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M. Inoue
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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: 2
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-026 - Individualized Adjuvant Chemotherapy for Resected Lung Cancer According to Collagen Gel Droplet-Embedded Culture Drug Sensitivity Test (ID 3959)
14:30 - 14:30 | Author(s): M. Inoue
- Abstract
Background:
The efficacy of adjuvant chemotherapy for locally advanced lung cancer cannot be assessed during the treatment, since there is no measurable lesion after surgical resection. We conducted a prospective clinical trial according to the results of drug sensitivity test with an aim to individualize adjuvant chemotherapy.
Methods:
Patients with resectable c-Stage IB-IIIA non-small cell lung cancer were registered between 2005 and 2010. Collagen gel droplet-embedded culture drug sensitivity test (CD-DST) was performed on fresh surgical specimen. The clinical utility and prognostic outcome of adjuvant chemotherapy with carboplatin/paclitaxel in patients who showed chemo-sensitivity on CD-DST were evaluated. The primary endpoint was disease-free survival, and the secondary endpoints were overall survival and adverse effects during chemotherapy.
Results:
Among 92 registered patients, 87 (p-Stage IB in 54, IIA in 4, IIB in 10, IIIA in 19) were eligible and were included in the analysis. All patients were followed up for more than 5 years. The median age was 66 years old. The success rate of CD-DST was 87% and chemo-sensitivity to carboplatin and/or paclitaxel was observed in 75% of patients. Adjuvant chemotherapy was completed in 70% and the 5-year disease-free and overall survival rates were 68% and 82%, respectively. The 5-year disease-free and overall survival rates in Stage II–IIIA patients were 58% and 75%, respectively. As for the adverse effects during adjuvant chemotherapy, grade 4 neutropenia was found in 13%. Figure 1
Conclusion:
Chemo-sensitivity could be evaluated using CD-DST after lung cancer surgery. CD-DST might contribute to individualized adjuvant chemotherapy for locally advanced lung cancer.
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P2.02-033 - The Role of Surgery for Treating Occult N2 Non-Small Cell Lung Cancer (ID 5419)
14:30 - 14:30 | Author(s): M. Inoue
- Abstract
Background:
The presence of mediastinal nodal metastasis is one of the most important factors in the treatment of non-small cell lung cancer (NSCLC). The role of surgical intervention for treating N2 disease is controversial, and two randomized trials failed to show an overall survival benefit. Consequently, the purpose here is to elucidate the needs for surgical intervention of resectable N2 NSCLC.
Methods:
Between April 2010 and May 2016, 316 patients with NSCLC underwent pulmonary resection and mediastinal lymph node dissection. Patients with pathologic N2 were 26. Clinical outcomes and risk factors for pathologic N2 disease were retrospectively analyzed for this cohort.
Results:
Surgical treatment was performed of 26 pathologic N2 disease patients; there were 18 men and 8 women with a mean age of 68.3 years old (range 55-84). Occult pathologic N2 disease was identified in 22 patients (84.6%). The most common type of resection was lobectomy (96.1%). Adjuvant chemotherapy was administered in 21 patients (80.8%). N2 involvement was single-station in 4 (15.4%) and multiple-station in 22 (84.6%). All patients recovered and were discharged home. There was no operative mortality, and no hospital deaths. The 5-year overall and disease-free survival rates were 58.6% and 33.4%, respectively. The 5-year survival rates of single-station and multiple-station N2 were 50% and 73.2%, respectively (p =0.92). Patients with clinical (expected) N2 disease exhibited better survival outcomes compared with those with occult N2 disease (100% vs 59.8%). The group receiving adjuvant chemotherapy had significantly higher the 5-year survival rates. The 5-year survival rate in patients who received 4 or more cycles of adjuvant chemotherapy was 78.1%, as compared with 0% in non-treated patients (p =0.0008).
Conclusion:
The 5-year overall and disease-free survival rates of N2 disease tend to improve in recent years. The reasons for improved survival are the increasingly successful treatment options for recurrent disease, including chemotherapy, radiotherapy, and/or molecular targeting drugs. It is common knowledge that therapy of N2 disease needs not only surgery but also chemotherapy. The multiple courses of adjuvant chemotherapy may further improve the outcome in N2 disease. However, patients treated with surgery and chemotherapy had significantly better the 5-year survival rates than patients treated with chemotherapy alone. Though surgery might be very important in that way, the role of surgery for treating N2 disease remains an open question. Because we acknowledge that as a single-institution and retrospective analysis, our sample size was limited. We consider that large-scale, multicenter clinical trials are needed.
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P3.04 - Poster Session with Presenters Present (ID 474)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.04-017 - Wedge Resection for Clinical-n0 Non-Small Cell Lung Cancer (ID 4564)
14:30 - 14:30 | Author(s): M. Inoue
- Abstract
Background:
Sublobar resection is generally indicated for small ground-glass opacity (GGO)-dominant clinical T1 adenocarcinomas below 2 cm in diameter. Recently, some reports show that GGO-dominant clinical T2 adenocarcinomas measuring below 3 cm are also favorable prognosis after segmentectomy. The aim of this study was to evaluate the prognosis of the patients with non-small cell lung cancers after wedge resection.
Methods:
From 2008 to 2012, 66 patients underwent wedge resection for clinical-N0 lung cancer at Kyoto Prefectural University of Medicine. Patients who had multiple tumours or previously underwent lung surgeries were not included. The median age of the subjects was 73.0 years. High-resolution computed tomography (HRCT) was performed for preoperative staging of the entire lung cancer. The median tumour size was 2.2 cm. All tumours were evaluated to estimate the GGO on HRCT. We defined the ratio of the maximum diameter of the consolidation to the maximum tumour diameter as the consolidation-to-tumour ratio (CTR). All the patients who underwent wedge resection were followed up with HRCT every 6 months for the first 2 years and every 12 months for the subsequent 3 years. The median postoperative follow-up period was 41.5 months. The Kaplan-Meier method was used to assess recurrence-free survival (RFS) and 5-year overall survival (OS), which were statistically analyzed using the log-rank test. We set the significance level at p<0.05.
Results:
Twenty two (33.3%) of the 66 patients had GGO-dominant tumours with CTR of less than 50%, and have survived without recurrence. The 5-year OS, RFS and CSS of whole patients were 66.1%, 53.4% and 81.6% respectively. The 5-year OS significantly differed according to CTR and solid tumour size. The 5-year RFS significantly differed according to CTR, solid tumour size, CEA level, and histological type. No significant differences in sex, whole tumour size and Brinkman index were observed. Multivariate Cox proportional hazard model revealed that solid tumour size and CTR were independent prognostic factors for OS, RFS and CSS. Lung cancer death accounted for 10 of the 20 cause of death, leading cause of death of remaining half was 7 other malignant tumours. 18 patients experienced a recurrence of lung cancer. Site of recurrence was 8 lung parenchyma including 2 stump recurrences, 8 mediastinal lymph node, 4 pleural dissemination and 4 distant organ.
Conclusion:
A solid tumour size <1.2cm and CTR <50 might be a good, radiologically noninvasive indicator for performing wedge resection of clinical-N0 non-small cell lung cancer.
