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T. Oto
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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: 3
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-009 - Clinical Outcomes of Induction Chemoradiotherapy with High Dose Chest Radiation for Locally Advanced Non-Small Cell Lung Cancer Patients (ID 4362)
14:30 - 14:30 | Author(s): T. Oto
- Abstract
Background:
In the treatment of patients with locally-advanced non-small cell lung cancer (LA-NSCLC), we usually apply chemoradiotheraphy (CRT) consisted of docetaxel and cisplatin with concurrent 40-60 Gy radiation therapy. The radiation dose of 60 Gy is generally planned in the case of definitive CRT. On the other hand, the radiation dose of 46 Gy is planned in the case of induction CRT, considering the safety of surgery. In the induction CRT, if the treatment response is poor and complete resection is supposed to be difficult, additional radiation is performed. In this study, we examined the safety and clinical outcome of lung resection after induction CRT using high-dose radiation in patients with LA-NSCLC.
Methods:
One hundred and eighteen patients with LA-NSCLC who underwent induction CRT followed by surgery between March 1999 and December 2014 in our hospital were reviewed. We categorized those patients into low-dose radiation group who received less than 60 Gy of radiation (n=105) and high-dose radiation group who received more than 60 Gy of radiation (n=13). We compared postoperative outcomes between these two groups applying match-paired analysis with using propensity score.
Results:
One hundred and eighteen cases consisted of 91 males and 27 females, and the average age was 60 years. Eleven patients had stage IIB disease, 73 patients had stage IIIA disease, and 34 patients had stage IIIB disease before CRT. The background between low-dose group and high-dose group was similar. There were no significant differences in the mortality (0.8% vs 0% in low-dose group and high-dose groups), the incidence of postoperative complication (57% vs 77%), and post-operative hospital days (median 22 vs 28 days) between each group. In addition, there were no significant differences in the 5-year OS rates (73% vs 77% in low-dose group and high-dose groups, p =0.66), and the 5-year DFS rates (56% vs 77%, p =0.11) between each group, even when we applied matched-paier analyses.
Conclusion:
This study showed that lung resection after induction CRT using high-dose radiation for LA-NSCLC patients had been performed safely with equivalent prognosis compared with that using low-dose radiation.
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P2.02-035 - The Advantage of Induction Chemoradiotherapy in Bronchoplastic Procedure for Non Small Cell Lung Cancer Accompanied with Central Disease Region (ID 5565)
14:30 - 14:30 | Author(s): T. Oto
- Abstract
Background:
A bronchial sleeve lobectomy is a widely accepted procedure for enabling the pulmonary parenchyma to be spared. Trimodality therapy is one of therapeutic options for locally advanced non-small-cell lung cancer (NSCLC), though the negative effect of chemotherapy or radiotherapy on tissue healing is a concern. This study aimed to compare the clinical outcomes of pulmonary resection with bronchoplasty with or without prior induction chemoradiotherapy (CRT) and to investigate the feasibility of induction CRT in bronchoplastic procedure.
Methods:
The medical records of NSCLC patients who underwent surgery with bronchoplasty at our institution between January 1999 and September 2014 were reviewed. We compared the clinical outcomes of bronchoplasty with or without induction CRT.
Results:
A total of 58 NSCLC patients were the subjects of this study. Among them, 38 patients underwent primary surgery with bronchoplasty and 20 patients underwent surgery with bronchoplasty after induction CRT. The median patient age was 64 years (range: 31–81 years). The histological subtype was adenocarcinoma in 18 patients, squamous cell carcinoma in 39, large cell carcinoma in one. Of the 58 patients, seven patients had stage IA disease, five had stage IB disease, 10 had stage IIA disease, six had stage IIB disease, 24 had stage IIIA, and six had stage IIIB. Regarding the postoperative complications, there are no significant differences between the primary surgery group and the induction CRT group (P = 0.47). For the entire population, the 5-year overall survival (OS) rate was 69.9 %, and the 2-year recurrence-free survival (RFS) rate was 64.2 %. Even though the clinical stage was significantly higher in the induction CRT group than in the primary surgery group (P = 0.0006), no significant differences in OS and RFS rate were observed between the two groups. Regarding the intraoperative procedures, patients in the primary surgery group had a significantly higher rate of additional bronchial resection because of positive bronchial margin for cancer cell than those in the induction CRT group (P = 0.023).
Conclusion:
In bronchoplasty, additional resection of airway after intraoperative histological examination should be avoided to prevent tumor cell dissemination. Our experience suggests the possible advantage of induction CRT to ensure the surgical margin and indicates that surgery with bronchoplasty after induction CRT is a feasible procedure.
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P2.02-054 - Impact of Prognostic Nutrition Index for Induction Chemoradiotherapy Followed by Surgery in Locally Advanced Non-Small Lung Cancers (ID 4607)
14:30 - 14:30 | Author(s): T. Oto
- Abstract
Background:
The preoperative nutritional and immunological statuses have an important impact in predicting the clinical outcome of surgery. Induction chemoradiotherapy (iCRT) followed by surgery is one of treatment options for locally advanced (LA) non-small cell lung cancers (NSCLCs) although there is a risk for increasing postoperative complications with protracted would healing. A prognostic nutritional index (PNI), calculated using serum albumin levels and peripheral lymphocyte count, has been used to predict the clinical outcome of various cancers including early stage NSLCCs but not LA-NSCLC after iCRT. In this study, we investigated the impact of PNI on clinical outcome of iCRT followed by surgery in the patients with LA-NSCLCs.
Methods:
During 2009 to 2014, 70 patients underwent iCRT followed by surgery in Okayama University Hospital. We retrospectively calculated the PNI at (1) pre-iCRT, (2) pre-operation (Ope), and (3) post-Ope (about one month later) and reviewed the medical records.
Results:
The median age was 63 years old (range 34 – 78) and 53 patients were male. Forty-three patients were adenocarcinomas and 24 were squamous cell carcinomas. Clinical stages were IIA (n =3), IIB (n = 6), IIIA (n = 44), IIIB (n = 15), and IV (n = 2). Main regimen of iCRT was CDDP / DOC with concurrent radiotherapy (46 gray). Treatment responses were partial response (n = 44), no change (n = 24), and progressive disease (n = 2). Lung resections were lobectomy (n = 66), bi-lobectomy (n = 6), and pneumonectomy (n = 2) and additional procedure such as combined resection was performed in 43 patients (61%). Pathological responses were Ef1 (n = 20), Ef2 (n = 29), and Ef3 (n = 21). The median values of PNI were significantly decreased during treatment course [50 (39 – 71) in pre-ICRT, 45 (31 – 58) in pre-Ope, and 41 (24 – 54)]. We defined the cutoff value of PNI as 45 based on previous reports. The patients with high PNI (more than 45) in pre-iCRT showed significantly better prognosis than those with low PNI (3 years overall survival rate, 85% in high PNI vs 53% in low PNI, P = 0.03).
Conclusion:
Pre-treatment nutritional and immunological statuses that were evaluated using PNI may affect clinical outcome of the patients who received the iCRT followed by surgery for LA-NSCLCs.
