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A. Martin-Marco



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    P1.09 - Poster Session 1 - Combined Modality (ID 212)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 2
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      P1.09-003 - Prognostic impact of secondary pathologic findings on the outcome of patients with resected locally advanced non-small cell lung cancer previously treated with inductive chemotherapy or chemoradiation (ID 296)

      09:30 - 16:30  |  Author(s): A. Martin-Marco

      • Abstract

      Background
      Half of non-small cell lung cancers are diagnosed in locally-advanced stages (LA-NSCLC), and warrant multidisciplinary treatments. Inductive and adjuvant therapies obtain the same survival benefit after surgery, but the first ones also provide prognostic information. Mediastinal downstaging and pathologic complete response preclude a better outcome. However, the value of minor pathologic features has been scarcely analyzed. We report the impact of lymphovascular invasion (LVI) and tumor necrosis (TN) on the prognosis of resected LA-NSCLC after inductive chemotherapy (iCT) or chemoradiation (iCRT).

      Methods
      We retrospectively reviewed 50 resected LA-NSCLC treated with iCT or iCRT in our center from October-2004 to June-2012. Three patients died due to early surgery complications and were not analyzed. The impact of ILV, TN, pneumonitis, extracapsular (EI) and pleural invasion (PI) on disease free (DFS) and overall survival (OS) was analyzed in the remaining patients

      Results
      Our series included 42 men and 5 women aged between 47-82 years. Non-specified NSCLC was diagnosed in nine, adenocarcinoma in two, and squamous carcinoma in 36. Thirty-seven received cisplatin-based and 10 carboplatin-based chemotherapy. Concurrent radiation was administered in 21. Pneumonectomy was performed in 15, lobectomy in 26, and segmentectomy in 6. The presence of pneumonitis, EI, or PI in the resected specimens did not impact on the outcome of the patients. However, DFS and OS clearly worsened when LVI (34.1 vs. 14.1 months, p= 0.01; and 43 vs. 29, p= 0.005; respectively), and absence of TN (31.6 vs. 24.3, p= 0.045; and 42 vs. 33, p= 0.041, respectively) were found. Radiation, cis- or carboplatin administration, and treatment length did not modify LVI and TN incidence

      Conclusion
      Minor pathologic features as LVI and TN significantly impact on the prognosis of resected LA-NSCLC after iCT or iCRT. Implications of that should be further analyzed. Figure 1. DFS and OS Kaplan-Meier curves according to the presence of LVI. Figure 1

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      P1.09-004 - Feasibility and efficacy of inductive chemo or chemoradiation for patients with locally advanced non-small cell lung cancers and reduced respiratory function (ID 297)

      09:30 - 16:30  |  Author(s): A. Martin-Marco

      • Abstract

      Background
      Half of non-small cell lung cancers are diagnosed a locally advanced stage (LA-NSCLC) and are treated by combining chemotherapy, radiation, and surgery (S). However, many patients are not able to receive complete multidisciplinary therapies due to previous respiratory dysfunctions. We report the feasibility and efficacy of inductive chemotherapy (iCT) or chemoradiation (iCRT) followed by S or consolidative radiation (RT) in LA-NSCLC patients with normal (NRF) and reduced respiratory function (RRF)

      Methods
      We retrospectively reviewed 100 LA-NSCLC ECOG-0-2 patients treated with iCT or iCRT followed by S or RT in our center between October-2004 and June-2012. No patient was excluded to receive treatment due to RRF, but all those without initial determination of basal forced expiratory volume in the first second (FEV1) were not analyzed. Patients were classified into two groups according to initial FEV1: 1) NRF FEV1≥ 60%, and 2) RRF FEV1< 60%. A comparison of toxicity, compliance, treatment modality, and outcome between these groups was performed

      Results
      Seventy-two patients initially presented NRF, and 28 RRF. Seventy (97.2%) patients with NRF completed curative treatments (20 iCRT+S; 20 iCRT+RT; 19 iCT+S; and 11 iCT+RT). Twenty-six patients (92.8%) with RRF completed curative treatments (3 iCRT+S; 14 iCRT+RT; 3 iCT+S; and 6 iCT+RT). The rest of them progressed during inductive treatment and did not receive curative approaches. Any patient interrupted the treatment due to toxicity. Resection rate was lower among patients with RRF (55.7% vs. 23%, p= 0.004), but tolerance to S was similar to those with NRF (p= 0.72). RT was applied in 44.2% and 76.9% of patients with NRF and RRF, respectively. Incidence of grade 3-4 toxicities was similar in both groups of patients (13.9% vs. 11%; p= 0.72). There were no significant differences in disease free survival (16 vs. 21.8 months, p= 0.689), but overall survival paradoxically trended to be better in patients with RRF (27.4 vs. 37.3 months, p= 0.066)

      Conclusion
      RRF does not necessarily contraindicate a multidisciplinary curative approach for LA-NSCLC. In our series, iCT and iCRT were followed by S in 23% of patients with RRF, and by RT in 77%. Outcome of patients with RRF receiving an intentionally curative treatment was at least as good as that of patients with NRF. Figure 1. Kaplan-Meier DFS and OS curves according to initial FEV1. Figure 1

