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J. Usuda
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P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.02-013 - The New Interventional Technique by Photodynamic Therapy Using Composite-Type Optical Fiberscope of 1.0 mm in Diameter (ID 2749)
09:30 - 17:00 | Author(s): J. Usuda
- Abstract
Background:
Ground-glass opacity (GGO) nodules at peripheral parenchyma of the lung noted at thin –section computed tomography (CT) scan have shown to have a histopathologic relationship with atypical adenomatous hyperplasia (AAH) and adenocarcinoma (AIS) which is newly classified by International Association for the study of Lung Cancer (IASLC). We hypothesize that those early lung cancers in peripheral parenchyma such as AIS, do not need surgical resection may be curred by interventional approach such as Photodynamic therapy (PDT). For peripheral type early lung cancer, it is unable to observe using bronchoscopy nor to treat by PDT. Therefore, we have developed a new minimally invasive laser device using a 1.0 mm in diameter composite-type optical fiberscope (COF), which could transmit laser energy and images for observation in parallel, consisting a laser Doppler blood-flow meter. The use of COF technology was previously used in the field of atomic energy. It enables the acquisition of an image while simultaneously performing laser treatment such as PDT, measuring the blood-flow, estimating the irradiational distance.
Methods:
In this study, we aimed to develop a new endoscopical treatment for peripheral parenchymal cancer by NPe6-PDT and a COF. We administered NPe6, 10mg/kg to pigs and we observed the peripheral parenchyma through the bronchus using COF. One h after the administration of NPe6, we irradiated 664 nm-laser (120 mW, 100J) for normal lesion of the peripheral lung using COF. Seven days after PDT, we extracted lungs and examined pathologically.
Results:
We were able to introduce the 1.0 mm COF into pig peripheral parenchyma of the lungs and observed feasibly and clearly, and then we performed NPe6-PDT safely. We measured the blood-flow at the irradiated area by COF during PDT, and we observed gradually disappearance of the blood-flow. The mean diameter of necrosis in normal peripheral lung caused by NPe6-PDT was 16 mm.
Conclusion:
The 1.0 mm COF was a very useful device of NPe6-PDT for peripheral parenchyma of the lung. In the future, for non-invasive adenocarcinoma such as AIS, NPe6-PDT using COF will become one option of standard treatment and play a important role for the treatment of syncronous or metachronous multiple primary lung cancer lesions.
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P2.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 210)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.02-016 - A New Strategy for Preoperative-Management of Patients with Lung Cancer with Chronic Obstructive Pulmonary Disease (COPD) (ID 2339)
09:30 - 17:00 | Author(s): J. Usuda
- Abstract
Background:
Recently, it has been reported that the prognosis for patients with lung cancer with Chronic obstructive lung disease (COPD) was worse than that of patients with lung cancer without COPD. Therefore, long-term respiratory management not only perioperative care is also important. For lung cancer patients with COPD, the frequency of the postoperative complications should be reduced.
Methods:
In lung cancer patients with COPD, it was examined whether it is possible to reduce the frequency of post-operative complications after surgical resection of the lungs by smoking cessation not only the introduction of inhaled long-acting anticholinergic (LAMA) or long-acting β2-agonists (LABA). Patients who quit smoking more than 6 months before the operation were defined as former smokers and those who were smoking at the time of the operation or quit within 6 months before the operation were defined as current smokers. COPD was defined as FEV1/FVC< 0.7 (FEV1; forced expiratory volume in one second, FVC, forced vital capacity) with a smoking history. Among 260 patients who underwent surgical resection for lung cancer from January 2013 to February 2015 in our hospital, COPD patients 77, non-COPD 183. We analyzed retrospectively the relationship between the introduction of inhaled LABA or LAMA and the frequency of the postoperative complications in lung cancer patients with COPD.
