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S. Watanabe



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    MO13 - SCLC I (ID 118)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Medical Oncology
    • Presentations: 1
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      MO13.08 - A pilot study of adjuvant chemotherapy with irinotecan and cisplatin for completely resected high grade pulmonary neuroendocrine carcinona (Large cell neuroendocrine carcinoma and small cell lung cancer) (ID 1562)

      10:30 - 12:00  |  Author(s): S. Watanabe

      • Abstract
      • Presentation
      • Slides

      Background
      Large cell neuroendocrine carcinoma (LCNEC) and small cell lung cancer (SCLC) are recognized as high grade neuroendocrine carcinoma (HGNEC) of the lung. In patients with completely resected HGNEC, platinum-based adjuvant chemotherapy may be considered. However, the optimum chemotherapy regimen has not been determined. We conducted a multicenter single-arm phase II trial to evaluate irinotecan and cisplatin in postoperative adjuvant chemotherapy for HGNEC patients.

      Methods
      Patients with completely resected stage I- IIIA HGNEC received 4 cycles of irinotecan (60 mg/m[2], day 1, 8, 15) plus cisplatin (60 mg/m[2], day 1). This regimen was repeated every 4 weeks. Other eligibility criteria included ECOG PS 0–1, age 20, and <75 years old, adequate organ function, and no prior chemotherapy or radiotherapy. Patients with UGT1A1 polymorphisms (homozygous for *6 or *28, or simultaneously heterozygous *6 and *28), associated with irinotecan-related severe toxicity, were excluded. The primary endpoint was the rate of completion of chemotherapy (defined as underwent 3 or 4 cycles), and secondary endpoints were 3-year relapse free survival (RFS), rate of 3-year survival and toxicities.

      Results
      Forty patients were enrolled between September 2007 and April 2010. Patients’ characteristics were as follows: median age (range) 65 (45-73) years; male 85%; ECOG-PS 1 60%; LCNEC 57% and SCLC 43%; stage IA/IB/IIB/IIIA 32/35/8/5%; 95% received lobectomy. The rate of completion of chemotherapy was 83% (90% C.I.; 71-90%). The rate of overall survival at 3 years was estimated at 81%, and of RFS at 3 years was 74%. The rates of overall survival and RFS at 3 years were 86% and 74% among 23 LCNEC patients, and 74%, 76% among 17 SCLC patients, respectively. Nineteen patients (48%) experienced grade 3 or 4 neutrophils, but only five patients (13%) developed febrile neutropenia. Two patients (5%) developed grade 3 diarrhea, and 4 patients (10%) had grade 3 nausea. No treatment related deaths were observed in this study. All 40 specimens were also diagnosed as HGNEC at pathological central review among 7 pathologists. There were two specimens that showed the difference in between institutional diagnosis and central pathological diagnosis.

      Conclusion
      The combination of irinotecan and cisplatin as postoperative adjuvant chemotherapy was feasible and possibly efficacious for resected HGNEC.In Japan, a randomized phase III trial is ongoing to evaluate adjuvant chemotherapy of irinotecan and cisplatin, compared with etoposide and cisplatin, for completely resected HGNEC.

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    P3.07 - Poster Session 3 - Surgery (ID 193)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P3.07-029 - Clinicopathological Features of Resected Subcentimeter Lung Cancer (ID 2253)

      09:30 - 16:30  |  Author(s): S. Watanabe

      • Abstract

      Background
      Background. Subcentimeter lung cancers are still rare and their pathobiological behavior and management have not yet been fully clarified. In this retrospective study, we investigated the clinicopathological characteristics of patients with subcentimeter lung cancers.

      Methods
      Methods. From among 7,463 patients with primary lung cancers that were surgically resected at the National Cancer Center Hospital, Tokyo, from 1993 through 2011, 291 (4%) patients with peripheral lung cancers of 1.0 cm or less in diameter were studied retrospectively with regard to their clinicopathological characteristics including prognosis. Of these 291 patients, 141 (48%) were male and 150 (52%) were female, and they had a mean age of 62.0 years. According to the proportion of consolidation component within the tumor in preoperative imaging on high-resolution computed tomography (HRCT), the tumors were classified into 4 types; Type 1 (n = 50): non-solid ground-glass opacity (GGO) lesion, Type 2 (n = 89): part-solid GGO lesion including 50% or more GGO within the lesion, Type 3 (n = 62): part-solid GGO lesion including less than 50% GGO within the lesion, and Type 4 (n = 90): solid lesion with no GGO component.

      Results
      Results. Patients with Type 4 included significantly greater percentages of males and smokers than those with the other types. Pleural invasion and vascular/lymphatic permeation were significantly more frequent in Type 4 than in the other types. While none of the patients with Type 1 to 3 had lymph node metastases, these were found in 10% of the patients with Type 4. Overall, recurrence was observed in 13 patients (4.5%). Almost all of these patients with recurrence had Type 4 tumors. The lone exception was a Type 3 patient in whom local recurrence developed adjacent to a surgical staple line. The 5-year overall survival rates were 100% in Type 1 and Type 2, 98% in Type 3, and 88% in Type 4. Patients with Type 4 had a significantly worse prognosis than those with other types.

      Conclusion
      Conclusions. Subcentimeter lung cancers with a GGO component on preoperative HRCT (Type 1 to 3) can be considered “early” lung cancers. Thus, in these cases, limited resection may be warranted to achieve a cure because patients with Type 1 to 3 did not have lymph node metastasis. On the other hand, lobectomy should still be considered the standard operation of choice for Type 4 tumors.