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J.A. González Luna
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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 16.12 - Prolonged Survival after Pulmonary Metastasectomy for Testicular Germ-cell Tumors in a Single Institution (ID 10183)
17:00 - 17:05 | Author(s): J.A. González Luna
- Abstract
- Presentation
Background:
Testicular Germ-cell tumors are a common cancer in adults younger than 30 years-old. Extensive dissemination and high senitivity to chemotherapy are their principal characteristics. Chemotherapy is the standard of care, with an 80% probability of complete biochemical response with first line chemotherapy. Surgical resection of residual lesions after chemotherapy is indicated in some cases to rule out the presence of mature teratoma or viable tumor.
Method:
Retrospective chart review of patients with metastastic testicular Germ-cell tumors treated with chemotherapy and pulmonary metastasectomy from January 2006 to December 2014.
Result:
We found 56 cases with complete data for revision. Mean age was 25 years (16-48) Patients with lung metastases at diagnosis were 83.9%. All patients were treated with chemotherapy after initial orchiectomy. Preoperative serum tumor markers were negative in 44 patients (78%) Thoracotomy was performed in 48 cases (85.7%) and minimally invasive surgery in 8 cases (14.3%) Pulmonary wedge resection was performed in 52 patients (92.8%) and a lobectomy was required in 4 patients (7.2%) A R0 resection was achieved in 98.3%. Necrosis was reported in 25 cases (44.6%), mature teratoma in 17 (30.4%), viable germ-cell tumor in 13 patients (23.2%) and 1 case with seminoma (1.8%) All patients with viable tumor were offered postoperative chemotherapy. Median follow-up was 53.2 months (6-110). Median Overall Survival has not reached. Factors associated with improved survival were negative preoperative serum tumor markers and abscense of viable germ-cell tumor on resected specimens. Figure 1
Conclusion:
Removal of residual lesions after chemotherapy serves a double purpose, as an adjuvant treatment to chemotherapy allowing for “local” control of metastases and it also provides information about response to chemotherapy, with implications on prognosis and guiding postoperative treatment. In our cohort we demonstrate that despite a high proportion of viable tumors on surgical specimen, multi-modality treatment including lung metastasectomy is associated with prolonged survival
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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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P1.17-008 - Clinical and Oncological Outcomes on Resected Thymomas over a Decade at the National Cancer Institute at Mexico City (ID 9293)
09:30 - 09:30 | Author(s): J.A. González Luna
- Abstract
Background:
Despite the fact that Thymic tumors are considered as an orphan disease, they represent the most common adult tumor in the anterior mediastinum. Most of evidence in this neoplasm comes from small, single institution reports. Moreover, the low incidence and a wide spectrum of clinical and morphological characteristics are well-known factors that difficult treatment decisions.
Method:
Single Institution, retrospective chart review of patients with resected thymoma, from January 2005 to December 2016.
Result:
We found 25 patients, with complete clinical data available for review, who underwent thymectomy for epithelial thymic neoplasm. There were 14 females (56%) and 11 males (44%), mean age 56.6 years (27 to 82 years). A total of 22 patients underwent up-front surgery and only 3 patients required neo-adjuvant treatment due to advanced disease. Trans-esternal thymectomy was the most common approach with 18 cases (72%), lateral thoracotomy in 4 cases (16%) and VATS in 3 cases (12%). A complete resection was achieved in 92% of patients. Most of cases, 15 (60%) required an extended thymectomy due to their extension, in 7 (28%) a standard thymectomy was performed,1 case (4%) required a maximal thymectomy and in 2 cases (8%) only a biopsy was performed. R0 resection was achieved in 88% (22 cases) and one patient (4%) was reported as R1 and 2 cases were R2 resections (8%). Distribution according to WHO classification was: A 12%, AB 36%, B1 8%, B2 28%, B3 8% and C 8%. Staging according to Masaoka-Koga Classification was: I 28%, IIA 16%, IIB 24%, III 8%, IVA 12% and IVB 8% Median size of thymomas was 82mm (47-140mm). Mean operative time was 194 minutes (88 – 480), mean blood loss was 362 ml (15 – 2000). Chest tube mean duration was 5.4 days, with a mean hospital stay of 6.2 days (3-18) Morbidity was 24%, but none of patients required re-intervention. Only 2 patients die in the 90 days after surgery for an 8% mortality. In 12 patients (48%) adjuvant treatment was required. Median follow-up was 11.03 months (1.8-108.5) and Median OS was 12.4 months. To date, 21 patients (84%) still alive and only 2 relapses were documented.
Conclusion:
Surgical resection stills the mainstay of treatment for thymomas. Our series comprises mostly large size thymomas requiring extended thymectomy for complete resection. Despite this fact, our perioperative and oncological results and are encouraging
