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S. Senan
Moderator of
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Imaging and locally advanced NSCLC (ID 41)
- Event: ELCC 2017
- Type: Poster Discussion session
- Track:
- Presentations: 9
- Moderators:H. Prosch, S. Senan, P. Van Schil
- Coordinates: 5/06/2017, 14:45 - 15:45, Room W
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Invited Discussant 45PD and 46PD (ID 529)
14:45 - 15:00 | Author(s): H. Prosch
- Abstract
Abstract not provided
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Invited Discussant 61PD and 72PD (ID 530)
15:05 - 15:20 | Author(s): P. Van Schil
- Abstract
- Presentation
Abstract not provided
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Invited Discussant 73PD and 74PD (ID 531)
15:25 - 15:40 | Author(s): S. Senan
- Abstract
- Presentation
Abstract not provided
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- Abstract
Background:
Integrated 18F-FDG, PET-CT has shown somewhat variable sensitivity and specificity for nodal staging in tuberculosis endemic areas. This variation is mainly because PET scans show falsely increased 18F-FDG uptake in inflammatory nodes, which may be observed in lymph nodes containing calcification or showing higher attenuations than those of surrounding vessels on unenhanced CT scans. The AIM of the study was to evaluate the efficacy of PET-CT for mediastinal nodal staging in non-small cell lung cancer (NSCLC) patients in a tuberculosis-endemic country.
Methods:
From February 2012 to February 2016, a total of 160 patients underwent surgery for pathologically proven NSCLC. Patients who received neoadjuvant treatment were excluded from the study. Assessment of the diagnostic efficacy of integrated PET- CT for detecting nodal metastasis was performed in 46 patients (Male to Female ratio:4; mean age- 55 years). Patients underwent an integrated PET/CT examination and subsequent surgical nodal staging. Nodes showing greater 18F-FDG uptake at PET without benign calcification or high attenuation >70 household unit (HU) at unenhanced CT were regarded as being positive for malignancy. All patients underwent hilar and mediastinal lymph node dissection according to the AJCC lymph node map after resection of the main tumour. The histologic nodal assessment results were used as reference standards. Of these 46 patients, 10 (20%) had a past medical history of pulmonary tuberculosis as determined by clinical or imaging studies.
Results:
A total of 230 mediastinal nodal stations were evaluated in 46 patients; 5 (2%) stations in 4 (8%) patients proved to be malignant by histopathology. Mean number of lymph node stations were 5. On a per-nodal station basis, PET CT for mediastinal lymph nodes staging has sensitivity: 60%; specificity: 97%; accuracy: 96%; positive predictive value (PPV): 38%; negative predictive value (NPV): 99%.
Conclusions:
Integrated PET-CT provides high specificity and high accuracy, but low sensitivity for mediastinal staging of NSCLC. The high specificity is achieved at the expense of sensitivity by interpreting calcified nodes or nodes with high attenuation at CT, even with high FDG uptake at PET, as benign in a tuberculosis-endemic region.
Clinical trial identification:
Legal entity responsible for the study:
Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute Medical Sciences, New Delhi
Funding:
Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute Medical Sciences, New Delhi
Disclosure:
All authors have declared no conflicts of interest.
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46PD - The solid component evaluated on computed tomography can predict the invasiveness and lymph node metastasis in lung adenocarcinoma as well as pathological invasive size (ID 248)
14:45 - 14:45 | Author(s): Y. Sakao, H. Kuroda, T. Mizuno, N. Sakakura, Y. Yatabe
- Abstract
Background:
The newly revised TNM classification shows that cT and pT are to be evaluated with solid component on CT and pathological invasive size in adenocarcinoma of the lung. We evaluated the predictive factors for invasiveness, lymph node metastasis and recurrence in patients with adenocarcinomas of the lung, particularly pathological tumor diameters both of gross and invasive size, and solid component diameter using computed tomography (CT) both with lung window settings and mediastinal window settings.
Methods:
We evaluated 533 patients with lung adenocarcinomas (diameter, 6–132 mm) who underwent surgical resections. 447 of the 533 have been underwent systematic node dissection. Tumors were examined using CT with thin section conditions (1.25-mm thick: high-resolution CT), with tumor dimensions evaluated under two conditions: lung window (LD) and mediastinal window (MD) settings. Both of the tumor size on CT (LD, MD), consolidation component size on CT with lung window settings (C), preoperative serum carcinoembryonic antigen (CEA) levels, pathological tumor diameter both of gross(GS) and invasive lesion(IS), and pathological status [invasion of lymphatic vessels (ly), vascular vessels (v), pleura (pl), lymph node metastasis] were examined. Area under the curve (AUC) of Receiver Operating Characteristic (ROC) was used for evaluation.