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    P2.09 - Poster Session 2 - Combined Modality (ID 213)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P2.09-002 - Prognostic impact of conventional and modified measurement of mediastinal lymph node involvement in the outcome of patients with resected locally advanced non-small cell lung cancers previously treated with inductive chemo or chemoradiation (ID 299)

      09:30 - 16:30  |  Author(s): A. Martin-Marco

      • Abstract

      Background
      Mediastinal lymph node involvement (MLNI) is the strongest prognostic factor of resected locally advanced non-small cell lung cancers (LA-NSCLC). The 7[th] edition of the TNM is based in purely topographic criteria: N2 is applied for ipsilateral MLNI and N3 for contralateral and unresectable MLNI. Different authors have proposed many other prognostic classifications of MLNI

      Methods
      We retrospectively reviewed 45 resected LA-NSCLC previously treated with inductive chemo or chemoradiation in our center between October-2004 to June-2012. Three patients died due to early surgical complication were not analyzed. Systematic mediastinal dissection was performed in all of them. The prognostic impact of pN2 was statistically compared to number of resected nodes; number of affected areas; number of metastatic nodes; and ratio of metastatic/resected nodes

      Results
      Our series included 37 men and 5 women with a mean age of 64.64 years-old. There were diagnosed eight non-specified NSCLC, two adenocarcinomas, and 32 squamous carcinomas. Cis- and carboplatin-based chemotherapy was administered in 35 and seven patients, respectively. Concurrent radiation was administered in 21. pN2 MLNI clearly worsened both disease free (DSF) and overall survival (OS) of the patients (p= 0.006; and p= 0.018, respectively). Proportion of patients with pN2 MLNI was lower when radiation was applied (p= 0.033) and did not significantly vary according to chemotherapeutic regimen or histology. The number of resected nodes did not impact on survival (DFS p= 0.261, and OS p= 0.277), but OS was better in patients with a lower rate of pathologically detected nodes (p= 0.046). The number of metastatic nodes according to the Tokio score did not impact on survival. The Regina Elena and the Mount Sinai ratios of metastatic nodes according to the number of resected nodes neither impacted

      Conclusion
      The presence of pN2 MLNI according to the 7[th] edition of the TNM classification is the strongest mediastinal prognostic factor in our series of resected LA-NSCLC previously treated with inductive chemo or chemoradiation. No other tested classification of MLNI could predict significant differences in survival. The prognostic significance of the lower detection rate of resected nodes after inductive treatment should be explored. Figure 1. DFS and OS Kaplan-Meier curves according to MLNI. Figure 1

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    P3.09 - Poster Session 3 - Combined Modality (ID 214)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P3.09-002 - I want it all! The better outcome of patients with locally advanced non-small cell lung cancer receiving chemoradiation followed by surgery over any other combination of inductive chemotherapy, radiation or surgery (ID 298)

      09:30 - 16:30  |  Author(s): A. Martin-Marco

      • Abstract

      Background
      Half of Non-small cell lung cancers are diagnosed in locally advanced stage (LA-NSCLC) and warrant multidisciplinary treatments including chemotherapy, radiation, and surgery (S) in a not well-defined combination and sequence. We compared tolerance and effectiveness of different combos of inductive chemo (iCT) or chemoradiotherapy (iCRT) followed by S or consolidative radiation (RT)

      Methods
      We retrospectively reviewed 108 consecutive LA-NSCLC diagnosed in our center between October-2004 and June-2012 and treated with: 1) iCRT+S (N= 24); 2) iCT+S (N= 31); 3) iCRT+RT (N= 36); 4) iCT+RT (N= 17). Their tolerance, response, and outcome were statistically compared. Survival of five patients that progressed during inductive therapy was not analyzed

      Results
      Mean age of the patients was 66.2 years-old, 92% were male, and 85.1% ECOG-0. Histology was squamous carcinoma in 71.3%, non-specified NSCLC in 15.7%, and adenocarcinoma in 12%. iCT included platin-doublets with taxanes, vinorelbine, and gemcitabine. CBDCA-combinations were commonly used in elderly patients (15.6% vs. 31.8%, p= 0.001). Grade 3-4 toxicity was observed in 14.8% of inductive therapies, without significant differences between iCT and iCRT arms (p= 0.976). No patient interrupted therapies due to toxicity. Progression rate was higher with iCT than iCRT (8.3% vs. 0; p= 0.023). S was performed in 51 patients (pneumonectomy 30%, bi/lobectomy 56%). Severe S complications appeared in 13.7% of cases. Three patients in the iCRT+S arm died due to early postoperative complications. Complete pathologic responses were higher with iCRT than iCT (25% vs. 11.5%, p= 0.049). Resected patients presented better disease free (DFS) and overall survivals (OS) than those definitively radiated (27.9 vs. 12 months, p= 0.000; and 37.8 vs. 25.9 months, p= 0.009). Higher DFS and OS was found among patients of the iCRT+S arm (p= 0.000 and p= 0.049, respectively)

      Conclusion
      Those LA-NSCLC that achieved S after inductive therapy presented a better outcome that those non-resected. iCRT+S was tolerable, feasible, and obtained the higher response and survival rate of our series, although these results are biased by the better prognosis of resectable patients. Anyway, prospective trials are warranted to confirm the benefits of triple multidisciplinary approach. Figure 1. DFS and OS Kaplan-Meier curves of patients according to the treatment arm. Figure 1