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N.K. Shukla



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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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      P1.03-072 - Mediastinal Lymphnodes Staging by PET CT for Resectable Non-Small Cell Lung Cancer in a Tuberculosis Endemic Country (ID 4155)

      14:30 - 14:30  |  Author(s): N.K. Shukla

      • Abstract
      • Slides

      Background:
      Integrated 18 fluorine fluorodeoxyglucose (18F-FDG) PET-CT has shown somewhat variable sensitivity and specificity for nodal staging in tuberculosis endemic areas. This variation mainly because PET scans show falsely increased 18F-FDG uptake in inflammatory nodes, which may be observed in lymph nodes containing calcification or showing higher attenuations than those of surrounding great vessels on unenhanced CT scans. TB is a major health problem in India, incidence is around 2.1 million cases annually.The purpose of the study was to evaluate the efficacy of PET-CT for mediastinal nodal staging in non-small cell lung cancer (NSCLC) patients in a tuberculosis-endemic country.

      Methods:
      Prospective assessment of the diagnostic efficacy of integrated PET-CT for detecting mediastinal nodal metastasis was performed from February 2012 to February 2016. A total 160 patients underwent surgery for pathologically proven NSCLC. Patients who received chemotherapy or radiotherapy prior to surgery were excluded from study. Thus assessment of the diagnostic efficacy of integrated PET-CT for detecting nodal metastasis was performed in 46 patients (Male to Female ratio:4; mean age- 55 years). Patients underwent an integrated PET-CT examination and subsequent surgical nodal staging. One radiologist and 1 nuclear medicine specialist together prospectively evaluated PET-CT datasets.Nodes showing greater 18F-FDG uptake at PET without benign calcification or high attenuation >70 household unit (HU) at unenhanced CT were regarded as being positive for malignancy. All patients underwent hilar and mediastinal lymph nodes dissection according to the AJCC lymph node map (nodal stations 2R, 4R, 7, 8 and 9 for a right-sided tumour; 4L, 5, 6, 7, 8 and 9 for a left-sided tumour) after resection of the main tumour. Histologic nodal assessment results were used as reference standards. Of these 55 patients, 10 (20%) had a past history of pulmonary tuberculosis as determined by clinical or imaging studies.

      Results:
      Of 230 mediastinal nodal stations evaluated in 46 patients, 5(2%) stations in 4(8%) patients proved to be malignant by histopathologic assessment. Mean number of lymph node stations evaluated were 5. On a per-nodal station basis, the overall sensitivity, specificity, accuracy, PPV, NPV of PET-CT were 60%, 97%, 96%, 38%,99% for mediastinal lymph nodes staging(N2) respectively.

      Conclusion:
      Integrated PET-CT provides high specificity and high accuracy, but low sensitivity for mediastinal staging of NSCLCs. The high specificity is achieved at the expense of sensitivity by interpreting calcified nodes or nodes with high attenuation at CT, even with high FDG uptake at PET, as benign in a tuberculosis-endemic region.

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    P1.08 - Poster Session with Presenters Present (ID 460)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Surgery
    • Presentations: 1
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      P1.08-076 - Recurrence Patterns in Lung Cancer Patients Treated with Protocol Based Multimodality Treatment at a Tertiary Care Cancer Center in India (ID 4940)

      14:30 - 14:30  |  Author(s): N.K. Shukla

      • Abstract
      • Slides

      Background:
      Wide disparity has been reported in lung cancer survival between high income countries (HIC) and low-middle income countries (LMIC). The aim of present study is to analyze treatment outcomes and relapse patterns following protocol based multimodality management including quality control surgery in lung cancer patients from a tertiary care cancer center in India (LMIC).

      Methods:
      A retrospective analysis of computerized prospective clinical database of lung cancer patients treated consecutively during January 2006 to June 2015, in the department of Surgical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India was performed. The AJCC/ TNM (2010) staging system was referred for staging purpose. All patients were offered protocol based trimodality therapy (Surgery + Systemic therapy + Radiotherapy). Clinical spectrums, Follow up patterns, compliance to treatment and relapse patterns were analyzed.

      Results:
      A total of 136 patients underwent surgery during this period. Mean age at presentation was 53.16 years (SD 13.56) with male predominance (78%). Cough (58%) and Hemoptysis (42%) were most common presenting symptoms. Majority operated upfront (70%) and 126 (92.6%) underwent curative resection. Most common procedure was lobectomy (52%) however 42 patients (30%) underwent pneumonectomy due to advanced stage. Most common histology was squamous cell carcinoma (45%) followed by adenocarcinoma (36%). Most common stage was IIIA (30%) followed by IIB (27%). Median duration of surgery and hospital stay was 180 minutes and 7 days respectively. One patient developed post operative pneumonia and succumbed to it while 15 others developed major postoperative morbidity which was managed conservatively. Total of 30% received adjuvant chemotherapy and 11% received adjuvant radiotherapy. After median follow up of 7.26 months 16 (11.75%) patients had documented recurrences. Out of 16 patients 3 had isolated loco-regional, 4 had loco-regional with systemic and 9 had systemic recurrence. Among systemic recurrences five had multiple visceral, bone and brain in three each followed by contralateral lung in two patients.

      Conclusion:
      Majority of lung cancer patients presents in advanced stage. With good protocol based approach including quality-controlled surgery excellent outcomes can be achieved which are comparable to western world even in resource constrained low middle income countries like India.

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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
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      P2.02-048 - Predictive Factors of Outcome in Locally Advanced NSCLC Patients Treated with Neo-Adjuvant Chemotherapy in Resource-Constrained Settings (ID 5350)

      14:30 - 14:30  |  Author(s): N.K. Shukla

      • Abstract
      • Slides

      Background:
      Locally advanced lung cancer is an important cause of cancer-related morbidity and mortality in resource-constrained settings. Investigations and treatment options should be prioritized for optimal management based on availability and cost-effectiveness. We studied the impact of various factors on the risks of recurrence and survival in NSCLC patients undergoing surgery after NACT.

      Methods:
      We analysed prospectively maintained computerised database of operated carcinoma lung patients. Among 160 patients with NSCLC operated, 40(25%) received NACT. ALl patients underwent staging workup; physical examination, imaging(PET CT or CECT, brain CT), fibrooptic bronchoscopy. Chemotherapy regimen consisted of paclitaxel and carrboplatin for squamous cell carcinoma and pemtrexed based regimen for for adenocarcinoma. The decision of NACT before surgery was taken in multidisciplinary clinic in view of N2 disease or possibility of pneumonectomy. Histopathologic evaluation of gross residual tumour was done and percentage of residual tumour was estimated. Association between clinical, imaging and histopathologic factors with Disease Free Survival(DFS ) was assessed by univariate and multivariate cox propotional hazards model using stata software.

      Results:
      Median age of cohort was 57 years and male to female ratio 4:1. Squamous cell histology was present in 21 patients. Pathologic complete response(pCR) was achieved in 9 patients(22.9%). Median follow up period was 25 months. All patients with pCR are disease free. Median DFS was 27 months. Median overall survival not reached. Two year survival was 76%. All deaths were cancer related(n=6) and all these patients had post surgery residual N2 disease. Thre were 12 recurrences and all were distant metastasis. Cox regression analysis revealed that major pathological response and post surgery pathological N0/N1 status associated with improved DFS Figure 1



      Conclusion:
      Neoadjuvant chemotherapy is a feasible in resources constrained settings, result in major pathological response in a proportion of patients with locally advanced NSCLC. Major pathological response and post-surgery pathological N0/N1 status associated with good outcome

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