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Shota Nakamura
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P1.08 - Locally Advanced NSCLC (ID 694)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.08-002 - Blood Supply to the Tumor Do Not Predict the Effect of Induction Therapy in Patients with Locally Advanced Lung Cancer (ID 8065)
09:30 - 09:30 | Author(s): Shota Nakamura
- Abstract
Background:
Induction therapy is a promising optional treatment for locally advanced lung cancer including superior sulcus tumors. However, predictors of the effect and pathologic complete responses have not been well-known. We hypothesized that those tumors invading neighboring structures would be more sensitive to induction therapy owing to the richer blood supply to them from involved organs. The purpose of this study was, therefore, to evaluate predictors for pathologic complete responses of induction therapy and whether the volume of blood supply to the tumor could predict the efficacy of induction therapy.
Method:
Patients who underwent induction therapy followed by surgery for locally advanced lung cancer were retrospectively reviewed. The volume of blood supply to the tumor was defined as the CT value (HU; Hounsfield Unit) calculated by subtraction of the non-enhanced value from the contrast-enhanced value (divided early phase and late phase) at the maximal dimension of the tumor on dynamic CT before induction therapy. The measured areas of the tumor were encircled by freehand with disengaging of bony structures. The efficacy of induction therapy was categorized to the pathologic complete response (pCR) and residual tumor (pRT) group.
Result:
From 2005, 50 patients were enrolled in this study. There were 43 males and 7 females, with a median age of 63 years old. The tumors consisted of 38 T3 lesions and 12 T4 lesions (40 chest wall, 7 mediastinum, and 3 vertebrae). Induction therapy included chemoradiotherapy in 39 patients, chemotherapy in 6, and radiotherapy in 5, and the dose of radiation was 40Gy in 33 patients, 45Gy in 1, 50Gy in 6, and 60Gy in 4, respectively. All patients except one underwent a complete resection, and the pathologic complete response was obtained in 15 (30%). The mean CT values of early and late phases in pCR groups were 14.1±12 HU and 30.6±14 HU, and those in pRT were 15.3±13 HU and 35.3±19 HU, respectively. By a logistic regression analysis, smaller size of the tumor (less than 42 mm) was the only trend of the predictor for pCR (p = 0.064), whereas maximum standardized uptake value on FDG-PET and CT values of early and late phases on contrast-enhanced CT had no correlations toward pathologic complete responses.
Conclusion:
The volume of blood supply to locally advanced lung cancers did not predict the effect of induction therapy, whereas smaller sized tumor tended to have a better effective response in this study.
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P1.17 - Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies (ID 703)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.17-004 - Extrapleural Pneumonectomy for Patients with Stage IVa Thymoma: Pathological Evaluation of Disseminated Pleural Nodules (ID 8445)
09:30 - 09:30 | Presenting Author(s): Shota Nakamura
- Abstract
Background:
The optimal treatment method for thymoma with pleural dissemination remains controversial. We have performed a multimodality treatment including extrapleural pneumonectomy (EPP) for patients with stage IVa thymoma and pleural dissemination. There are few literatures investigating malignant behavior of disseminated nodules at the parietal and visceral pleura. Therefore, whether complete resection can be accomplished by EPP is not known.
Method:
Our treatment strategy for those patients was induction chemotherapy with cisplatin, doxorubicin, and methylprednisolone (CAMP therapy), followed by thymectomy combined with EPP. We pathologically investigated parietal and visceral pleural nodules obtained by EPP in 8 patients with thymoma and pleural dissemination.
Result:
The median age was 49 (31 to 60) years old. Seven patients had stage IVa disease and 1 had recurrent disease. Preoperative CAMP therapy was performed in 5 patients. Macroscopic complete resection was archived in all patients. Parietal pleural invasions by disseminated nodules were found in 6 patients, invasions to the diaphragm in 6 and visceral pleural invasions in 7. Invasions into the muscle layer of the diaphragm were discovered in 4 patients. Pathological complete resection (R0) was archived in all patients, and the 5-year recurrence free survival rate was 80.0%.
Conclusion:
EPP could be a successful complete resection and might be beneficial for patients with stage IVa thymoma and pleural dissemination. In those some patients, resection of the muscle layer of the diaphragm is needed to obtain R0.
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P3.09 - Mesothelioma (ID 725)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.09-006 - Preoperative Six-Minute Walk Distance and Desaturation in Patients with Malignant Pleural Mesothelioma (ID 8762)
09:30 - 09:30 | Author(s): Shota Nakamura
- Abstract
Background:
Surgery for malignant pleural mesothelioma (MPM) is an invasive procedure associated with high morbidity. MPM often invades adjacent structures such as the chest wall, diaphragm, and mediastinum. Therefore, pulmonary functions and levels of physical fitness are reduced in advanced MPM. The aim of this study was to characterize preoperative exercise capacity and relate it to pulmonary functions, oxygenation, and postoperative outcomes in patients with MPM.
Method:
A retrospective study was conducted on 18 patients with MPM who were scheduled to undergo extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D) followed by postoperative rehabilitation at Nagoya University Hospital from July 2012 to April 2016 (Institutional Review Board approval No. 2015-0413). To estimate preoperative exercise capacity, 6-min walk test (6MWT) and oxygen saturation of a peripheral artery (SpO~2~) during the 6MWT were assessed. Grades III and IV of the Clavien-Dindo classification were defined as major postoperative complications.
Result:
The age was 65.8 ± 6.4 years. Preoperative 6-min walk distance (6MWD) was 465.9±96.7 m. Minimum SpO~2~ ranged from 86% to 97%. The 6MWD significantly correlated with inspiratory capacity (r=0.507, P<0.05) and % of predicted value of diffusing capacity of the lung for carbon monoxide (%DL~CO~) (r=0.470, P<0.05). The minimum SpO~2~ during 6MWT significantly correlated with % of predicted values of vital capacity (r=0.619, P<0.01) and total lung capacity (r=0.493, P<0.05) and postoperative days of extubation (r=-0.495, P<0.05). The preoperative partial pressure of oxygen in arterial blood significantly correlated with %DL~CO~ (r=0.505, P<0.05). There was a total of 13 major postoperative complications (8 respiratory failure, 2 pneumonia, 1 empyema, 1 atrial fibrillation, and 1 prolonged air leak) in 6 patients. There was no in-hospital death or death within 30 days after surgery. The incidence of major complications was significantly associated with longer stays in intensive care unit (3.3±1.8 vs. 1.7±1.0 days, P<0.05) and hospital (54.2±31.2 vs. 12.3±3.2 days, P<0.05) but not with preoperative physical status or pulmonary functions. Stays in hospital after EPP (n=7) were significantly longer than those after P/D (n=11) (median 28 vs. 12 days, P=0.01) but there was no significant difference in incidence of major complications between the EPP and P/D groups.
Conclusion:
Our results indicate that the 6MWT is a convenient and useful field test to assess preoperative physical status in patients with MPM. Future studies with a larger cohort are required to elucidate risk factors for postoperative morbidity and mortality.
