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F. Lococo

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    MS05 - Modern Management of Neuroendocrine Tumours (ID 22)

    • Event: WCLC 2013
    • Type: Mini Symposia
    • Track: Surgery
    • Presentations: 1
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      MS05.3 - Mediastinal Neuroendocrine Tumours (ID 478)

      14:00 - 15:30  |  Author(s): F. Lococo

      • Abstract
      • Presentation
      • Slides

      INTRODUCTION Mediastinal Neuroendocrine Tumors occur most frequently in the thymus. Primary Thymic Neuroendocrine Tumors (NETs) are rare and highly aggressive neoplasms; a little more than 350 cases have been described in the literature, many of which are single case reports. We collected one of the largest series ever reported through a multicenter International study, with the aim to evaluate factors influencing survival and recurrence development in patients with Thymic NETs. MATERIAL AND METHODS A multicenter retrospective study of patients operated for NETs between 1989 and 2012 in 9 high-volume International Thoracic Surgery Institutions, was conducted. According to the International Thymic Malignancy Interest Group (ITMIG) outcome measures, primary and secondary outcome were Cause Specific Survival (CSS) and Disease Free Survival (DFS). Competing-risks regression models (Fine and Gray method), taking into account death by any causes as competing event, were used to identify the association between individual factors and tumor related death. Cox proportional hazards regression models were used to define association between individual factors and DFS, considering R0 cases only. Univariate and multivariate analyses were also performed. RESULTS There were 52 patients (41 males –79%-, median age 49 years). The tumor was asymptomatic in 22 cases (42%). Endocrine paraneoplastic syndromes were observed in 23 cases (44%): 13 Cushing’s syndrome and 10 MEN-1 syndrome. Well differentiated neuroendocrine carcinoma (Typical and Atypical Carcinoid) was the commonest histological subtype (30 cases –58%-). Eight patients (15%) received induction therapy (3 chemotherapy, 2 chemo+radiotherapy, 2 biological therapy and 1 chemo+radio+biological therapy), because of their radiological invasiveness. Median sternotomy was the commonest surgical approach (29 cases). The median tumor size was 8 cm (range 1 – 31 cm); a complete resection (R0) was achieved in 48 cases (92%). Advanced Masaoka-Koga stage (III-IV) was observed in 35 patients (67%). Postoperative treatment was offered to 26 (50%): radiotherapy in 17, chemotherapy in 1, chemo+radiotherapy in 5 and chemo+radio+biological therapy in 3 patient, respectively. Three, 5 and 10-year survival rates were 89%, 76% and 51% (Figure 1). Recurrences were observed in 32 cases (62%): 11 local, 10 intrathoracic and 11 distant. Cumulative incidence of recurrence was 41% at 2 years and 70% at 3 years (Figure 2). Variables influencing survival were: tumor size (p< 0.00) and recurrences (p=0.01). Independents DFS predictors were: age > 50 (p= 0.02), paraneoplastic syndromes (p=0.02), symptoms at presentation (p= 0.01) and poor differentiated histology (p= 0.04). CONCLUSIONS We have confirmed that Thymic NETs are rare mediastinal tumors presenting with an aggressive biological behavior; surgery remains the mainstay of treatment and it should be proposed whenever possible, even in case of advanced diseases. Recurrences are frequent, especially in the first years after operation. Survival is statistically related to the tumor size and to the presence of recurrences, whereas, surprisingly, it is not influenced by induction/adjuvant treatment. A global International effort is needed to collect larger series and to confirm these conclusions. Figure 1: Thymic NETs overall survival curveFigure 1Figure 2: Thymic NETs: cumulative incidence of tumor recurrencesFigure 2

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    P3.19 - Poster Session 3 - Imaging (ID 181)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P3.19-011 - The role of 18F-FDG PET/CT and 68Ga-DOTANOC PET/CT in differentiating typical<br /> and atypical pulmonary carcinoids (ID 1934)

      09:30 - 16:30  |  Author(s): F. Lococo

      • Abstract

      Pulmonary carcinoids are histologically classified into typical and atypical. It is important to identify these preoperatively for treatment planning and prognosis. Our purpose was to calculate the diagnostic sensibility of positron emission tomography/computed tomography (PET/CT) using two different tracers ([18]Fluorine-fluorodeoxyglucose [FDG], a glucose analogue and [68]Gallium-DOTANOC, a somatostatin analogue) in a series of patients with suspected bronchial carcinoids (BCs). Additionally, we have evaluated the combination of dual tracer PET/CT findings in differentiating typical and atypical pulmonary carcinoids.

      Forty-four patients (16 male/28 female; mean age: 57.8 y.o.) with suspected BCs (based on radiological findings) underwent PET/CT with FDG and [68]Gallium-DOTANOC in 2 high-volume centers. Detection rates of BCs on a per patient-based analysis were calculated. Histology was used as reference standard. The Chi-square test was used to correlate histology and PET findings.

      After surgery, 23 typical carcinoids (TCs), 10 atypical carcinoids (ATCs) and 11 benign pulmonary lesions (amartomas) were found. Overall and histology-based sensibility rates of both PET-methods are shown in Table. In particular, no false positive results were found and the overall detection rate for BCs was 100% when combining both PET methods (one positive at least). DOTANOC-PET/CT is superior in detecting TCs (sensibility= 91.3%) while FDG-PET/CT seems to be more useful in ATCs (sensibility= 100%). A significant association between histological type and PET findings with the two tracers was found (p<0.05). Moreover, the ratio of SUVmax values (DOTANOC/FDG) was significantly higher in TC-group when compared with ATC-group (10.00 vs 0.90; p= 0.027) Figure 1

      Overall diagnostic performance of PET-CT in detecting BCs is optimal when integrating dual tracer PET-CT findings (FDG and DOTANOC). The combination of dual tracer PET/TC findings and the ratio of SUVmax values (DOTANOC/FDG) may be useful in differentiating TCs and ATCs. Therefore, both PET/CT methods should be performed in suspected BCs or when the histological subtype of BCs is unknown.