Virtual Library
Start Your Search
Gail Elizabeth Darling
Author of
-
+
MA 14 - Diagnostic Radiology, Staging and Screening for Lung Cancer I (ID 672)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:H. Kondo, Hong Kwan Kim
- Coordinates: 10/17/2017, 15:45 - 17:30, F205 + F206 (Annex Hall)
-
+
MA 14.14 - The First 100 Days: Early findings from the Lung Cancer Screening Pilot for People at High Risk in Ontario, Canada (ID 8579)
17:10 - 17:15 | Presenting Author(s): Gail Elizabeth Darling
- Abstract
- Presentation
Background:
An estimated 330,000 people in the province of Ontario are at high risk of developing lung cancer and eligible for screening with low-dose computed tomography (LDCT). On June 1 2017 Cancer Care Ontario launched the Lung Cancer Screening Pilot for People at High Risk with the purpose of informing the design and implementation of a province-wide organized screening program. Organized screening is available at 3 hospitals, and provider and public recruitment strategies are being implemented to engage the target population in regional catchment areas. Key aspects of pilot design include eligibility based on the PLCO~M2012noRace~ risk prediction model, navigation support, informed participation, embedded smoking cessation services, radiology quality assurance, LDCT findings categorized in accordance with Lung-RADS™, provision of same-visit screening results and seamless transition to a Diagnostic Assessment Program (DAP) for assessment of findings suspicious for lung cancer. Data collected for 3,000 participants over a 2-year period will inform a comprehensive evaluation of the pilot.
Method:
Indicators were selected to assess impacts of early recruitment efforts and outcomes of key screening processes related to eligibility assessment, the LDCT scan and smoking cessation. Data were collected by the pilot sites and submitted to Cancer Care Ontario. Participant feedback on the screening experience was collected by survey. Data were collected in June and July 2017; data from August 2017 will be available for presentation.
Result:
The majority (87%) of the 862 people recruited into the pilot were provider-referred. Of the 472 people who completed a risk assessment, 71% were found to be eligible for screening (PLCO~M2012noRace~ 6-year risk ≥2.0%). Baseline LDCT scans were conducted for 156 participants; approximately 8% of these participants were referred to a DAP for further assessment. Uptake of smoking cessation services by current smokers was high (data to be included in presentation). Feedback surveys were received from 78 of 156 participants screened. Overall experience with the screening visit was rated as ‘excellent’ by 91% of respondents, and 70% indicated a preference to receive results during the same visit as the LDCT.
Conclusion:
Provider-led recruitment supports the identification of screen-eligible individuals. Implementation of navigator-guided organized screening, following a detailed screening pathway that features provision of same-visit results, has contributed to high participant satisfaction to date. To our knowledge, this pilot involves the most detailed organized screening pathway and comprehensive evaluation plan developed to date. Learnings from this pilot will be highly relevant to jurisdictions around the world that are adopting screening.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
-
+
MTE 16 - Technical Issues after Neoadjuvant Chemoradiation - Surgeon's Perspective (Sign Up Required) (ID 565)
- Event: WCLC 2017
- Type: Meet the Expert
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 07:00 - 08:00, Room 311 + 312
-
+
MTE 16.02 - Surgery for Stage IIIA NSCLC - Surgeon's Perspective (ID 8128)
07:30 - 08:00 | Presenting Author(s): Gail Elizabeth Darling
- Abstract
- Presentation
Abstract:
Surgery for Stage IIIA NSCLC - Surgeon's Perspective Gail E Darling MD FRCSC, University Health Network, University of Toronto, Toronto Canada Outline Indications for operating on IIIA Choice of Induction regimen: chemotherapy vs chemoradiation Restaging the mediastinum: why or why not? how (EBUS vs med, redo med?) , Factors in decision making whether or not to proceed with surgery after induction Salvage resection after definitive chemoradiation Indications for Surgery for Stage IIIA NSCLC 1.T3N1M0, T4N0M0, T4N1M0: if primary is resectable with R0 resection 2.T1-3N2M0: single station microscopic N2, resectable with R0 resection, selected multistation N2 if microscopic N2 and nodal disease is resectable with R0 3.Patient is fit for planned resection Contraindications to surgery for Stage IIIA NSCLC 1. Extracapsular N2 2. Fixed bulky nodes 3. Inability to achieve an R0 resection 4. T4N2 5. Patient not fit for planned resection (right pneumonectomy required?) Choice of Induction: Chemotherapy alone vs Chemoradiation 1. Intergroup 0139 trial: concurrent cisplatin + etoposide + 45 Gy improved disease free survival over surgery alone 2. SAKK trial: RCT Chemo vs chemoRT ( sequential) →No difference in survival 3. Concurrent chemoRT higher rates of mediastinal downstaging compared to chemotherapy alone 4. Radiation may be undesirable if sleeve resection of bronchus or artery is planned Restaging after Induction therapy 1. CT scan: to assess response but primarily to confirm resectability and exclude progression 2. PET: to rule out progression; assess response to determine if surgery is required? 