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I. Ilonen



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    MINI 24 - Epidemiology, Early Detection, Biology (ID 140)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
    • Presentations: 1
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      MINI24.06 - Mesothelioma in Finland: 10 Year Population-Based Cohort Between 2000-2009 (ID 1048)

      16:45 - 18:15  |  Author(s): I. Ilonen

      • Abstract
      • Slides

      Background:
      Malignant pleural mesothelioma (MPM) is associated with high morbidity and poor prognosis. We evaluated in population-based analysis the impact of enhanced diagnostics like positrone emission tomography (PET) and thoracoscopy. Also introduction of new medical therapy, Pemetrexed in 2004 could also benefit overall survival.

      Methods:
      Complete national data on 763 patients from the Finnish Cancer Registry sampled from 2000 to 2009 are presented. Survival for 1 year and 2 years and median survival were calculated. Survival data was acquired in February 2013.

      Results:
      During study period the incidence of MPM has been significantly and steadily increasing. The incidence was highest among men in all time periods (fig 1). Median age at the diagnosis was 68 years (range: 25-94 years). Reported histology was epitheloid in 211 (27.7%), sarcomatoid in 79 (10.4%), biphasic 33 (4.3%) and non-specified in 437 patients (57.3%). Median survival was 10 months (range 0 - 150 months), Fig 2. Between two 5-year cohorts (2000-2004 and 2005-2009) no significant difference in overallsurvival was observed (0.537). One year survival was 43.1% and two year 18.7%, with no differences were noted in the 5-year cohorts (0.826 and 0.402 respectively). Primary diagnosis was made in autopsy in 50 (6.6%) patients. A total of 27 patients (3.7% of deceaced) died for other reasons than MPM. 34 patients (4.5%) lived over 5 years and 16 (2.1%) of these are still alive. Figure 1Figure 2





      Conclusion:
      Despite significantly increased availability of new diagnostic tools like thoracoscopy, PET, and pemetrexed therapy during this cohort, no significant difference in overall survival was noted in this population based analysis. In order to facilitate better outcomes nationaly, new means are needed to coordinate both diagnostic and therapy of MPM.

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    P1.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 212)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      P1.03-001 - Survival of the NSCLC Patients with Clinical Stage IIIA Disease with N2 Involvement: Case-Control Study with Emphasis on Treatment Modality (ID 1074)

      09:30 - 17:00  |  Author(s): I. Ilonen

      • Abstract
      • Slides

      Background:
      The aim of this study was to determine the survival rate of patients with non-small cell lung cancer (NSCLC) who were preoperatively diagnosed with positive N2 lymph node and compare survival with chemo- or chemoradiotherapy treated patients to surgically operated patients, with or without preoperative chemoradiation therapy.

      Methods:
      Study included two patient groups. Operative patient group consisted of 74 clinical Stage IIIA patients with cN2 lymph node involment, from a 1105 patient cohort, who were operated between January 2000 and December 2014. Definitive chemoradiation group consisted of 49 Stage IIIA NSCLC patients that were treated between September 2008 and October 2014. Institutional tumour board was used to evaluate operative treatment. Routine positron emission tomography (PET) was established in 2006 at our institution.

      Results:
      37 had preoperative mediastinoscopy, 66 PET-CT and 24 received both. In the operative patient group, adjuvant chemotherapy was administered 25 and chemoradiation to 7 patients. No differences were observed between patient groups in age or Charlson Co-morbidity Index. A total of 47 operated patients were downstaged to pathological N0 or N1 disease and pathological N2 disease was observed in 27 patients, of 11 patients had multi-level N2 involvement. Median survival for pN0/1 was 47 months, pN2 15 months and definitive chemoradiation 19 months. Survival for pathological N-stage is presented in Figure 1, and for preoperative therapy in Figure 2. Figure 1Figure 2





      Conclusion:
      Operative treatment for clinically suspected N2 disease is feasible option if patients are downstaged to pathological N0 or N1 with means of chemoradiation therapy or pre- or intraoperative frozen sections. Surgery for pathological N2 disease has no survival advantage over definitive chemoradiation and should be discouraged.

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