Results:
AUCs according to the variables.rnTable: 46PDrnrn
rnGS: pathological gross tumor size, IS: Pathological invasive size, LD: Diameter with lung window settings on CT, MD: diameter with mediastinal window settings on CT, C: consolidation diameter with lung window settings on CT.rnrn rnrnVariables rnly(N = 533) rnv(N = 533) rnpl (N = 533) rnLymph node metastasis (N = 447) rnRecurrence (N = 447) rnCorrelation coefficient IS and other variables rnrn rnGS rn0.73 rn0.71 rn0.72 rn0.72 rn0.83 rnN.A rnrn rnIS rn0.86 rn0.82 rn0.79 rn0.79 rn0.86 rnN.A rnrn rnLD rn0.71 rn0.70 rn0.70 rn0.71 rn0.79 rn0.65 rnrn rnMD rn0.87 rn0.82 rn0.81 rn0.80 rn0.85 rn0.80 rnrn rnC rn0.83 rn0.80 rn0.79 rn0.79 rn0.83 rn0.78 rnrn rnC/LD rn0.81 rn0.78 rn0.75 rn0.73 rn0.69 rnN.A rnrn rnrnCEA rn0.68 rn0.66 rn0.69 rn0.70 rn0.72 rnN.A rn
Conclusions:
The solid component evaluated on computed tomography especially by MD and C can predict the invasiveness and lymph node metastasis in lung adenocarcinoma as well as pathological invasive size.
Clinical trial identification:
N.A.
Legal entity responsible for the study:
Yukinori Sakao
Funding:
N/A
Disclosure:
All authors have declared no conflicts of interest.
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- Abstract
Background:
The presence of solid histologic pattern in lung adenocarcinoma (ADC) is associated with early recurrence. However, individualized prognosis in patients with solid component is still unclear. This study aimed to develop a nomogram predicting the recurrence probability in stage I lung ADC patients with solid component.
Methods:
A total of 5904 patients with stage I lung ADC who underwent curative surgical resection from January 2008 through December 2014 at Shanghai Chest Hospital were retrospectively reviewed. Tumors were subtyped by using the IASCL/ATS/ERS classification. Of these patients, 708 contained a solid component. Prognostic value of gender, age at diagnosis, smoking history, operation type, tumor location, tumor size, pathological subtype, cell differentiation, lymphovascular and visceral pleural invasion were investigated. Multivariate Cox regression analysis of recurrence-free survival (RFS) in patients with solid component was performed and a nomogram to predict RFS was constructed. The nomogram was internally validated.
Results:
The overall recurrence rate in patients with solid component was 25.0% (177/708), with predominant solid subtype and minor solid component in 49.2% (87/177) and 50.8% (90/177) of cases, respectively. Larger tumor size (P = 0.002), predominant solid component (P = 0.003), advanced age at diagnosis (P = 0.015), and visceral pleural invasion (P = 0.040) were associated with an increased risk of recurrence and were included in the nomogram. The predictive model had a concordance index of 0.643 (95% confidence interval, 0.601-0.685) and showed good calibration.
Conclusions:
The nomogram model including identified risk factors for RFS is applicable in treatment decision-making for early stage lung ADC with pathological solid component. External validation is required to recommend this nomogram in routine practice.
Clinical trial identification:
Legal entity responsible for the study:
Shanghai Chest Hospital
Funding:
Shanghai Chest Hospital
Disclosure:
All authors have declared no conflicts of interest.
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72PD - Video-Assisted Thoracic Surgery (VATS) lobectomy for non-small cell lung cancer after induction chemotherapy: A propensity score-matched analysis on behalf of the Italian VATS group (ID 255)
15:05 - 15:05 | Author(s): L. Bertolaccini, A. Pardolesi, D. Argnani, J. Brandolini, D. Divisi, A. Bertani, A. Droghetti, A. Gonfiotti, R. Crisci, P. Solli
- Abstract
Background:
The aim of the present study was to assess outcomes among non-small cell lung cancer (NSCLC) patients treated with preoperative chemotherapy followed by Video-Assisted Thoracic Surgery (VATS) lobectomy from a National multi-institutional Registry.