3. Mediastinum: a) restage only if surgeon will not operative if persistent N2. Intergoup 0139 trial reported best survival if mediastinum was sterilized by induction but even if persistent disease survival was better with surgery than chemoRT alone. B) Restaging: if first mediastinal staging was performed by mediastinoscopy PET is most accurate; EBUS/EUS not reliable (sampling error); redo mediastinoscopy difficult, not reliable. If first staging was performed by EBUS/EUS then mediastinoscopy is appropriate and reliable for restaging. Factors in Decision Making to Proceed with Surgery after Induction 1. Patient is fit ( recovered fully from induction, good performance status) 2. Cancer has not progressed 3. Lack of radiographic response is not a contraindication to resection 4. R0 resection is possible Salvage Surgery after Definitive Chemoradiation 1. Patient is fit with good performance status 2. Primary site is only site of disease
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
-
+
P1.13 - Radiology/Staging/Screening (ID 699)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
-
+
P1.13-004 - The Role of Lymph Node Staging by EBUS-TBNA in Stereotactic Body Radiation Therapy for patients with Non-Small Cell Lung Cancer. (ID 8070)
09:30 - 09:30 | Author(s): Gail Elizabeth Darling
- Abstract
Background:
Stereotactic body radiation therapy (SBRT) is an option for treatment of patients with non-small cell lung cancer (NSCLC). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, diagnostic modality for mediastinal and hilar staging of NSCLC. We evaluated the diagnostic value of EBUS-TBNA in SBRT candidates and compared it to that of computed tomography (CT) and positron emission tomography (PET) scans.
Method:
Inclusion criteria for this single institutional retrospective study included 1) biopsy-proven or clinically suspicious NSCLC with diameter <6 cm; 2) no evidence of distant metastasis; 3) EBUS-TBNA staging between April 2008 and November 2014; 4) medically SBRT-eligible other than nodal staging. CT and PET positive nodes were defined as short axis ≧1cm and standardized uptake value ≧2.5, respectively. Node positive by clinical-pathologic confirmation (NPCP) was defined as confirmed malignancy by EBUS-TBNA or clinically diagnosed recurrence in hilar or mediastinal lymph nodes within one year after SBRT. The survival after SBRT was compared between CT or PET node-positive but EBUS-TBNA result-negative patients, and a matched cohort (tumor size; radiation dose; operability) who underwent SBRT in our institution within the same time period but without EBUS-TBNA staging.
Result:
There were 35 eligible patients (mean age 77±8.2, 24 male). Thirty-two (91.4%) patients had pathological confirmation of NSCLC (mean diameter 2.5±1.0 cm) (T1a N=12, T1b N=15, T2a N=7, T2b N=1). Thirty (85.7%) patients were medically inoperable. After EBUS-TBNA, 20 out of 24 patients who had positive nodes in CT (N=13) or PET (N=17) were ultimately pathologically N0. All eleven image-negative patients were N0 following EBUS-TBNA. Thirty-one patients (20 image positive plus 11 image negative) underwent SBRT. Sensitivity/specificity of CT, PET and EBUS-TBNA for NPCP were 42.9/64.3%, 100/64.3% and 57.1/100%, respectively. Positive predictive value of CT and PET for NPCP was 23.1% and 41.2%, respectively. Negative predictive value of CT, PET and EBUS for NPCP was 81.8%, 100% and 90.3%, respectively. A 1:4 (Case; N=20, Control; N=76) match was obtained. Regional failure-free survival (p=0.71, HR=0.88 CI 0.45-1.74) and disease-free survival (p=0.77, HR=1.10 CI 0.58-2.11) of the Case were not significantly different from the ones of Control. There were no major complications related to EBUS procedures.
Conclusion:
EBUS-TBNA can be considered for invasive staging in SBRT-eligible NSCLC patients with radiographically positive lymph nodes because of its safety and possibility of false positive imaging. If EBUS-TBNA result is negative, these patients may remain candidates for SBRT with comparable outcomes to those who are conventionally selected for SBRT.
-
+
PL 04 - Closing Plenary: Where We Are Now, and Where We Will Be in 10 Years (ID 587)
- Event: WCLC 2017
- Type: Plenary Session
- Track:
- Presentations: 1
- Moderators:H. Kato, Rafael Rosell
- Coordinates: 10/18/2017, 16:30 - 17:45, Main Hall
-
+
PL 04.04 - WCLC 2018 - Welcome to Toronto (ID 7844)
17:30 - 17:35 | Presenting Author(s): Gail Elizabeth Darling
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
