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J.L. Gross
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P2.09 - Mesothelioma (ID 710)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.09-002 - Prevalence and Survival of Malignant Pleural Mesothelioma Patients Treated in a Single Brazilian Cancer Center (ID 9942)
09:30 - 09:30 | Author(s): J.L. Gross
- Abstract
Background:
Malignant pleural mesothelioma (MPM) is an unusual neoplasm, originated from the mesothelial surface of the pleural cavity. The disease is associated with occupational exposure to asbestos. Although it has low incidence, it carries an elevated morbimortality, determined by its aggressiveness and aggravated by the lack of efficient therapeutic strategies. Most patients are diagnosed at advanced stages and median overall survival (OS) remains around 9-17 months. In Brazil, some studies have suggested the number of new cases will increase till 2030, nevertheless there is no official epidemiologic data available.
Method:
Clinicopathological data from patients diagnosed with MPM and treated at A.C.Camargo Cancer Center between January/2000 and December/2014 were retrospectively collected from medical records. Demographics and clinicopathological variables were described using descriptive statistics. OS was calculated from the date of diagnosis to death. Progression-free survival (PFS) was calculated from the date of diagnosis to the date of disease progression or death. Kaplan–Meier method was used to calculate survival curves. The impact of relevant variables on survival was evaluated by the log-rank test.
Result:
We identified 29 patients between 2000 and 2014. Median follow-up was 108 months. Median age at diagnosis was 68 years (43-85y). 72.4% was men and most were Caucasian (51.7%). Tobacco consumption reported (58.6%), history of asbestos exposure (44.8%) and positive family history of cancer (34.5%). The presenting symptom was dyspnea (44.8%); followed by chest pain (24.1%). Epithelioid subtype was reported (69%) and most patients were diagnosed in stage III (34,5%) and IV (24.1%). 79% of patients were submitted to surgery: pleural decortication (36,4%), pleurodesis (31,8%), and pleuro-pneumonectomy+mediastinal lymphadenectomy (31,8%). Chemotherapy was administered to 72.4% and radiotherapy to 24.1%. Median PFS was 8 months (95%CI 5.4-10.5) and the only factor associated with improved PFS was disease resectability (resectable vs. unresectable: 10mo vs. 7mo; p=0.041). Median OS was 12 months (95%CI 5.6-18.3). Variables associated with improved OS were lack of distant metastasis at diagnosis (M0 vs. M1-MX: 15mo vs. 6mo; p=0.008) and being able to receive further lines of chemotherapy (yes vs. no: 18mo vs. 6mo; p=0.016).
Conclusion:
Since there is no national official data in Brazil, collection of local data is extremely relevant to help unraveling the epidemiological scenario in our country. Our data reinforce the low prevalence of the disease, though it could also reflect issues regarding patient referral to specialized centers. As expected, we observed an association with occupational exposure to asbestos and a poor PFS and OS.
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P2.13 - Radiology/Staging/Screening (ID 714)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.13-020 - Lung-RADS Used in Lung Cancer Screening: Does Granulomatous Disease Intereferes with the Results? Initial Findings at a Brazilian Cancer Center (ID 10327)
09:30 - 09:30 | Author(s): J.L. Gross
- Abstract
Background:
Lung cancer is the leading cause of cancer death in the world. Screening has proved effective in reducing mortality in one major trial. In countries where granulomatous disease is prevalent, CT-screening false positive results may increase, even when Lung-RADS is used in the screening-CT analysis. Purpose: To analyze the outcomes of low-dose computed tomography (LDCT) lung cancer screening using Lung CT Screening Reporting and Data System (Lung-RADS) at a Brazilian cancer center.
Method:
Medical records of 552 patients initially selected to baseline LDCT- lung-cancer-screening program between May/2016 and April/2017 were analyzed. Only 287 patients complied NLST[1 ]inclusion criteria and were included in the study. These had a mean age of 61.8 years and a history of smoking of a mean of 45.3 pack-year. Mean Dose Length Product (DLP) of LDCT was 21.3 mGy/cm[2] with a mean effective dose of 0.30 mSv. LDCT findings were classified according to Lung-RADS[2] assessment categories.
Result:
Most patients (n=207; 72.1%) had a negative screening CT (Lung-RADS categories 1 or 2), 55 (19.2%) had probably benign findings (Lung-RADS category 3) and 25 (8.7%) had suspicious findings (Lung-RADS categories 4A [5.6%], 4B [2.1%] and 4X [1.0%]). The most common finding was a solid nodule (64.1%), followed by non-solid nodule (8.7%) and then by part solid nodule (2.8%). One patient classified as Lung-RADS category 3S had an incidental diagnosis of chest wall lymphoma, confirmed after biopsy. Patients in Lung-RADS category 4A (n=9) had a CT follow-up and most of them (n=7) showed stable findings and in two patient the nodules increased in size on follow-up CT. Histologic results confirmed lung cancer in 2 cases (prevalence of 0.7% of all screened patients).
Conclusion:
Lung cancer prevalence in our sample was compatible with the literature. However, we had a higher prevalence of Lung-RADS categories 3 and 4A than expected[3]. This may be associated with the higher incidence of granulomatous disease, especially tuberculosis, in the Brazilian population. 1.National Lung Screening Trial Research Team, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug 4;365(5):395-409. doi: 10.1056/NEJMoa1102873. 2.American College of Radiology. Lung CT Screening Reporting and Data System (Lung-RADS) 3.Pinsky PF, et al. Performance of Lung-RADS in the National Lung Screening Trial: a retrospective assessment. Ann Intern Med 2015 Apr 7;162(7):485-491 doi: 10.7326/M14-2086.
