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J. Usuda
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MA05 - Innovative Techniques in Pulmonology and the Impact on Lung Cancer (ID 378)
- Event: WCLC 2016
- Type: Mini Oral Session
- Track: Pulmonology
- Presentations: 1
- Moderators:J. Eckmayr, P.R. Mohapatra
- Coordinates: 12/05/2016, 16:00 - 17:30, Strauss 1
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MA05.11 - Photodynamic Therapy for Peripheral Lung Cancer Using Composite-Type Optical Fiberscope of 1.0 Mm in Diameter (ID 5457)
17:12 - 17:18 | Author(s): J. Usuda
- Abstract
- Presentation
Background:
Photodynanic therapy (PDT), is a treatment modality for many cancers, and uses a tumor-specific photosensitizer and laser irradiation. PDT is recommended as a treatment option for centrally located early lung cancer. The detection of peripheral lung cancers is increasing, and stereotactic body radiotherapy (SBRT) and percutaneous thermal ablation are emerging as alternatives to surgical resection, but PDT has not been a modality. Recently, we have developed a new minimally invasive laser device using a 1.0 mm in diameter composite-type optical fiberscope (COF), which could transmit laser energy and images for observation in parallel. In this study, we aimed to develop a new endobronchial treatment for peripheral cancer using PDT and a 1.0 mm in diameter composite-type optical fiberscope (COF), and we evaluated the feasibility of PDT using COF for peripheral lung cancer.
Methods:
This phase I study enrolled patients with peripheral lung cancers (primary tumor< 20 mm, stage IA), which were definitively diagnosed by bronchoscopic modalities using radial-probe endobronchial ultrasound (EBUS) and guide sheaths. We conducted irradiation using a diode laser (664 nm) and optical fiberscope (COF), four hours after the administration of NPe6 40 mg/m2. Before performing PDT, we evaluated the tumor lesions using EBUS through the guide sheaths for peripheral small lesions. Then, we introduced the COF into the peripheral lung cancer, observed the lesions and irradiated of red light 664 nm (120 mW, 50 J/cm2).
Results:
Three patients met our criteria, and 2cases were adenocarcinoma and 1 case squamous cell carcinoma. We were able to observe the cancer lesions at the peripheral lung by the COF, and feasibly irradiated. Two weeks and 3 months after NPe6-PDT, there was no morbidity including pneumothorax, pneumonia, skin photosensitivity.
Conclusion:
The 1.0 mm COF was a very useful device of NPe6-PDT for peripheral lung cancers, and PDT using the COF was a feasible and non-invasive treatment. Now, we have started phase II study of PDT using the COF for peripheral lung cancers. In the future, for non-invasive adenocarcinoma such as AIS, NPe6-PDT using COF will play an important role.
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P1.05 - Poster Session with Presenters Present (ID 457)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.05-036 - A Propensity-Matched Study of Multi-Port versus Single-Port Video-Assisted Thoracoscopic Surgery for Early Lung Cancer (ID 4595)
14:30 - 14:30 | Author(s): J. Usuda
- Abstract
Background:
Several thoracic surgeons have already reported the beneficial effects of single-port (SP) video-assisted thoracoscopic surgery (VATS) for the patients with lung cancer. We also analyzed surgical outcomes between SP VATS and multi-port (MP) VATS, which was defined as surgery through 3-4 ports alone, and showed the inhibitory effect of postoperative wound pain in the SP VATS (Eur J Cardiothorac Surg 2015 ). In this study, we aimed to compare the effectiveness of SP and MP video-assisted thoracoscopic surgery for stage I lung cancer.
Methods:
A total of 212 patients with non-small cell lung cancer underwent lobectomy via SP and MP procedure between April 2008 and June 2015 in our institute. We examined the a propensity-matched analysis, perioperative variables and short-term outcomes of both operations.
Results:
Propensity matching produced 80 pairs in each group. The clinical outcomes of SP /MP group were as follows. The mean Fev1.0 and maximum size of tumor was 1.88±0.32/1.65±0.41 liter and 2.8±0.3/2.7±0.3 cm, respectively. The median operation time, intraoperative blood loss was 165±35/172±26 min. and 85±25/75±26 ml. The median drainage duration and postoperative hospital stay were 1.8±0.7/1.9±0.8 and 7.5±1.9/7.2 ±1.8 days and the mean number of dissected lymph nodes was 19.8±3.8/17.5± 3.1. The number of days that was used with analgesic agents within a month after surgery was 8.1±1.2/12.5±2.5 (P<0.05). Conversion rate to open thoracotomy was 3.9/3.6 %. The overall 3-year disease free survival rate was 92/88%. As for mortality and morbidity, there was no significant difference in both groups.
Conclusion:
SP VATS lobectomy, showing alomost as effective as the MP VATS should be considered as a new treatment option for stage I lung cancer.
