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Hideo Ichimura
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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)
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MA 14.06 - Population Based Cohort Study to Evaluate Lung Cancer Screening Using Low Dose CT in Hitachi City (ID 8087)
16:20 - 16:25 | Author(s): Hideo Ichimura
- Abstract
- Presentation
Background:
In 1998, low-dose CT screening for lung cancer was introduced in Hitachi City, Japan. Based on time trend analysis, a significant reduction in lung cancer mortality was observed 4–8 years after introduction of CT screening.
Method:
To evaluate the effectiveness of lung cancer screening, we conducted a cohort study for CT screening participants and X-ray screening participants among Hitachi residents. Citizens aged 50 to 75 who underwent CT screening from 1998-2006 were defined as the CT group, and those who underwent X-ray screening during the same period, but did not receive CT screening throughout the follow-up period were defined as the X-ray group. We investigated lung cancer mortality and all-cause mortality of both groups from the first lung cancer screening of the subject to the end of 2012 using residence registry, the regional cancer registry, and national death statistics.
Result:
From the CT group (17,935 cases, 9,790 men and 8,145 women), 273 cases of lung cancer (1.5%), 72 cases of lung cancer death (0.4%), and 885 cases of all-cause mortality (4.9%) were observed. On the other hand, 164 cases (1.1%) of lung cancer, 80 cases (0.5%) of lung cancer death, and 1,188 cases (7.6%) of all-cause mortality were observed in the X-ray group (15,548 cases, 6,526 men and 9,022 women). The hazard ratios of the CT group to the X-ray group adjusted for sex, age, and smoking history were 0.49 for lung cancer mortality and 0.57 for all-cause mortality.
Conclusion:
Low dose CT screening participants exhibited a 51% reduction in lung cancer mortality during the observation period compared with the X-ray group. Although all-cause mortality also decreased by 43% in the CT group, the decrease in proportion of lung cancer deaths was greater.
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P2.17 - Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies (ID 718)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.17-004 - Salvage Surgery for Pulmonary Metastases in Patients with Testicular Germ Cell Tumors (ID 10054)
09:30 - 09:30 | Author(s): Hideo Ichimura
- Abstract
Background:
Germ cell tumors of testicular origin are the most common malignancy in young males. The lungs and the retroperitoneal space are frequently the initial sites of metastatic disease. Salvage surgery is an important treatment modality for residual post-chemotherapy pulmonary masses. We analyzed the prognostic predictors of survival in the patients after pulmonary metastasectomy.
Method:
Between September 1989 and December 2015, 32 patients underwent pulmonary resection of thoracic metastases following cisplatin-based chemotherapy. Germ cell tumors of mediastinal origin were excluded. These patients’ records were subsequently reviewed.
Result:
All patients underwent high orchidectomy and cisplatin-based chemotherapy. The primary tumor histology demonstarated 2 seminomas and 30 nonseminomatous germ cell tumors. Twenty-three patients (72%) received two or more chemotherapy regimens. International Germ Cell Cancer Collaborative Group classification, TNM factors, and serum tumor marker level at diagnosis were not associated with prognosis after pulmonary metastasectomy. The mean age at pulmonary surgery was 31.9 years. The surgical procedures included wedge resection in 23 (72%) and segmentectomy/lobectomy in 9 (28%). There were no perioperative deaths and major postoperative complications. The overall 5-year survival rate was 73% after an average follow-up of 55 months. The pathology of residual pulmonary masses revealed viable tumor cells in 12 patients (38%), necrosis alone in 18 patients (56%), and mature teratoma alone in 2 patients (6%). Preoperative increased lactic dehydrogenase (LDH) levels were significantly associated with the viable tumor cells of residual masses. The size of pulmonary metastases has not been found to be statistically related to malignant tumor cells. A significantly poor survival was observed using univariate analysis in patients with preoperative high free-βHCG (p=0.012), high intact HCG (p=0.031), high LDH (p<0.001), removing 5 or more lung metastases(p=0.012), and viable tumor cells of residual masses (p=0.026).
Conclusion:
We conclude that pulmonary resection in metastatic testicular tumors is a safe and effective treatment strategy. Increased tumor marker levels, free-βHCG/intact HCG or LDH, removing 5 or more lung metastases, and viable tumor cells of residual masses were identified as prognosis-related criteria for a poor prognosis.
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P3.16 - Surgery (ID 732)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.16-039 - Right Upper Lobectomy with SVC Reconstruction after Induction Chemoradiotherapy for a Patient with Bulky N2 NSCLC (ID 7522)
09:30 - 09:30 | Presenting Author(s): Hideo Ichimura
- Abstract
Background:
The treatment strategy for N2 IIIA non-small cell lung cancer (NSCLC) is still controversial. Some believe that patients with bulky N2 are not good candidates for trimodality treatment. In addition, with regard to the survival of patients underwent lung resection with SVC reconstruction, patients with SVC involvement due to direct invasion of the main tumor have longer survival compared to those with SVC involvement due to mediastinal lymph node (LN) metastasis. We encountered a patient with bulky N2 NSCLC with SVC involvement.
Method:
A 69-year-old man complaining of cough was referred to our hospital for examination of a chest abnormal shadow. Chest CT showed a 58-mm pulmonary mass lesion in the right upper lobe and mediastinal LN swelling (#4R: 31 mm, #2R: 15 mm), which resulted in stenosis of the SVC. Transbronchial biopsy of the mass and EBUS-TBNA of the #4R LN showed squamous cell carcinoma. Since distant metastasis was not apparent, the patient was diagnosed with locally advanced IIIA lung cancer with bulky N2. After induction of concurrent chemoradiotherapy (2 cycles CDDP+VNR + 45 Gy radiotherapy), the lesion showed 9.5% reduction and was defined as stable disease according to the RECIST criteria.
Result:
Since it would be difficult to dissect the SVC and #4R LN, and this procedure would require substantial time, we approached by median sternotomy and right fourth intercostal thoracotomy and established the shunt between the left brachiocephalic vein and the right atrial appendage prior to cross-clump of the SVC. The SVC was resected because of extensive firm adhesion of the #4R LN, and reconstructed with a 12-mm reinforced polytetrafluoroethylene graft. The anastomosis was performed using a 5-0 Plorene suture. The patient underwent right upper lobectomy with mediastinal dissection and combined resection of the SVC. The operation time was 494 min and blood loss was 700 g. The patient was discharged on postoperative day 16. Pathological examination revealed the effect of chemoradiotherapy was Ef2, and viable cells were present in the #4 LN (ypN2).
Conclusion:
While the long-term outcome of this patient is unknown, we believe the trimodality treatment is an option for bulky N2 NSCLC with SVC involvement.
