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R. Bechara



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    P1.04 - Poster Session with Presenters Present (ID 456)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Pulmonology
    • Presentations: 1
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      P1.04-003 - Incidence of Non-Caseating Granulomas Diagnosed in PET Avid Mediastinal/Hilar Nodes in Patients with Known Breast Cancer (ID 4189)

      14:30 - 15:45  |  Author(s): R. Bechara

      • Abstract

      Background:
      Breast cancer is known to metastasize to the lung.. Most breast malignancies are clinically staged using radiographic modalities (e.g. PET scans). Importantly, many inflammatory disorders will present similar lymph node FDG-uptake on PET- as that of metastasized breast cancer. The latter confuses the treatment for individuals within whom both undiagnosed autoimmune disorders and breast cancer co-occur. We aim to examine the frequency of non-caseating granulomas diagnosed in PET avid mediastinal/hilar nodes in patients with known breast cancer.

      Methods:
      Between March 2013 and December 2015, 46 patients diagnosed with breast cancer were staged by PET-CT. Those with positive result in the mediastinum/hilum underwent linear endobronchial ultrasound (EBUS) for pathologic diagnosis and ensuing treatment

      Results:
      Of the 46 patients with avid mediastinal/hilar adenopathy, 31 (67%) had malignant cytology on EBUS; the remaining 15 had positive PET but negative cytology for malignancy. Twelve of the 15 patients with false positive PET had reactive lymph nodes, and 3 had non-caseating granulomas on cytology (table 1). . Table 1: Results from EBUS Procedure and Resulting Percentage Following Identification of Sarcoid-like Symptoms

      Total Number of patients in study: n=46 with positive PET Number of patients Percentage of total (all PET positive patients) Percentage among negative patients
      Positive EBUS 31 67.40%
      Negative EBUS 12 26.10% 80%
      Negative/Non-caseating granulomas EBUS 3 6.50% 20%
      Twenty percent of the patients with negative cytology and positive PET had non-caseating granuloma, and 6.5 % of all patients with positive PET had non-caseating granulomas.

      Conclusion:
      Conclusion: This study represents the largest cohort of breast cancer patients, where the incidence of non-caseating granulomas is investigated in PET-positive mediastinal/hilar nodes. We conclude that PET may not be sufficient for staging the mediastinum in patients with breast cancer and, in selected patients, pathologic staging should be done. In addition, the finding of non-caseating granulomas in these patients may either indicate an incidental diagnosis of early stage sarcoidosis, or an inflammatory reaction to the current treatment (sarcomatoid reaction). We also suggest that these patients should be followed for any manifestations of sarcoidosis.

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    P1.08 - Poster Session with Presenters Present (ID 460)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Surgery
    • Presentations: 1
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      P1.08-083 - Hyperthermic Pleural Lavage for Pleural Metastases (ID 5343)

      14:30 - 15:45  |  Author(s): R. Bechara

      • Abstract

      Background:
      To evaluate the safety and efficacy of hyperthermic pleural lavage (HTPL) with cisplatin in patients who have undergone cytoreductive surgery pleurectomy/decortication (PD) for isolated chemoresistant pleural metastases (PM). This may be an alternative treatment for patients with isolated pleural metastases with controlled primary disease.

      Methods:
      After Health Care System and Cancer Committee approval, 10 patients with unilateral chemo resistant pleural metastasis were registered prospectively. The patients’’ primary sites of malignancy were under control for a median of 40 months (range, 28-76). Patients underwent a unilateral radical P/D and lymph node dissection, 60 minute pleural lavage (1,500 – 1,700 cc/min) with 225 mg/m2 of cisplatin at 42°C. Cisplatin levels were drawn at time zero, 1 hour, 4 hours, and 24 hours after completion of HTPL.

      Results:
      Median age was 53 years (range, 38-64); 7 patients (70%) were women. Primary tumor: breast 5, colon 2, and thymic, renal cell and anal cancer 1 each. Surgical approach was a thoracotomy in 9 patients (90%). Morbidity included atrial fibrillation in 3 (30%), and acute respiratory distress syndrome in 1 (10%). Median hospital stay 7 days (range, 4-14). Serum cisplatin levels peaked at 4 hours after lavage; none to toxic range. Median dose of cisplatin was 386 mg (range, 299-450); no patient developed renal insufficiency. Median follow up was 10 months (range, 1-15). 8 patients had no signs of malignant disease at last follow up; 1 patient (anal cancer – 6 months) developed local recurrence and 1 patient (renal cell cancer – 9 months) developed contralateral pleural disease. All patients experienced improved quality of life, respiratory function, and reduced pleuritic pain.

      Conclusion:
      Surgical cytoreduction of chemoresistant PM followed by HTPL with cisplatin was well tolerated with no cisplatin-related toxicities. Early results are promising. This novel treatment for patients with isolated secondary PM represents the first series reported. Longer follow-up is warranted to determine a survival and quality of life advantage as well as defined inclusion and exclusion criteria.

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    P2.04 - Poster Session with Presenters Present (ID 466)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
    • Presentations: 1
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      P2.04-040 - Pleural Effusion Characteristics and Relationship with Outcomes in Cancer Patients (ID 3763)

      14:30 - 15:45  |  Author(s): R. Bechara

      • Abstract

      Background:
      Pleural effusion is a common occurrence in cancer patients, with an estimated annual incidence of 150,000 in the United States. It generally represents advanced malignant disease with median survival of 3-12 months. It can lead to debilitating symptoms such as dyspnea and pain, adversely affecting the quality of life.

      Methods:
      We performed a retrospective analysis of a dataset of 62 cancer patients with pleural effusion after first thoracentesis procedure. The recorded data included: age , gender, type of cancer, number of thoracentesis, pleural fluid volume characteristics and volume.

      Results:
      We studied 62 patients, with ages between 20-77 years, median 57 years; 64% were females and 36% were males. The number of patients deceased by the end of follow up was 43 (69.4%), alive at the end of follow up was 8 (12.9%), lost to follow up 11 (17.7%). Median overall survival was 3 months. The cancer type was divided into breast, 32.3%, non-small cell lung, 25.8% and 41.9% other cancers. Thirty-three (53.2%) patients had malignant pleural effusion with a median of 3 months of survival. Twenty-nine (46.8%) patients had non-malignant effusion with a similar median survival of 3 months. We analyzed the correlation of the radiologically estimated effusion volume, thoracentesis volume and presence of blood and malignant cells with outcomes (overall survival, OS). There is a negative correlation between the radiologically estimated effusion volume and OS (Pearson rank correlation of -0.43). This negative correlation is maintained in subgroup analysis (breast -0.56; lung -0.33). The thoracentesis volume was also negatively correlated with OS (Pearson rank correlation of -0.45), finding also maintained in subgroup analysis (breast -0.39, lung -0.66). We found no statistically significant difference in OS between malignant effusions (average OS 6.1 months, median 3 months) and non-malignant effusions (average OS 4.9 months, median 3 months). There was no statistically significant difference in survival between bloody effusions (average survival 3.5 months, median survival 1.25 months) and non-bloody effusions (average survival 6.2 months, median 3.5 months).

      Conclusion:
      We found an inverse correlation between the radiologically estimated pleural fluid volumes and OS as well as between thoracentesis volume and OS among cancer patients. This correlation is maintained in subset analysis of the two most common types of cancer in our sample, breast and NSCLC. Survival was not influenced by the presence of malignant cells or blood in the pleural fluid. A prospective study to better characterize the prognostic value of first thoracentesis may be warranted.