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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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P1.08-013 - Preoperative Managements for Pulmonary Complications Using Inhalations in Lung Cancer Patients with Chronic Obstructive Pulmonary Disease (ID 5566)
14:30 - 14:30 | Author(s): J. Usuda
- Abstract
Background:
Chronic obstructive pulmonary disease (COPD) is related to the prognosis of patients with lung cancer, and one of risk factors of respiratory complications after surgical resections. This study aimed to investigate whether perioperative inhalations of long-acting beta-agonists (LABAs) or long-acting muscarinic antagonists (LAMAs) would decrease the postoperative complications in lung cancer patients with COPD.
Methods:
We retrospectively analyzed 108 patients with COPD who underwent pulmonary resections for primary lung cancer at our hospital between January 2013 and January 2016, in order to determine the association between the incidence of postoperative complications (e.g., prolonged air leakage and pneumonia) and the use of LABAs or LAMAs.
Results:
Among 108 patients with COPD patients, there were 86 men and 22 women, with a mean age of 69.3 years (range, 46–84). The mean Brinkman index was 1172.1(range, 50-3480). The mean FEV1.0/FVC was 61.4%(range, 26.8%-69.9%). The surgical procedures were partial resection in 11 patients, pulmonary segmentectomy in 3 patients, lobectomy in 92 patients, and pneumonectomy in 2 patients. The histological types showed adenocarcinoma in 53 patients, squamous cell carcinoma in 38 patients, adenosquamous carcinoma in 5 patients, large cell neuroendocrine carcinoma in 3 patients, large cell carcinoma in 4 patients, small cell carcinoma in one patient, and pleomorphic carcinoma in 4 patients. There were 29 postoperative complications in COPD (26.9%), prolonged air leak (more than 7 days) 14 cases, pneumonia 9 cases, arrhythmia 2 cases, chylothorax 2 cases, wound infection 2 cases. The frequency of postoperative pulmonary complications such as prolonged air leakage and pneumonia, was significant higher in COPD (23 cases, 21.3%) than in non COPD (15 cases,6.7%). Inhaled bronchodilators such as LAMA or LABA were prescribed to 34 cases in COPD, not to 74 cases. The pulmonary complications were significant lower in LAMA or LABA users (3 cases, 8.8%) than in no users (20 cases, 27.0%).
Conclusion:
For lung cancer patients with COPD, preoperative management using the inhalants with LABA or LAMA, and smoking cessation can reduce the frequency of the postoperative pulmonary complications after surgical lung resection. The inhalants with LAMA or LABA may be adapted for the management of not only perioperative care but also long-term survival of COPD patients after surgery.
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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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P3.01-046 - Klotho Regulates Epithelial-Mesenchymal Transition in Lung Squamous Cell Carcinoma (ID 5240)
14:30 - 14:30 | Author(s): J. Usuda
- Abstract
Background:
Klotho gene was known as one of the anti-aging gene. We previously reported that the expression of the Klotho gene was an important postoperative prognosticator for lung large cell neuroendocrine carcinoma and lung small cell carcinoma. Recently, it has been shown that the Klotho gene suppresses epithelial-mesenchymal transition (EMT). In this study, we examined the association between the expression of Klotho and the regulation of EMT in lung squamous cell carcinoma.
Methods:
We examined the expression of Klotho in patients with lung squamous cell carcinoma, who received surgical resection or photodynamic therapy, by immunohistochemical analysis. In order to elucidate the association between the expression of Klotho and expression of EMT related protein, such as E-cadherin, N-cadherin, Vimentin and Snail, we transfected GFP-Klotho plasmid DNA into human squamous lung cancer cell line SQ5. Twenty four hours later, we sorted GFP-positive cells by flowcytometry using FACSCantoII (BD Biosciences, CA, USA), and then we examined the protein levels by Western blot analysis.
Results:
By immunohistochemical analysis, Klotho expression was observed in not only normal bronchial epithelial cells but also centrally located early lung cancers, which were all carcinoma in situ and treated by PDT. However, in lung cancer patients with invasive and or advanced squamous cell carcinoma who received surgical resection completely, Klotho expression was observed in only 4 patients (13%). In SQ5 cells transiently overexpressing GFP-Klotho, the expression of N-cadherin,which is one of mesenchymal markers, was completely inhibited compared with the SQ5 cells transfected with GFP vector. Overexpression of Klotho affected the regulation of neither other mesenchymal markers such as Vimentin and Snail nor epithelial marker, E-cadherin.
Conclusion:
We conclude that the expression of Klotho was related to the cancer invasive ness and Klotho inhibited the expression of N-cadherin, and regulates the EMT in lung cancer. Klotho may play an important role in cancer treatment and molecular-targeted therapy.