Methods:
A National Registry established in 2013 was used to collect data from 65 Thoracic Surgery Units (>3,700 patients enrolled); only information from Units with >100 VATS lobectomies enrolled were analysed. A retrospective analysis was performed on patients with NSCLC who received preoperative chemotherapy followed VATS lobectomy within one year and compared to a propensity score matched population without preoperative chemotherapy. Propensity score (greedy 5 to 1 digit matching algorithm) estimated with multiple logistic regressions based on selection bias and potential confounding variables produced 221 patients (control group). After propensity score matching, data were compared with the paired Student’s t-test, Pearson’s χ[2] and Fisher’s exact test. Differences were considered to be statistically significant when the p - value was <0.05.
Results:
56/1679 (3.34%) patients met study inclusion criteria. There were no significant differences in baseline characteristics between groups (Table 1a). The majority of patients were clinical stage IIIA, although a small percentage of clinical stage II patients had preoperative therapy. Anatomic distribution of lobectomies and the number of resected lymph nodes not significantly differed between groups. Table 1b presents postoperative histology in the neoadjuvant groups. Table 1c reports short-term perioperative outcomes. No perioperative mortality was recorded in both groups. Overall morbidity (pneumonia, atrial fibrillation) was significantly higher in the neoadjuvant group, but interestingly, all the other variables were not influenced (conversion rate, operative time, blood loss, air leak duration, length of stay).rnTable: 72PDDemographics, postoperative histology/stage of the neoadjuvant group, and selected perioperative/postoperative outcomes. NA = not applicable, SD = standard deviationrnrn
rnrn rnTable 1a. Demographics characteristics rnrn rnrnCharacteristics rnNeoadjuvant Group (N = 56) rnPropensity Matched Group (N = 221) rnp - value rnrn rnM/F (%) rn50 rn61.99 rn0.938 rnrn rnAge (mean ± SD) rn64.14 ± 10.64 rn67.44 ± 11.93 rn0.888 rnrn rnCharlson Index (mean ± SD) rn4.19 ± 1.75 rn4.43 ± 1.85 rn0.530 rnrn rnECOG score rn0 rn0 rnNA rnrn rnPreoperative stage (N, %) • IIA • IIB • IIIA rn13 (23.21) 18 (32.14) 25 (44.64) rn64 (28.96) 59 (26.70) 98 (44.34) rn0.877 0.568 0.964 rnrn rnSurgical procedure (N, %) • Left upper lobectomy • Left lower lobectomy • Right upper lobectomy • Right lower lobectomy • Lower bilobectomy rn8 (14.29) 10 (17.86) 25 (44.64) 12 (21.43) 1 (1.79) rn43 (19.46) 29 (13.12) 89 (40.27) 36 (16.29) 3 (1.36) rn0.808 0.124 0.628 0.663 0.882 rnrn rnrnrn rn
rnrn rnrnTable 1b. Postoperative histology and stage of the Neoadjuvant Group (N, %) rnrn rnPostoperative histology • Adenocarcinoma • Squamous cell carcinoma • Other rn25 (44.64) 12 (21.43) 21 (37.5) rnrn rnStage • IA • IB • IIA • IIB • IIIA rn7 (12.5) 12 (21.43) 22 (39.29) 1 (1.79) 14 (25) rnrn rnrnrn rn
rnrn rnTable 1c. Selected perioperative and postoperative outcomes rnrn rnrnCharacteristics rnNeoadjuvant Group (n = 56) rnPropensity Matched Group (n = 221) rnp - value rnrn rnDuration of surgical operation, minutes (mean ± SD) rn182.14 ± 65.69 rn182.76 ± 66.17 rn0.933 rnrn rnIntraoperative blood loss, mL (mean ± SD) rn148.93 ± 153.57 rn154.19 ± 126.09 rn0.163 rnrn rnResected lymph nodes (mean ± SD) rn17.54 ± 10.37 rn14.04 ± 7.65 rn0.890 rnrn rnOverall conversion to thoracotomy (N, %) • Lymph nodes on pulmonary artery • Anomalies of anatomy • Bleeding rn6 (10.71) 3 (5.36) 1 (1.79) 2 (3.57) rn20 (9.05) 11 (4.98) 1 (0.45) 8 (3.62) rn0.0634 0.193 0.517 0.195 rnrn rnPostoperative air leaks (N, %) rn6 (10.71) rn12 (5.43) rn0.0396 rnrn rnPostoperative complications (N, %) • Pneumonia • Atrial fibrillation rn6 (10.71) 4 (7.14) rn7 (3.17) 10 (4.52) rn0.0398 0.0419 rnrn rnHospital length of stay, days (mean ± SD) rn8.73 ± 6.60 rn9.54 ± 8.92 rn0.759 rnrn rnrnrn
Conclusions:
VATS lobectomy after induction chemotherapy in stage II/IIIA NSCLC is feasible with a favourable profile regarding overall morbidity and mortality. This preliminary report shows that neoadjuvant treatment may not represent per se a contraindication to the VATS approach.
