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Y. Sakao
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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
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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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): Y. Sakao
- 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.
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P1.08 - Poster Session with Presenters Present (ID 460)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.08-032 - Impact of the Oncogenic Status on the Mode of Recurrence in Resected Non-Small Cell Lung Cancer (ID 5392)
14:30 - 14:30 | Author(s): Y. Sakao
- Abstract
Background:
Surgical resection is employed in patients with resectable non-small cell lung cancer (NSCLC). Despite complete resection, recurrence is sometimes observed. Oncogenic mutations promote initiation and progression of lung cancer, and mutation status predicts treatment outcome of advanced NSCLC; however, their impact on the recurrence patterns remain poorly understood.
Methods:
We retrospectively studied 401 patients showing recurrence after complete resection of NSCLC. Clinicopathological factors were reviewed for time to recurrence (TTR), and recurrence patterns were compared according to oncogenic status and examined according to EGFR mutational subtype.
Results:
Among 401 patients, 185 with EGFR mutation, 46 with KRAS mutation, 15 with ALK rearrangement, and 155 with triple negative mutation (TN) were identified. Multivariate analysis following univariate analyses showed that younger age, well–moderately differentiated histology, earlier pathologic stage, and presence of EGFR or ALK mutation were favorable prognostic factors for TTR. Locoregional recurrence was observed in 53.3% of ALK-positive patients, being significantly common in these patients than in EGFR- and KRAS-positive patients. EGFR-positive patients mostly experienced pleural recurrence, the incidence of which was significantly higher in TN patients. Adrenal recurrence was observed in 7.2% of TN patients, but it was rarely identified in EGFR-positive patients. (Figure) Among EGFR-positive patients, the incidence of brain metastases was significantly higher in L858R cohort than in Del Ex19 cohort. Figure 1
Conclusion:
In resected NSCLC, younger age, well–moderately differentiated histology, earlier pathologic stage, and presence of EGFR or ALK mutation were favorable factors for TTR, and distinct recurrence patterns were revealed according to oncogenic mutation status and mutational EGFR subtype. Our results may provide suggestions for developing a strategy for follow-up and adjuvant therapies after resection.
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P3.01 - Poster Session with Presenters Present (ID 469)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.01-023 - Quality Assessment of Resampling Specimens in Primary Lung Cancers with Acquired Resistance to the Initial Therapy (ID 5543)
14:30 - 14:30 | Author(s): Y. Sakao
- Abstract
Background:
Most patients treated against molecular targets eventually develop resistance even after an initial dramatic response. Although rebiopsy of tumors at progression provide information for next-line therapy, it is expected that the tumor tissues would be modified by the therapy.
Methods:
We retrospectively examined histologic features in the resampled specimens in lung cancer patients with resistance to the initial therapy. Furthermore, we also analyzed the differences of tumor cell contents and molecular testing performance according to each biopsy site.
Results:
A total of 315 resampled specimens were submitted to pathology department from 260 patients. Of 315 samples, 116 (37%) were obtained from the lung and 96 (30%) from pleural effusion, 42 (13%) from lymph node, 16 (5%) from liver, 12 (4%) from cerebrospinal fluid (CSF), 10 (3%) from pleura and pericardial effusion, 7 (2%) from bone and 6 (2%) from other biopsy sites. When we compared 48 paired lung tissues between initial and rebiopsies, rebiopsy specimens had significantly less extents of tumor cells and more fibrosis than those in initial biopsy, and these differences were statistically significant with digital quantitation. Resampled sites affect the tumor cell extents and those were high in the order of liver, subcutaneous tissue, lymph node and lung biopsy, whereas pleura and bone samples had a tendency to contain a less number of tumor cells. Molecular testing was performed in 272 samples (from 222 patients). Of 272 samples, 223 (82%) were successfully analyzed, whereas 49 samples were unsuitable for the testing due to low tumor-cell content or complete absence of tumor cells. Higher success rates for molecular testing were seen in the liver and lymph nodes and the value of bone was lowest. Resistant T790M mutations were also differently detected and the higher detection rates were seen in liver, pleura and pericardial effusions.
Conclusion:
Resampled specimens had different property in terms of tumor extents, which differed among the biopsy sites. For molecular testing using resampled specimens, the difference should be taken into account.
