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T. Demmy



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    O20 - Staging and Advanced Disease (ID 102)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      O20.01 - Transcervical Extended Mediastinal Lymphadenectomy (TEMLA) is Superior to PET/CT for Restaging of the Mediastinum after Neoadjuvant Therapy for Non-Small Cell Lung Cancer (NSCLC) (ID 358)

      16:15 - 17:45  |  Author(s): T. Demmy

      • Abstract
      • Presentation
      • Slides

      Background
      Accurate staging of the mediastinum is critical in therapeutic decision making in NSCLC. PET/CT has emerged as an important modality for staging of treatment-naïve NSCLC, but like endobronchial ultrasound and conventional mediastinoscopy typically is inaccurate following neoadjuvant therapy. We sought to determine the accuracy of TEMLA in staging NSCLC after induction therapy.

      Methods
      A retrospective chart review looking at clinical stage assessed by PET -CT and TEMLA, pathologic stage, lymph node yield and clinical characteristics was performed. Accuracy of staging by TEMLA and PET-CT was compared.

      Results
      71 of 100 consecutive patients that underwent TEMLA had it for restaging after neoadjuvant therapy; 65 of these patients were also restaged by PET-CT. Clinical characteristics of these 65 patients are presented (Table 1). TEMLA was completed successfully on 63 (96.9%) patients and was associated with permanent recurrent laryngeal nerve injury in 2 (3%) patients. On average, 17 lymph nodes were obtained per TEMLA. Concomitant anatomic resections were completed in 58 (89.2%) of patients. 12 and 3 (18.5% and 4.6%) patients were classified as having N2 and N3 disease on final pathology. Compared to PET-CT, TEMLA more accurately classified these patients (95.4% vs. 80.0%; P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of PET/CT and TEMLA for detection of N2 disease are 50.0%, 86.8%, 46.1%, 88.5% and 75%, 100%, 100%, 94.6% respectively (Table 2). Of the 3 patients inaccurately classified by TEMLA, only 1 patient had N2 disease in TEMLA-accessible nodes. Figure 1

      Table 2: Patient numbers according to nodal status.
      Path + Path - PET + PET -
      TEMLA + 9 0 4 5
      TEMLA - 3 53 9 47
      PET + 6 7
      PET - 6 46

      Conclusion
      TEMLA is superior to PET/CT for restaging of the mediastinum after induction therapy. Since TEMLA showed little added morbidity despite central tumor and treatment effects, consideration should be given for its widespread adoption for mediastinal re-staging of NSCLC after neoadjuvant therapy.

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    P3.24 - Poster Session 3 - Supportive Care (ID 160)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P3.24-055 - Neo-adjuvant Versus Adjuvant Treatment for Non-small Cell Lung Cancer (NSCLC) Less Than Clinical N2 Disease (ID 829)

      09:30 - 16:30  |  Author(s): T. Demmy

      • Abstract

      Background
      Increasingly, neoadjuvant therapy is being used for the treatment of NSCLC. While several randomized controlled trials have been performed to evaluate this approach in patients with N2 disease, limited data exists in patients less than N2 disease. We examined our experience with neoadjuvant therapy in our institution and compared it to patients receiving adjuvant therapy.

      Methods
      This retrospective analysis included patients with less than clinical N2 disease that underwent curative surgical resection and received either neoadjuvant or adjuvant chemotherapy with or without radiation therapy from 2005 to 2010. Patient characteristics, peri-operative outcomes and survival data were analyzed for patients receiving neoadjuvant vs. adjuvant therapy. Comparison of categorical, continuous and survival variables across groups were performed using chi-square, t-test and Kaplan-Meier methods respectively. Multivariate analyses were performed using Cox Regression analyses.

      Results
      130 patients fulfilled the inclusion criteria – 54 patients had neoadjuvant therapy and 76 patients had adjuvant therapy. Patient characteristics in both comparison groups are summarized in Table 1. No peri-operative deaths were seen in either group. There was no statistically significant difference between the comparison groups with respect to age, gender, race, histology and grade. Patients with neoadjuvant therapy had a higher clinical stage than those that had adjuvant therapy. At a median follow-up of 41.5 months, there was no difference in the overall survival and recurrence free survival of patients in both groups in univariate analyses and in multivariate analyses after adjusting for potentially confounding variables including stage. Patients treated with neoadjuvant therapy had a higher rate of empyema (11.1% vs. 0%; p=0.004) and a trend toward increased arrhythmia and pneumonia than those treated with adjuvant therapy.

      Conclusion
      For NSCLC less than N2 disease, neoadjuvant therapy increases peri-operative morbidity without an improvement in overall and recurrence free survival. For this patient population, the role of neo-adjuvant therapy is questionable. Figure 1Figure 2