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George Karimundackal
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P1.13 - Radiology/Staging/Screening (ID 699)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.13-010 - Is MRI Brain Mandatory in All Patients with Early Stage NSCLC? (ID 9779)
09:30 - 09:30 | Presenting Author(s): George Karimundackal
- Abstract
Background:
Non - small cell lung cancer(NSCLC) is known to have a high propensity for metastasis to brain. Conventional wisdom and guidelines recommend MRI brain as routine staging investigation for patients planned for radical treatment. However there is little data about the detection rate of brain metastasis using MRI brain in asymptomatic patients with operable/early stage NSCLC.
Method:
We conducted a prospective observational study to assess the incidence of MRI detected brain metastasis in early operable lung cancer. Consecutive patients presenting to the outpatient department with biopsy proven NSCLC were screened. All patients planned for radical treatment underwent PET CECT and MRI brain as per institutional protocol. Patients with early stage disease( Stage I to IIIA) on PET CECT with no symptoms suggestive of brain metastasis were included in the study. Data regarding histopathology, T stage, N stage, SUV uptake of primary, clinicoradiological stage, neurological symptoms and MRI brain findings was collected.
Result:
1944 consective biopsy proven patients of NSCLC presenting in the outpatient department from Jan 1st 2015 to Dec 31st 2015, were screened. 168 patients in stage I to IIIA as per PET CECT, without obvious evidence of brain metastastis were included in the study, 81(48.2%) were in stage I&II and 87(51.7%) were in stage IIIA. Among the remaining 1776 patients, 213 patients had brain metastasis at presentation. Two patients with early stage disease and symptomatic solitary brain metastasis were treated with radical intent and excluded from the study. The incidence of MRI detected asymptomatic brain metastasis in the study population(Stage I to IIIA) was 6/168 (3.5%) and all were in stage IIIA. MRI brain did not pick up any brain metastasis in asymptomatic Stage I&II NSCLC patients. No co-relation could be found between grade of tumour, SUV of primary, T stage or N stage with the incidence of brain metastasis. Three patients in the study population developed brain metastasis while on treatment.
Conclusion:
Although this study is limited by the small sample size, the role of MRI brain in staging of early stage NSCLC (Stage I & II) needs to be re evaluated in light of the low yield seen in asymptomatic patients. Rigorous evaluation of the patient's history and clinical symptoms may obviate the need of MRI brain in this subset. This may become increasingly relevant with the implementation of lung cancer screening programs.
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P3.02 - Biology/Pathology (ID 620)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Biology/Pathology
- Presentations: 2
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.02-036 - Feasibility Study to Evaluate Patterns of Metastases and Effect of Surgery on Lung Cancer Xenografts with Differing Sensitivity to EGFR TKI (ID 8660)
09:30 - 09:30 | Author(s): George Karimundackal
- Abstract
Background:
Lung cancer cell lines with differing sensitivities to the epidermal growth factor receptor tyrosine kinase inhibitor, Erlotinib have different invasive and metastatic potential. Surgical intervention may play a role in altering the pattern of metastases and survival. Studying these patterns may help in designing trials to evaluate the efficacy of peri-operative EGFR inhibition.
Method:
Two lung cancer cell lines with known different sensitivity to Erlotinib were selected; A549 known to be resistant to Erlotinib (sensitive to Everolimus) and HCC 827, known to be sensitive to Erlotinib. 12 NOD SCID mice were injected with A549 and 17 NOD SCID with HCC 827 as xenografts in the thigh. FDG-18 PET scans were performed in all mice thrice, at 7-10 days, 4 weeks and at 6 weeks. 8 of the 12 mice with A549 cell line and 12 of the 17 with HCC 827 cell line underwent surgery for local tumour at 4-5 weeks from inoculation. The rest of the mice; 4 in A549 group and 5 in HCC 827 group served as controls. All mice were subjected to autopsy at death.
Result:
For the mice with the HCC 827 cell line: Local invasive potential was 90%. 40% of the mice in the control group and 33.3% of the mice in the operated group produced metastases. Survival was similar in operated and control groups (126 versus 127 days). For the mice with A549 cell line: Local invasion and metastases were seen in all mice. The survival in the group undergoing surgery was 129 days versus 107 days in the control group.
Conclusion:
Both the cell lines have good invasive potential, A549 cell line scored over HCC827 in producing metastases. All the metastases were noted only in the lungs. This study can serve as a background to evaluate the role of peri-operative inhibition with epidermal growth factor receptor tyrosine kinase inhibitors and/or mTor inhibitors.
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P3.02-081 - Nutritional Status Assessment in Treatment Naïve Patients with Lung Cancer (ID 8900)
09:30 - 09:30 | Author(s): George Karimundackal
- Abstract
Background:
Malnutrition is multifactorial and frequently co-exists in patients with cancer. Cancer-related anorexia, cachexia and side effects of anticancer therapy can lead to inadequate nutrient intake and subsequent malnutrition. Lung cancer is the leading cause of cancer and cancer-related mortality globally and most patients present in an advanced stage. Nutritional status has a direct effect on the performance status, tolerance to treatment and outcomes.
Method:
We performed a cross-sectional, observational study in the outpatient department of a tertiary referral cancer hospital involving nutritional assessment of treatment-naïve patients with lung cancer. Patients who consented were assessed by two nutritionists using the patient reported subjective global assessment(SGA) and mini nutritional assessment (MNA) tools. Data collected included history, physical and anthropometric measurements. Assuming a prevalence of 33%, the required sample size was calculated to be 400.
Result:
400 patients were recruited between August 2015 and January 2016. The mean age of patients was 58 years and 72% were male. The mean body weight was 57 kilograms and the mean body mass index (BMI) was 21.9 kg/m2. The mean hemoglobin was 12.4 gm% and the mean albumin was 3.9 gm%. 50% of patients were smokers, and 34.7% of the smokers also chewed tobacco. 95% of the smokers were male; 21% consumed alcohol. 64.5% of patients had lost weight, and 60% had anorexia. Most patients presented in advanced stages, with 60.75% in stage IV and 24% in stage III. Nutritional status assessed by the Subjective Global Assessment (SGA) score showed that 24.5% were well nourished (SGA “A”), 64.5% were at risk of malnutrition (SGA “B”) and 11% were malnourished (SGA “C”). Using the Mini Nutritional Assessment (MNA) score, 80.7% of patients were found to be malnourished or at risk of malnutrition with 19.3% patients considered to have normal nutritional status. No significant correlation was found between age, ECOG status, smoking, disease stage or weight loss and the nutritional status scores. There was moderate agreement between the SGA and MNA scores with a kappa coefficient of 0.44.
Conclusion:
Malnutrition is widely prevalent in patients with lung cancer. Formal nutritional assessment using universally acceptable tools like the SGA or MNA should be a part of the work up of the patient along with staging and diagnosis. Early identification can guide nutritional intervention in order to improve the performance status and enable patients to receive and tolerate cancer directed therapy.