Clinical trial identification:
Legal entity responsible for the study:
Italian VATS Group
Funding:
Italian VATS Group
Disclosure:
All authors have declared no conflicts of interest.
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73PD - Prognostic value of pre- to post-treatment primary tumor metabolic volume reduction on 18F-FDG-PET/CT in a patient cohort with inoperable locally-advanced NSCLC treated with definitive chemoradiotherapy (ID 294)
15:25 - 15:25 | Author(s): O. Roengvoraphoj, C. Eze, W. Fendler, M. Dantes, C. Belka, F. Manapov
- Abstract
Background:
Previous studies have shown that primary tumor metabolic volume (PT-MV) on 18F-FDG-PET/CT could serve as a prognostic factor in patients treated with definitive chemoradiotherapy (CRT). We analyzed a correlation between pre- to posttreatment PT-MV reduction during the course of CRT and overall survival.
Methods:
Sixty-five patients with histologically confirmed NSCLC IIIA-B, treated with definitive CRT in the sequential (21/65 pts, 32.3%) or concurrent (44/65 pts, 67.7%) mode, who underwent 18F-FDG-PET/CT before and about 4-6 weeks after the CRT, were analyzed. Histology yielded 22 (33.8%) adenocarcinomas, 34 (52.3%) squamous cell carcinomas, 8 (12.3%) large-cell carcinomas and 1(1.5%) NSCLC not otherwise specified (NOS). Thirty-five patients (35/65, 53%) were enrolled in randomized clinical trials (16 pts in GILT, 10 pts in InCoDor and 9 pts in BROCAT study CTRT 99/97). The most common concurrent chemotherapy regimen (18/65 pts, 27.7%) consisted of cisplatin given intravenously at a dose of 20mg/m[2] on days 1-4 and oral vinorelbine 50mg/m[2] on days 1, 8 and 15, every 4 weeks for two courses.
Results:
Median OS for the entire cohort was 16 months (95% [CI],11.5–20.5). Complete remission (CR) was reached in 20 (31%), whereas partial and non-response occurred in 31 (48%) and 14 (22%) patients, respectively. The mean change from pre- to posttreatment PT-MV was -51% (range: +125% to -100%). Various cutoffs of PT-MV reduction (100- 90-85-80-70-60 and 50%) after the CRT were analyzed. CR(n = 20) had a median OS of 26 (95 CI: 5-47) vs. 13 months (95 CI:9-16) observed in the rest of treated group (p = 0.01, log-rank test). The results also showed a significant difference in OS favoring patients with PT-MV reduction >90% (n = 18) vs. the rest with a median survival of 24 vs. 13 months, respectively (p = 0.04, log-rank test). However, the association between PT-MV reduction at 80% and 70% and survival showed borderline significance (p = 0.07 and 0.09, log-rank test). PT-MV reduction at 60 and 50% failed to show an effect on OS.
Conclusions:
In this inoperable locally-advanced NSCLC cohort, a PT-MV reduction of at least 90% after definitive CRT correlated with improved OS.
Clinical trial identification:
Legal entity responsible for the study:
Deparment of Radiation Oncology, LMU Munich
Funding:
N/A
Disclosure:
All authors have declared no conflicts of interest.
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74PD - Radiation-induced lung toxicity prediction modeling in NSCLC: Importance of baseline toxicity scoring (ID 506)
15:25 - 15:25 | Author(s): G. Defraene, W. Van Elmpt, D. De Ruysscher
- Abstract
Background:
Validated outcome prediction models with high discriminative power are important for a cost-effective deployment of proton therapy for locally-advanced non-small cell lung cancer (NSCLC). We validated a model predicting lung toxicity 6 months after radiotherapy (RT) treatment.
Methods:
The model published by Appelt et al. (Acta Oncol 2014) was selected from a literature search. It relies on a review of radiation pneumonitis reports and retained the most important predictors, Mean Lung Dose (MLD) as dosimetric factor and 6 factors influencing the patient’s susceptibility: pre-existing pulmonary comorbidity, age>63 years, mid/inferior tumor location and sequential chemotherapy as risk factors, and current smoking and smoking history as protective factors. A dataset of 109 NSCLC patients treated at MAASTRO Clinic using 1.8 Gy fraction doses (two fractions per day) up to 79.2 Gy was studied. The required parameters were retrospectively collected together with the dyspnea endpoint (CTC 3.0 scoring) at baseline and at 6 months after RT. All treatments were performed using 3D-conformal RT techniques as it was the case in the study of Appelt et al. Odds ratios were calculated using logistic regression modelling.
