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Huseyin Melek
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MA 17 - Locally Advanced NSCLC (ID 671)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:S. Jheon, Georgios Stamatis
- Coordinates: 10/17/2017, 15:45 - 17:30, F203 + F204 (Annex Hall)
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MA 17.08 - The Validity of TNM Classification After Induction Treatment in Patients with NSCLC: Pulmonary Resection with or Without Induction Treatment (ID 9613)
16:30 - 16:35 | Author(s): Huseyin Melek
- Abstract
- Presentation
Background:
Pathological staging (pTNM) after lung resection provides the most reliable data for staging non-small cell lung cancer (NSCLC) and predicting long-term survival. However, the survival rate of patients who undergo direct surgical treatment (pTNM) may differ from those who undergo lung resection after induction treatment due to locally advanced lung cancer (ypTNM). In this study we aim to compare the survival rate of pTNM versus ypTNM.
Method:
In this study, we retrospectively reviewed the prospectively recorded data of the patients undergoing surgery (segmentectomy or more) for NSCLC between 2006 and 2016. The patients were staged according to the 8th edition of TNM staging and divided into two groups. Group 1: patients who underwent direct surgical resection (n:450), Group 2: patients who received induction treatment before surgical resection for locally advanced NSCLC (n:345). We compared the survival rates and additional factors that affected the survival rates.
Result:
Postoperative histopathological investigation revealed ypT0N0 in 66 patients (complete response, group 2), stage 1 in 310 patients (group 1 n=211, group 2 n= 99) stage 2 in 223 patients (group 1 n=133, group 2 n= 90), stage 3 in 177 patients (group 1 n=100, group 2 n= 77), stage 4 in 19 patients (group 1 n=6, group 2 n= 13). Five year survival rate in all patients was 59,4% (group 1= 64,6%, group 2= 52,7%, p=0,001). Five year survival rate was 69,7% for complete response group. For patients with stage 1 disease survival rates were 81,9% for group 1 and 63,5% for group 2 (p=0,001). Patients with stage 2 had 5 year survival rates of 55,9% for group 1 and 45,9% for group 2 (p=0,11). Patients staged 3 and 4 had 5 year survival rates of 44,8% for group 1 and 34,4% for group 2 (p=0,10).
Conclusion:
This study revealed that survival rates varied between the patients who underwent direct surgery (pTNM) and the patients who underwent induction treatment before lung resection for locally advanced NSCLC. We recommend that the IASLC should examine the ypTNM stage in more detail in order to achieve more accurate results.
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P2.14 - Radiotherapy (ID 715)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.14-016 - Pulomonary Resection After Curative Intent Chemoradiation for NSCLC (ID 9623)
09:30 - 09:30 | Author(s): Huseyin Melek
- Abstract
Background:
In this study, we aimed to investigate the validity and clinical outcomes of lung resection after curative intent chemoradiation for locally advanced NSCLC.
Method:
The retrospective review of the prospectively recorded data of patients with NSCLC that was treated with curative intent induction chemoradiation followed by surgery between 1996 and 2016 was carried out. The patients undergoing segmentectomy or bigger resection with lymph node dissection after chemoradiotherapy were included into study. Patients received 2-6 cycles of chemotherapy and 45-70 Gy radiotherapy and were divided into two groups; Group 1: patients who received 60 Gy radiotherapy or less; Group 2: patients who received 61 Gy radiotherapy or more. We compared the chemotherapy drugs, doses, cycles, body mass index and performance status, type of lung resection, 90-day postoperative complications, mortality and long term survival between the two groups.
Result:
One hundred and forty two patients were included into study (group 1 n=88, group 2 n=54). All but 17 patients were male with a mean age of 56.5y (31-85y). Twenty patients underwent pneumonectomy and 122 patients received lobectomy (55 patients with extended resection, chest wall resection and sleeve etc). Complete pathological response was observed in 44(31%) patients (group 1= 29.5% (26/88), group 2= 33.3% (18/54), p=0.63. Postoperative morbidity rate was 42.2% (group 1=47.7% (42/88), group 2=33.3% (18/54), p=0.09. In addition, 90-day mortality rate was 6.3% (group 1=5.6%, group 2=7.4%, p=0.68). The overall survival 5-year survival rate was 54.1% that was 61% in Group 1 and 43.6% in Group 2, respectively (p=0.14). We found no relationships between the radiotherapy dose and the complete response rate, mortality, morbidity and survival.
Conclusion:
These findings reveal that lobectomy or pneumonectomy can be safely performed following high-dose chemoradiotherapy without affecting surgical outcomes. However, the positive or negative effect of high-dose radiotherapy on complete response and survival has not been proven.
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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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P3.16-046 - Pneumonectomy After Induction/Neoadjuvant Treatment for NSCLC: Morbidity, Mortality and Long-Term Survival (ID 9562)
09:30 - 09:30 | Author(s): Huseyin Melek
- Abstract
Background:
To compare the effects of neoadjuvant/induction chemotherapy or chemoradiation on morbidity, mortality, and long-term survival in patients with locally advanced NSCLC undergoing pneumonectomy.
Method:
All pneumonectomies following neoadjuvant treatment performed for NSCLC between 2000 and 2016 were retrospectively reviewed. The study included 162 patients (28 females; median patient age, 55.4 years [range, 31–73]). Neoadjuvant treatment consisted of chemotherapy in 115 patients (71%, group I) and chemoradiation in 47 patients (29%, group II). Chemotherapy was cisplatin-based, and 2–6 cycles of treatment were completed. Radiotherapy was administered sequentially (dose, 45–60 Gy). Surgery was performed 3–6 weeks after neoadjuvant treatment. Both groups were assessed for 90-day mortality, morbidity, and long-term survival.
Result:
Right pneumonectomy was performed in 60 (37%) patients, and the procedure was completed in a standard manner in 64.2% of the patients. Morbidity was observed in 27.7% of the patients (27,8% in group I; 27.6% in group II,p=0.98). The incidence of bronchopleural fistula was 4.3% (4.2% in group I; 4.3% group II). The 90-days mortality rate was 3.1% (5 patients in group I, 0 in group II,p=0.17). The mortality rates for right and left pneumonectomy were 3.3 (2/60 patients) and 3% (3/102 patients), respectively (p=0.61). The 5-year survival rates were 46.2% in group I and 54.2% in group II, (P = 0.16).
Conclusion:
Pneumonectomy after neoadjuvant chemotherapy or chemoradiation appears to be safe with an acceptable morbidity, mortality, and long-term survival. Chemoradiation did not improve long-term survival compared to chemotherapy despite comparable 90-day mortality and postoperative morbidity.
