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T. Miyazaki
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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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P1.03-068 - Impact of Positive Pleural Lavage Cytology or Malignant Effusion on Survival in Patients Having Lung Resection for NSCLC (ID 4117)
14:30 - 14:30 | Author(s): T. Miyazaki
- Abstract
Background:
Pleural lavage cytology (PLC) is the microscopic study of cells obtained from saline instilled into and retrieved from the chest during surgery for NSCLC. PLC is not reflected in the 7th TNM classification of lung cancer by the Union for International Cancer Control (UICC),although it is known that PLC-positive means worth prognosis. The reason is that information regarding the treatment of PLC-positive patients is still limited. On the other hand, malignant effusion is categorized M1a, and reflect the grade of malignancy more. The aim of this study is to evaluate the possibility of being an established independent predictor of prognosis and the efficacy of intrapleural chemotherapy (IPC) in PLC-positive patients.
Methods:
1,165 of the 1,473 lung cancer patients who underwent surgery had undergone PLC before thoracotomy, following by a complete resection (PLC-positive:41 patients) and 16 patients with malignant effusion were evaluated. The treatment was performed for 16 patients with malignant effusion and 27 patents with PLC-positive. After pulmonary resection, IPC was performed after surgery, and the pleural cavity was filled with cisplatin with a normal saline solution. The disease-free survival (DFS) and the overall survival (OS) of the patients were evaluated.
Results:
The pathological diagnosis showed that 41 patients (2.8 %) were positive for (or suspected to have) malignancy in their PLC. The univariate analysis showed that only T category and Lymph node metastasis were significant predictors of a PLC-positive status. The 5-year overall survival in PLC-positive patients was 37 % and that in PLC-negative patients was 75 %. The univariate (p<0.01) analyses showed that the status of PLC was significantly associated with the overall survival. Correction for differences in survival were obtained in the earlier stages than stage IIIA . Twenty-six of the 42 PLC-positive patients underwent IPC. The median survival time of the IPC group was 47.0months and that of those without IPC was 17.4 monthes (p<0.01), respectively. But, there are no significant differences between these groups with respect of DFS and reccurent site.
Conclusion:
PLC should be considered in all patients with NSCLC suitable for resection. A positive result can be an independent predictor of adverse survival especially in early stages. IPC may improve the OS in PLC-positive NSCLC patients and patients with malignant effusion, and a further prospective evaluation regarding this therapy is warranted.
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P1.08 - Poster Session with Presenters Present (ID 460)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.08-079 - Sulvage Surgery after Definitive Radiotherapy or Chemoradiotherapy for Lung Cancer (ID 4262)
14:30 - 14:30 | Author(s): T. Miyazaki
- Abstract
Background:
Reports of salvage surgery especially bronchoplasty after definitive radiation therapy for locally advanced lung cancer are small. In addition, reports of surgery after stereotactic body radiotherapy (SBRT) are also small.
Methods:
Between 2011 and 2015, 3 patients who underwent salvage pulmonary resection after definitive radiation therapy (Group A) and 3 patients after SBRT (Group B) were identified.
Results:
Group A: One of two patients who underwent boronchoplasty failed in anastomosis failure. A 40-year-old woman underwent right upper sleeve lobectomy after chemo-radiation therapy including bevacizumab for primary lung adenocarcinoma (cT3N2M0 Stage IIIA). Two months after surgery, anastomosis dehiscence occurred. She underwent right completion pneumonectomy after preparing an omental flap. Bronchial stump was closed in overholt method with wrapping of omental flap. After surgery, left kidney and supraclavicular lymph node metastasis were detected, she was administered crizotinib. She is alive at 48 months after surgery. The other two patients are alive without recurrence at 8 and 35 months, respectively. Group B: The dose of radiation was 48Gy (12 Gy x 4 fractions ). Period from SBRT until surgery was 14, 18, 30 months, respectively. One patient underwent SBRT for second lung cancer after left upper lobectomy for first lung cancer. He died of respiratory failure on 103 days after surgery. The clinical courses of other two patients were uneventful. One patient died of distant metastasis at 7 months, and other one is alive without recurrence at 8months. There were no severe adhesion on both hilar and chest wall after SBRT.
Conclusion:
Caution is needed in the salvage pulmonary resection after chemo-radiation therapy including bevacizumab. On the other hand, there was not strong influence to the bronchial stump after SBRT.