Results:
19.3% of patients presented post RT dyspnea≥2. Our dataset confirmed current smoking and pulmonary comorbidity as prognostic factors for this endpoint, with similar odds ratios (OR = 0.28 (p = 0.02) and OR = 2.95 (p = 0.02), respectively). Tumor location OR was outside of the reported 95% CI. When predicting the change in dyspnea with respect to the baseline score (delta dyspnea≥1, prevalence of 18.6%), the two prognostic factors were not significant anymore (OR = 0.56 (p = 0.27) and OR = 0.47 (p = 0.21), respectively). Both factors exhibited strong correlation with the baseline patient status: worse baseline dyspnea is often a manifestation of existing comorbidities and it determines the probability to stop smoking. MLD was not associated with outcome in any of our models.
Conclusions:
It is crucial to consider delta toxicity endpoints in prediction modeling in order to obtain meaningful models reflecting radiotherapy outcome. Acknowledgement: This project has received funding from the EU under grant agreement no 601826 (REQUITE).
Clinical trial identification:
Legal entity responsible for the study:
KU Leuven
Funding:
EU
Disclosure:
All authors have declared no conflicts of interest.
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Optimal management of stage III NSCLC in 2017 (ID 19)
- Event: ELCC 2017
- Type: Multidisciplinary Interactive Session (MIS)
- Track:
- Presentations: 2
- Moderators:S. Senan, A.D.L.D.L. Sihoe
- Coordinates: 5/07/2017, 08:00 - 08:50, Room A
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Radiotherapy approach (ID 79)
08:15 - 08:30 | Author(s): S. Senan
- Abstract
- Presentation
Abstract not provided
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Surgical approach (ID 78)
08:00 - 08:15 | Author(s): A.D.L.D.L. Sihoe
- Abstract
- Presentation
Abstract not provided
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Standards for high-dose radiotherapy in lung cancer (ID 15)
- Event: ELCC 2017
- Type: Specialty Session
- Track:
- Presentations: 4
- Moderators:D. De Ruysscher, S. Senan
- Coordinates: 5/06/2017, 11:00 - 12:30, Room W
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ESTRO practice guidelines for lung SABR delivery (ID 62)
11:00 - 11:20 | Author(s): S. Senan
- Abstract
- Presentation
Abstract not provided
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Evidence-based guidelines for delivery of curative radiotherapy in stage III NSCLC (ID 63)
11:20 - 11:40 | Author(s): R. Dziadziuszko
- Abstract
- Presentation
Abstract not provided
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Extra-cranial oligometastatic NSCLC: Techniques, doses and timing (ID 65)
12:00 - 12:20 | Author(s): G. HANNA
- Abstract
- Presentation
Abstract not provided
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Practice guidelines for combining radiotherapy with targeted agents (ID 64)
11:40 - 12:00 | Author(s): D. De Ruysscher
- Abstract
- Presentation
Abstract not provided
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Author of
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Imaging and locally advanced NSCLC (ID 41)
- Event: ELCC 2017
- Type: Poster Discussion session
- Track:
- Presentations: 1
- Moderators:H. Prosch, S. Senan, P. Van Schil
- Coordinates: 5/06/2017, 14:45 - 15:45, Room W
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Invited Discussant 73PD and 74PD (ID 531)
15:25 - 15:40 | Author(s): S. Senan
- 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.
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Optimal management of stage III NSCLC in 2017 (ID 19)
- Event: ELCC 2017
- Type: Multidisciplinary Interactive Session (MIS)
- Track:
- Presentations: 1
- Moderators:S. Senan, A.D.L.D.L. Sihoe
- Coordinates: 5/07/2017, 08:00 - 08:50, Room A
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Radiotherapy approach (ID 79)
08:15 - 08:30 | Author(s): S. Senan
- 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.
-
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Standards for high-dose radiotherapy in lung cancer (ID 15)
- Event: ELCC 2017
- Type: Specialty Session
- Track:
- Presentations: 1
- Moderators:D. De Ruysscher, S. Senan
- Coordinates: 5/06/2017, 11:00 - 12:30, Room W
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ESTRO practice guidelines for lung SABR delivery (ID 62)
11:00 - 11:20 | Author(s): S. Senan
- 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.
