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M. Vrankar
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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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P1.03-069 - EGFR Mutations Have Greater Influence on Survival Than Proposed M Descriptors of New TNM Classification for Lung Cancer (ID 5294)
14:30 - 14:30 | Author(s): M. Vrankar
- Abstract
Background:
The forthcoming 8th edition of TNM staging system for lung cancer proposes revision of M descriptor. No changes of M1a category is suggested, while further sub-classification of M1b category into M1b (single distant metastatic lesion in single organ) and M1c (multiple distant metastatic lesions) is proposed. The limitations of new classification due to lack of information on EGFR and ALK status that significantly impact treatment response and outcome have been pointed out, however no further analysis addressing this issue has been published. Here we report the impact of EGFR mutation status on survival in view of new TNM classification system.
Methods:
Database of 479 metastatic non-small cell lung cancer (NSCLC) patients, treated between 2009 and 2011, all tested for EGFR mutations, was retrospectively reviewed to categorize them into one of the new sub-groups according to new M descriptors. Medical records of 355 patients, among them 89 with EGFR mutations (EGFR-m), had sufficient information that allowed appropriate new categorisation.
Results:
After a median follow up of 53.9 months, median overall survival (mOS) of EGFR-m patients (20.6 months) was significantly longer than mOS of patients without EGFR mutations (8.3 months, p<0.001). Patients with the smallest disease burden (M1b sub-group) had the longest mOS among EGFR wild type patients (EGFR-wt) and EGFR-m patients, 14.4 months and 41.1 month, respectively. However, due to small number of patients in M1b subgroup, the difference was not statistically significant (p=0.08). In spite of widespread metastatic disease in M1c EGFR-m patients, they had longer mOS than M1b EGFR-wt patients with the lowest disease burden, 18.8 vs 14.4 months, respectively.
Conclusion:
EGFR mutational status has probably more important impact on mOS than the number of metastasis or number of metastatic sites in NSCLC. Our results indicate that further analysis is warranted to address this issue.M descriptor EGFR-m EGFR-wt n mOS (months) n mOS (months) p M1a 17 22.3 61 10.7 0.022 M1b 5 41.1 32 14.4 0.080 M1c 67 18.8 173 6.6 <0.001 all 89 20.6 266 8.3 <0.001
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P2.05 - Poster Session with Presenters Present (ID 463)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.05-016 - Higher Dose of Radiotherapy Better for Outcome of Patients with Locally Advanced Non-Small Cell Lung Cancer (ID 5499)
14:30 - 14:30 | Author(s): M. Vrankar
- Abstract
Background:
The standard treatment for inoperable locally advanced non-small cell lung cancer (LA NSCLC) includes concurrent or sequential chemotherapy and radiation therapy (RT). RT with 60 to 66 Gy in 30-33 fractions represent a backbone of treatment in inoperable LA NSCLC and optimal radiation dose is essential for successful treatment. Long term survival rates with these approaches remains in the order of 15 - 20%.
Methods:
We evaluated the clinical significance of the RT doses in patients with inoperable LA NSCLC who underwent concurrent chemoradiotherapy in our institution between 2005 and 2010 and correlated the doses with outcome of treatment. All patients were treated with three 21-day cycles of induction chemotherapy with cisplatin and gemcitabine. Within 13 – 22 days after the last application of chemotherapy, all patients continued treatment with conventionally fractionated 3D-RT in 2 Gy fractions concurrently with cisplatin and etoposide. We evaluated the outcome of the patients treated with RT doses less or equal 62 Gy and treated with more than 62 Gy.
Results:
One hundred and five patients were treated with combined chemoradiotherapy between 2005 and 2010 in our institution, 82 males and 23 females. Most patients had surgically inoperable tumor in stages IIIA (50 patients) and IIIB (51 patients), 4 patients were medically inoperable. The most predominant histological subtype was squamous cell carcinoma (75%), followed by adenocarcinoma (15%). No statistical significant differences in patient characteristics, including age, smoking status, gender and histology were found according to the dose of RT. The dose intensity of induction and concurrent chemotherapy, expressed as a mean percentage of prescribed drug administered, was not statistically different for any drug used according to the dose of RT. Radical irradiation with doses of 54 - 62 Gy and 62.1 - 66 Gy was completed in 47 and 58 patients. After a median follow up of 103.4 months, 17 patients were still alive, 11 patients treated with > 62 Gy. Median overall survival (mOS) was 16.6 and 31.4 months for RT doses ≤ 62 Gy and > 62 Gy, respectively (p=.037) (Fig.1). 5-years survival was 19.1% and 29.3% for treatment with ≤ 62 Gy and > 62 Gy.
Conclusion:
RT dose may be an important factor for outcome of patients with LA-NSCLC. Our analysis confirms the importance of RT dose on outcome in patients with LA NSCLC, but since small number of patients were included, no firm conclusion could be made and further clinical investigation is warranted.
