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R. Nakanishi
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MA 16 - Mediastinal, Tracheal and Esophageal Tumor: Multimodality Approaches (ID 675)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:K. Shibuya, Francoise Mornex
- Coordinates: 10/17/2017, 15:45 - 17:30, Room 313 + 314
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MA 16.10 - Treatment Outcomes of Primary Malignant Germ Cell Tumors of the Mediastinum (ID 8753)
16:50 - 16:55 | Author(s): R. Nakanishi
- Abstract
- Presentation
Background:
Primary mediastinal malignant germ cell tumors (GCT) are rare neoplasms with various histopathological findings and contain complicated clinical characteristics. Chemotherapy plays an important role in the treatment and there are some cases where a good prognosis is expected with multimodal treatment including surgical resection, pre- and postoperative chemoradiotherapy.
Method:
The medical records of 27 patients who were treated in our institution between 1988 and 2014 were retrospectively reviewed. We investigated the clinical characteristics and the outcomes of treatment.
Result:
All patients were male with a mean age of 30.7 years (range, 16-53 years), including 17 cases of seminoma (SGCT group) and 10 cases of non-seminoma (NSGCT group). Twenty-three patients underwent surgery and the remaining four patients received chemotherapy and/or radiotherapy without surgery. Of the 23 patients who underwent surgery, 17 cases received preoperative chemotherapy and 15 cases were treated with postoperative chemo/radiotherapy. In six patients, surgery was performed without preoperative chemotherapy due to the suspicious of thymoma, and was followed by postoperative chemo/radiotherapy. Among 24 patients whose serum tumor marker levels were measured before the treatment, 15 patients showed elevated serum tumor marker levels [five (35.7%) in SGCT group and 10 (100.0%) in NSGCT group]. Furthermore, among 20 patients whose serum tumor marker levels were measured before surgery, four patients showed elevated serum tumor marker levels [one (9.1%) in SGCT group and three (33.3%) in NSGCT group]. The median follow-up period after the treatment was 68 months (range, 4-316 months). The 5-year and 10-year survival rate was 88% and 88% in SGCT group, respectively, and 60% and 45% in NSGCT group, respectively (p=0.031). Although there was no relationship between the serum tumor marker levels before the treatment and the prognosis, the patients without elevated tumor marker levels revealed better prognosis than those with elevated one (p=0.014).
Conclusion:
The treatment for mediastinal malignant GCT in our institution was feasible with favorable outcomes. Although malignant GCT has poor prognosis especially in NSGCT group, chemotherapy which normalizes serum tumor marker levels can improve its prognosis.
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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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P1.17-005 - Pure Red Cell Aplasia Associated with Thymoma: A Report of a Single-Center Experience (ID 8644)
09:30 - 09:30 | Author(s): R. Nakanishi
- Abstract
Background:
Acquired pure red cell aplasia (PRCA) associated with thymoma is relatively rare and relevant reports are limited. The optimal treatment and expected clinical outcomes are not yet standardized.
Method:
We have experienced 8 patients with PRCA in 146 patients who underwent surgical resection of thymoma at Nagoya City University Hospital between 2004 and 2015. These patients were retrospectively reviewed.
Result:
There were 5 males and 3 females, with a mean age at PRCA diagnosis of 61 years old (range 49-80 years). One patient had a complication of myasthenia gravis. Extended thymectomy (n=4) and thymectomy (n=4) was undergone in 8 patients with thymoma. In WHO classification of thymoma, subtypes were diagnosed as A (n=1), B2 (n=5), and B3 (n=2). According to the Masaoka’s classification, stages were classified into II (n=1), III (n=2), IVa (n=3), and IVb (n=2). Complete resection was achieved macroscopically in only 4 patients. Five patients received preoperative chemotherapy using cytotoxic agents (n=1) and high-dosed steroid (n=4). Postoperative radiotherapy was given in 6 patients. Recurrence of thymoma occurred in 3 patients who underwent complete resection. Six patients were diagnosed with PRCA after surgical resection of thymoma (range 1-88 months, median 56.5 months), 2 patients before 60 months and 1month of surgical resection. Ciclosporin was used for PRCA in 6 patients with or without corticosteroid and immunosuppressive agents were not used in the other 2 patients only with occasional transfusion. As treatment-related complications of ciclosporin, pneumonia was seen in 5 patients and renal insufficiency in 1 patient of 6 patients who received it. Follow-up period ranged 9-137 months (median 49.5 months) after PRCA diagnosis. Two patients obtained complete remission of anemia by ciclosporin with and without corticosteroid. Two patients remained transfusion-dependent. Four patients have died. In one patient, ciclosporin could be stopped because of complete remission of anemia. However, re-administration of ciclosporin was needed following 6 years interruption. Main causes of the death were diagnosed as pneumonia (n=2), thymoma (n=1), and cardiac failure (n=1).
Conclusion:
PRCA associated with thymoma was diagnosed postoperatively in three quarter patients. We should pay attention to the occurrence of PRCA even after the resection of thymoma especially in patients with incomplete resection or advanced disease. Ciclosporin was effective for PRCA, but treatment-related complications occurred, particularly as pneumonia. As treatment for PRCA associated with thymoma and its complications were combined complexly, it is not easy to treat PRCA associated with thymoma.
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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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P2.17-001 - Pulmonary Inflammatory Myofibroblastic Tumor with TPM4-ALK Translocation (ID 7971)
09:30 - 09:30 | Author(s): R. Nakanishi
- Abstract
Background:
ALK is a receptor tyrosine kinase that was discovered in anaplastic large cell lymphoma in the form of a fusion protein. To pick-up the patients with ALK-rearrangements is important to select the individual therapy as ALK inhibitor for mainly lung adenocarcinoma. There are several fusion partners with ALK 3’ region.
Method:
A 35-year-old woman with a short-breath and cough was referred and admitted taking a therapy for lung tumor in our hospital. By the bronchoscopic biopsy, she was suspected pulmonary IMT, but correct diagnosis was not indicated. Right upper wedge lobectomy was done. By the pathological examination of the permanent surgical resected tissue, the final diagnosis was pulmonary IMT.
Result:
The immunohistochemistry of ALK by using the iAEP method was positive. We extracted the RNA from frozen surgical resected tumor tissue, and prove the TPM4-ALK by 5’ RACE and RT-PCR. The preoperative bronchial biopsy specimen was also found positive for anti-ALK immunohistochemistry with iAEP method.
Conclusion:
The molecular therapeutic drug was expected as personalized therapy for the tumor with ALK translocation as oncogenic driver. We should examine the ALK protein expression and translocation about the cases of lung cancer and IMT by using adequate ALK immunohistochemistry system. We experienced a case of pulmonary IMT with TPM4-ALK translocation.
