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T. Tsuchiya
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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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P1.08-079 - Sulvage Surgery after Definitive Radiotherapy or Chemoradiotherapy for Lung Cancer (ID 4262)
14:30 - 14:30 | Author(s): T. Tsuchiya
- 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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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. Tsuchiya
- 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.
