumab) and are still in PR for 12+, 14+, 14+, 32+, 12+ mo respectively. In 40 selected pts (≥ 80y, PS=3, ± brain metastases ± ≥5 cbs ± weight loss ≥7%) single agent was given. RR in 44% with mPFS 7(3-12)mo, mOS 11(5-16)mo. The rest received 3 cycles least of chemo ± brain RT + GCSF support: ORR: 56% in A and 49% in B. mPFS: 9(3+ - 18)mo and mOS 18(3+ - 56+)mo, 17(3+ - 56+) in A and 16 (3+ - 44+) in B. RR was 64% and 34% for pts PS 0-1 vs 2-3, p<0.001. In 720 cycles (410 and 310 in A and B),toxicity grade ≥ III: Febrile neutropenia in 11 vs 19% cycles, p <0.01, Anemia in 23 vs 27%, p=NS, Thrombocytopenia in 25 vs 30%, p=NS, Mucositis in 11 vs 15%, p=NS.
Conclusion:
1. When indicative CT should be given, without reduction. 2. Haemoptysis and chest discomfort are common in older pts. 3. Febrile neutropenia was the main serious side effect. 4. GCSF prophylaxis is necessary. 5. In selective patients >80y single agent seems beneficial in second line .
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P2.03a - Poster Session with Presenters Present (ID 464)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.03a-029 - Efficacy and Safety of Combined Carboplatin, Paclitaxel and Bevacizumab for Patients with Stage IIIb and IV Non-Squamous NSCLC (ID 5374)
14:30 - 14:30 | Author(s): N. Alevizopoulos
- Abstract
Background:
The majority of patients (pts) with non-squamous non small cell lung cancer (NSq/NSCLC) present inoperable disease for which no curative disease exists. The combination of Carboplatin(CBDCA), Paclitaxel(PTX) and Bevacizumab(BEV) is one of the standards 1st line treatment for this group of pts without EGFR sensitizing mutation or ALK gene rearrangement. The aim of the study was to evaluate the effectiveness and safety of the combination of CBDCA, PTX and BEV in pts with NSq/NSCLC consecutively admitted and treated in our Dept between 03/2010 and 12/2015.
Methods:
In a total of 50 pts,37 men(74%),13 women(26%), median age 68 (47-82) and ECOG 1 (0-4), heavy smokers 42/50(84%), with no mutation of EGFR and ALK, were treated with CBDCA (AUC =5), PTX 175mg/m2, BEV 7.5 mg/Kg, every 3 weeks, and primary prophylaxis with G-CSFs d 1-10. The chemotherapy was repeated for a median of 4(1-11) cycles
Results:
The objective response was 36% (18/50), 27% for men and 61% for women (0.05
Conclusion:
In our unselected NSq NSCLC pts stages IIIb or IV: 1. The combination of CBDCA, PTX and BEV with G-CSF prophylaxis , was proved effective and very well tolerated independent of ECOG and age. 2. Women seemed to response better than men in this combination.
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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: 2
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.04-042 - Epithelial-Myoepithelial Tumour of Unknown Origin: An Interesting Case Report with Unexpected Outcome (ID 5513)
14:30 - 14:30 | Author(s): N. Alevizopoulos
- Abstract
Background:
Tracheobronchial submucous glands can be considered the pulmonary equivalent of minor salivary glands and therefore develop most of the tumours originated in these. Nevertheless, in spite of the wide distribution of this kind of glands along the tracheobronchial tree, pulmonary salivary gland-like neoplasms are not very frequent. Among them,most frequent are mucoepidermoid and adenoid cystic carcinomas. On the contrary, pulmonary neoplasms showing a mixture of epithelial and myoepithelial elements are extraordinary infrequent, with only 20 cases in literature.
Methods:
We present the case of a 55 year-old man complaining for bone pain and mobility deterioration.
Results:
The patient was hospitalized to exclude all possible reasons of malignant bone infiltration. His X-ray scanning showed multiple lytic infiltration of unknown malignant origination. A PET/Ct scan performed did not reveal any area implying the primary malignant development. Bone biopsy taken post macro and microscopic study, diagnosis of epithelial-myoepithelial tumour was hinted. Our case has the peculiarity of being connected neither to breast nor to salivary glands as expected; a characteristic not reported in any literature reviewed case. These tumours have been named in a lot of different ways, including adenomyoepithelioma, epithelial-myoepithelial tumour, epithelial-myoepithelial carcinoma or epithelial-myoepithelial tumour of uncertain malignant potential. The p27/kip-1 protein plays a fundamental role in the development of these neoplasms. The suggested therapeutic agents are platinum/taxane combinations with not excellent prognosis and unknown outcome. The palliative care is often proposed due to the deteriorated performance status. Our patient underwent combined radiotherapy and bisphosphonate infusion with pain relief and mobility improvement. The patient, 2 years later, is still alive, under bisphosphonate support and no primary malignant has identified
Conclusion:
It is not rare to have prolonged outcome and satisfactory improvement in Epithelial-myoepithelial tumour even in primary malignant lesion identification. Individualized therapeutic approach is always proposed
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P2.04-043 - Squamous Cell Carcinoma Arising from the Pleura. An Interesting Case Report (ID 5506)
14:30 - 14:30 | Author(s): N. Alevizopoulos
- Abstract
Background:
Squamous pleura carcinoma is a very rare entity with sporadic literature reports. Literature research reveals 12 reports of squamous carcinoma arising from pleura in patients with chronically draining empyema/ locally deteriorated inflammation.
Methods:
We state an unusual interesting case report of primary squamous pleura carcinoma and present relevant literature surveillance.
Results:
The patient,48 years old, male ,heavy smoker, reported constant right chest pain and experienced dyspnea recently started His chest X ray revealed pleural effusion and mesothelioma infiltration was suspected. Endoscopy revealed no abnormalities. Subsequent Ct scan showed a 4cm mass arising from pleura and a computed tomography scan revealed an expanded mass in the right thoracic cavity, involving the surrounding tissue. He underwent needle biopsy ultrasound guided. The macroscopic pathologic findings demonstrated a grayish-white mass with hemorrhage beneath the pleura. They revealed multifocal, poor-differentiated, squamous cell carcinoma with histology that was distinctly different from that of original lung cancer arise and consistent with pleura (p63+, CK5/6 +, p40+, TTF/1- ). He received 1rst line chemotherapy treatment with platinum based combination with taxane and the patient had an excellent response with no effusion production and rapid thoracic pain and dyspnea relief. He is still in excellent status post 6 cycles chemotherapy, with no evidence of disease deterioration. The final scope of surgical total resection is being considered.
Conclusion:
Cases of squamous cell carcinoma arising from pleura in patients with a chronically draining empyema or inflammation cavity are rare. The documented in literature review chemotherapy combinations are of limited expectations and no complete response is reported when rare reports are documented. We suggest a thorough pathologic study when pleura masses are found to exclude the common mesothelioma diagnoses since seldom entities as pleura cancers need an individualized therapeutic manipulation.
