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H. Furuta



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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
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      P1.03-044 - EUS-Guided Sampling of Mediastinal Lymph Nodes and Abdominal Lesions in Lung Cancer (ID 5147)

      14:30 - 14:30  |  Author(s): H. Furuta

      • Abstract

      Background:
      Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS–TBNA) was introduced to provide access to mediastinal and hilar lymph nodes. However, it is difficult to use EBUS to approach the aortopulmonary window and paraesophagaeal stations. Transesophageal endoscopic ultrasound (EUS) was introduced to provide access to this area. In addition, transgastroduodenal endoscopic ultrasound can evaluate abdominal lesions.

      Methods:
      Endoscopic ultrasound fine needle aspiration (EUS-FNA) was performed under conscious sedation with the administration of intravenous midazolam and pethidine hydrochloride. It was performed with a convex array echoendoscope connected to an ultrasound scanning system. Lymph nodes of paraesophageal, subcarinal, lower paratracheal, subaortic, and upper paratracheal regions were evaluated from esophagus. Left adrenal gland and right adrenal gland were evaluated from stomach and duodenum, respectively. Abdominal lesions were also evaluated from stomach and duodenum. After obtaining tissue via EUS-FNA, the tissue was reviewed immediately (rapid on-site cytopathological evaluation: ROSE) by a cytopathologist. Subsequent punctures in the same patient were not performed before confirming the results of ROSE so as to minimize the complications.

      Results:
      As to the lymph node level, the lower mediastinum and the aortopulmonary window are particularly important for detection by transesophageal EUS, whereas pretracheal and hilar lymph nodes are out of reach because of the interposition of air from the trachea and bronchi. EUS was chosen to assess the posterior mediastinum nodes (#5, 7, 8, or 9) but not the anterior ones. A final diagnosis was obtained by EUS-FNA in 76 patients. The lesions sampled were mediastinal lymph nodes (n=64; #5, 7, 8, or 9), abdominal lymph nodes (n=8), and adrenal gland (n=4).

      Conclusion:
      Repeat tumor biopsies from patients with acquired resistance were initially obtained through research efforts to ascertain mechanisms of resistance, but are now recommended to help select second-line therapies. However, such biopsies are associated with both risk and discomfort and may not always supply enough tumor tissue for genetic analyses. Although EUS–FNA does not provide access to pretracheal and hilar lymph nodes, EUS-FNA is an accurate, safe, and minimally invasive modality for evaluating mediastinal lymphadenopathy and abdominal lesions in patients suspected of having lung metastases.

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    P1.07 - Poster Session with Presenters Present (ID 459)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: SCLC/Neuroendocrine Tumors
    • Presentations: 1
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      P1.07-007 - Clinical Outcomes of Patients with LS-SCLC Treated with Chemoradiotherapy. Can We Find Candidates for Salvage Surgery? (ID 5288)

      14:30 - 14:30  |  Author(s): H. Furuta

      • Abstract

      Background:
      Although small cell lung cancer (SCLC) is generally considered a systemic disease even in patients with limited stage (LS). Selected recurrent LS-SCLC patients after chemoradiation treatment have been reported long survival with receiving salvage surgery. Purpose of this study was to find candidates for salvage surgery.

      Methods:
      We retrospectively reviewed the charts of 43 consecutive patients who were treated with chemoradiotherapy for LS-SCLC at our hospital from January 2011 to December 2015 to search for the patients with locoregional progression without mediastinal lymph node involvement.

      Results:
      Of the 43 patients, the median age was 69 (38-83), 91% were male and all of them had ECOG PS 0 or 1. Clinical stage: IIA (12%), IIIA (53%), IIIB (35%). 35 (81%) received hyperfractionated RT (45Gy/30fr/3w). Objective response rate was 95%. One patient died of pneumonia. The median survival time was 1584 days and the median progression free survival was 280 days. 33 (77%) demonstrated disease progression. The first progression site was distant (include pulmonary metastasis and malignant pleural effusion) in 17, locoregional in 11, lymph node metastasis out of the radiation field in 2 and both distant and locoregional in 3. In the locoregional progression patients, 6 developed mediastinal lymph node progression in their clinical courses. Finally, 5 in 33 progressive patients had locoregional progression without mediastinal lymph node progression, and were thought possible candidates for salvage surgery.

      Conclusion:
      Most of the patients experienced distant metastasis and/or mediastinal lymph node progression. About 15% of patients who presented with apparently localized disease at the primary pulmonary site after chemoradiation might become possible candidates for salvage surgery.