Results:
In COPD patients 77 cases, male 62 cases, female 15 cases, age 60-85 years old (mean: 74). Smoking history 15~150 pack-years (mean 57), current smokers were 39 cases, and former-smokers were 38 cases. The average of FEV1/FVC is 59.6% (26.6~69.5%). Lung resection, partial resection 11 cases, segmental resection 1 case, lobectomy 64 cases, pneumonectomy 1 case. There was no mortality. There were 17 postoperative complications in COPD (22.1%), prolonged air leak (more than 7 days) 9 cases, pneumonia 3 cases, arrhythmia 2 cases, chylothorax 2 cases, wound infection 1 case. In particular, the frequency of postoperative pulmonary complications such as prolonged air leakage and pneumonia, showed a significant high in COPD (12 cases, 15.6%) compared with non COPD (9 cases, 4.9%).Inhaled bronchodilators such as LAMA or LABA were prescribed to 22 cases in COPD, not to 50 cases. The pulmonary complications were significant lower in LAMA or LABA users (2 cases, 9.1%) than in no users (10 cases, 18.2%). Among current smoker 38 cases, which were preoperatively treated with smoking cessation and chest physiotherapy for more than one month, the inhalants with LABA or LAMA were prescribed before pulmonary resection in 18 cases, not prescribed in 20 cases. The frequency of the pulmonary complications was 2 cases (11.1%) in the inhalant users, respectively 4 cases (20%) in the inhalant-no-users.
Conclusion:
For lung cancer patients with COPD, preoperative management using the inhalants with LABA or LAMA, and smoking cessation can reduce the frequency of the postoperative pulmonary complications after surgical lung resection. The inhalants with LAMA or LABA may be adapted for the management of not only perioperative care but also long-term survival of COPD patients after surgery, and the hypothesis should be examined in the future.
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P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.02-006 - How Should We Handle Elderly Patients of the Non-Small Cell Lung Cancer? (ID 2590)
09:30 - 17:00 | Author(s): J. Usuda
- Abstract
Background:
In Japan, the ratio of lung cancer patients of octogenarian was still increasing in 2012. Elderly patients used to have comorbidities. Thus it is more difficult to select the surgical treatment of the elderly person in the lung cancer. Therefore, we aimed to clarify the preferred surgical management in this patient group.
Methods:
A retrospective study was conducted between April 2008 and March 2015 that included patients with non-small cell lung cancer (NSCLC) aged ≥75 years. Patients were divided into those who underwent partial resection and those who underwent lobectomy.
Results:
This study included 44 patients: 28 men and 16 women. We divided into two groups; one is partial resection (P-group) and another is lobectomy group (L-group). In patient’s characteristics, there were mostly no significant differences between two groups, without preoperative diabetes mellitus (p = 0.0271), tumor size on CT (p = 0.0002), operation time (p < 0.0001), post-operative hospital days (p = 0.0003), or pathological tumor size (p < 0.0001). In survival analysis, there were significant differences in overall survival (OS) between P-group and L-group (p = 0.0335). However, there was no significant difference in disease-free survival (DFS) rate among the two categories (p = 0.41), and in OS among stage I patients (p = 0.16). Postoperative complication caused poor prognosis (p = 0.0004). However, operation procedure did not correlate with postoperative morbidity. Cox regression analysis revealed statistical significance for the Brinkman Index(BI) (p = 0.0318), the ratio of the pulmonary artery diameter to the ascending aorta diameter (PA:A) (p = 0.0182), and the alveolar–arterial oxygen gradient (A-aDO2) (p = 0.0300). Only the PA:A ratio remained significant after multivariate analysis, with a higher ratio associated with better survival. Only the PA:A ratio remained significant after multivariate analysis, with a higher ratio associated with better survival, by Wilcoxon’s test (p = 0.0376).
Conclusion:
In elder patients with NSCLC, surgical resection should not be denied by only age. However, operation procedure should select Partial resection, compare to Lobectomy, as much as possible, especially, with the higher patients of PA: A ratio.