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P1.08-084 - Treatment for Elderly Patients with Clinical Stage I Non-Small Cell Lung Cancer; Surgery or Stereotactic Body Radiotherapy? (ID 3906)
14:30 - 14:30 | Author(s): T. Miyazaki
- Abstract
Background:
The number of elderly lung cancer patients requiring surgery has been increasing due to the aging society and less invasive perioperative procedures. Stereotactic body radiotherapy (SBRT) is one of the effective treatments for early stage non-small cell lung cancer (NSCLC). The aim of this retrospective study was to compare the outcome of pulmonary resection to SABR for elderly clinical stage I NSCLC in our hospital.
Methods:
Over 80-year-old patients with clinical stage I NSCLC between August 2008 and December 2014 were treated either surgery or SBRT at Nagasaki university hospital. Propensity score matching (PSM) was performed to reduce selection bias in various clinicopathological factors including age, gender, tumor size, carcinoembryonic antigen (CEA), Charlson comorbidity index (CCI), Glasgow prognostic scale (GPS) and forced expiratory volume in one second (FEV1.0) were compared between surgery and SBRT.
Results:
Pulmonary resection was performed in 57 cases, SABR in 41 cases. In surgery group, operations included 34 lobectomies, 23 limited resection (segmentectomy and wedge resections). Systemic lymph node dissection was 16 and limited dissection was 41 cases. In SABR group, 17 cases (41.5%) were not proven in histology. 27 cases were given 48 Gy by 4 fractions, 14 were 60 Gy by 10 fractions, respectively. No treatment deaths were observed. Before PSM, the 5 year overall survival (OS) in surgery (68.3%) was significantly better than that in SBRT (47.4%, p=0.02). the 5 year disease specific survival (DSS) (94.1%, 78.2%, p=0.17, respectively) was not significant. Similar characteristics were identified in age (82 years), gender, tumor size (2.2 cm), CEA (3.6 ng/ml), CCI (1), GPS (0) and FEV1.0 (1.7 Litter) after PSM. The difference in 5 year OS became insignificant between the matched pairs (57.0%, 49.1%, p=0.56, respectively). 5 year DSS was not significant (87.1%, 70.2%, respectively). Both treatments for elderly clinical stage I NSCLC were acceptable though unknown histology and precise lymph node status still existed as important bias.
Conclusion:
Surgery for early stage NSCLC is a safe and feasible treatment. SABR could be effective and a good option for early stage NSCLC.
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P2.02 - Poster Session with Presenters Present (ID 462)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-038 - Surgical Outcome of Stage III A-cN2/pN2 Non-Small Cell Lung Cancer (ID 5834)
14:30 - 14:30 | Author(s): T. Miyazaki
- Abstract
Background:
Treatment for patients with confirmed mediastinal lymph node involvement(cN2/IIIA) is still a controversial issue. In this study, we evaluated the effect of surgical outcome in patients with clinical(c-) stage IIIA-N2 non-small cell lung cancer (NSCLC) pathologically proven N2(cN2/pN2) before surgery.
Methods:
The subjects selected for analysis were 63 patients with Stage IIIA-cN2/pN2 NSCLC who underwent surgical complete pulmonary resection among 1340 cases receiving surgical resection for NSCLC at Nagasaki University between January 2000 and July 2013. Of these 63 cases, 32 patients pathologically proven N2-positive stage III NSCLC underwent induction therapy. As for the induction therapy, 21 cases had chemotherapy, and 11 cases had induction chemoradiotherapy (Cisplatin plus oral S-1 and concurrent 40 Gy radiation in 10 cases, Cisplatin, Vinorelbine, and Bevacizumab plus 60Gy radiation in 1 case).
Results:
In all 63 cases, 5-year overall survival (OS) was 32.3%. On univariate analysis, patholocial T factor (pT1-2), upper lobe origin, single-station pathological N2, negative subcarinal node status, and extent of N2 metastasis (localized N2 metastasis) were favorable predictive factors in OS. On multivariate analysis, identified adjuvant chemotherapy was the only independent predictors of survival.In the cases of induction therapy, partial response (PR) was observed in 20 patients (63%). Pathological down staging of N2 disease (from pN2 to pN0-1) was confirmed in 12 cases (37%). OS in this cases was 33.5%. In 10 patients with cisplatin plus oral S-1 and concurrent radiation, there were 4 patients (40%) had a down staging of disease with complete lymph node response. In these patients 3 cases are alive without recurrence during 12-32 months follow up.
Conclusion:
Induction therapy containing cisplatin plus oral S-1 and concurrent radiation seems be feasible and had good response rate. At present, although no improvement in survival was shown for the statistical analysis with induction chemoradiotherapy followed by surgery in cN2/pN2 NSCLC because the number of cases was low, we come to expect improving outcomes in the future.
