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J.C. Trujillo



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    OA 16 - Treatment Strategies and Follow Up (ID 686)

    • Event: WCLC 2017
    • Type: Oral
    • Track: Early Stage NSCLC
    • Presentations: 1
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      OA 16.06 - Mediastinal Staging by Videomediastinoscopy in Clinical N1 Non-Small Cell Lung Cancer: A Prospective Multicentre Study (ID 8454)

      14:30 - 16:15  |  Author(s): J.C. Trujillo

      • Abstract
      • Presentation
      • Slides

      Background:
      A fourth of patients with cN1-NSCLC based on PET-CT imaging are at risk for occult mediastinal nodal involvement. In a previous prospective study, endosonography alone had an unsatisfactory sensitivity (38%) to detect mediastinal nodal disease. This prospective multicenter trial investigated the sensitivity of preoperative mediastinal staging by video-assisted mediastinoscopy (VAM) in patients with cN1 (suspected) NSCLC.

      Method:
      Consecutive patients with operable and resectable cN1 (suspected) non-small cell lung cancer (NSCLC) underwent a VAM or VAM-lymphadenectomy (VAMLA). All patients underwent FDG–PET and CT-scan. The primary study outcome was sensitivity to detect N2-disease. Secondary endpoints were the prevalence of N2-disease, negative predictive value (NPV) and accuracy of VAM(LA).

      Result:
      Figure 1 Out of 105 patients with cN1 on imaging, 26% eventually had N2-disease. Invasive mediastinal staging with VAM(LA) reached sensitivity of 73% to detect N2-disease. The median number of assessed lymph node stations during VAM(LA) was 4. In 96% ≥3 stations were assessed. VAMLA was performed in 31%, 69% underwent VAM.

      N Prevalence of mediastinal disease Sensitivity OR(95%CI) Negative Predictive Value OR(95%CI) Negative Posttest probability OR(95%CI)
      Dooms et al. Chest. 2014; 147(1): 209–15. Endosonography alone 100 24% 0.38 (0.18-0.57) 0.81 (0.71-0.91) 0.19 (0.13-0.27)
      Endosonograpy, if negative followed by mediastionoscopy 0.73 (0.55-0.91) 0.91 (0.83-0.98) 0.09 (0.04-0.17)
      Current Study Mediastinoscopy 105 26% 0.73 (0.54-0.86) 0.92 (0.83-0.97) 0.08 (0.03-0.17)




      Conclusion:
      VAM(LA) has a satisfactory sensitivity of 73% to detect mediastinal nodal disease in cN1-NSCLC and could be the technique of choice for pre-resection mediastinal lymph node assessment in this patient group with 26% chance of occult positive mediastinal nodes after negative PET-CT. (ClinicalTrials.gov NCT02222194)

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    P2.05 - Early Stage NSCLC (ID 706)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 1
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      P2.05-007 - Sterotactic-Body-Radiotherapy for Early-Lung Cancer: Is FDG-PET/TC a Predictor of Outcome? (ID 10045)

      09:30 - 16:00  |  Author(s): J.C. Trujillo

      • Abstract
      • Slides

      Background:
      Follow-up recommendations after stereotactic body radiation therapy (SBRT) for early non–small cell lung cancer (NSCLC) patients are not well defined. We analyzed the prognostic value of early response evaluated by FDG-PET/TC scan.

      Method:
      Between April 2012 and September 2016, 63 primary lung lesions in unfit patients or who refused surgery were treated with SBRT. Three risk-adapted fractionation schemes that ensure DBE>100Gy were considered: 3x18Gy, 5x11Gy and 8x7.5Gy. In all patients two FDG-PET/TC scans were performed: one before the SBRT treatment and another one a month after the completion of the treatment. Changes in FDG-uptake were evaluated. We considered complete response (CR) when the FDG-uptake was normalized, partial response (PR) when there was a decrease and stable disease (SD) when no modification was observed. Local control (LC), cause-specific survival (CSS) and overall survival (OS) were analyzed according to response.

      Result:
      With a median follow-up of 16 months; LC, CSS, and OS at 2 years were 100%, 91% and 64%, respectively. We correlated the FDG-PET/TC response at one month with LC and OS at 2 years. The FDG-PET/CT response at one month was not related to LC at 2 years, which was above 95% for all patients. For patients who achieved CR at one moth, OS and CSS at 2 years was both 100% while patients with PR was 49% and 86% respectively and for those with SD were 63% and 92% respectively (Figure 1). Figure 1



      Conclusion:
      Our results suggest that an early complete response on FDG-PET/TC may be a good predictor factor of survival. Based on the grade of early PET-CT response, patients for stricter monitoring could be selected. Longer follow-up to confirm these findings is necessary.

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    P3.14 - Radiotherapy (ID 730)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Radiotherapy
    • Presentations: 1
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      P3.14-014 - Lung Stereotactic Body Radiotherapy (SBRT): Patient's Outcome and Prognostic Factors (ID 9866)

      09:30 - 16:00  |  Author(s): J.C. Trujillo

      • Abstract
      • Slides

      Background:
      Stereotactic body radiotherapy (SBRT) is the standard of care in patients with medically inoperable early stage NSCLC and an effective method of treatment of lung metastases (LM) in oligometastatic patient.We evaluated local control (LC), overall survival (OS), cause-specific survival (CSS), and related toxicity in the both group of patients treated in our center.

      Method:
      Between April 2012 and September 2016, 107 lung lesions were treated with SBRT; 62 early NSCLC(58%) and 45 LM(42%). Three risk-adapted fractionation schemes that ensure DBE>100Gy were considered: 3x18Gy, 5x11Gy and 8x7.5Gy. Kaplan-Meier(KM) curves were used to evaluate LC,OS and CSS. We analyzed toxicity and predictive factors.

      Result:
      The median follow-up was 16 months(range 6-44). For primary NSCLC: LC,CSS, and OS at 2 years were 100%,91% and 64%, respectively.19 patients died, 5 because of a lung cancer and 14 due to concurrent disease. Regional relapse was observed in five patients(7.6%).Six patients(9.2%) developed distant metastases. There was no statistically significant difference in OS and CSS when comparing peripheral-central tumors or T1-T2 tumors. However, T2 and central tumors showed lower survival rates. For lung metastatic lesions: LC,CSS, and OS at 2 years were 69%, 66% and 66%, respectively.The primary tumors were:colorectal 17(38%), lung 15(33%) and others 13(29%).There was no statistically signficant difference in survival among primary tumor or 1-3 metastatic lesions, but colorectal primary tumors and more than one lung metastases had lower survival.We compared LC and CSS in both group of patients. There was a statistically significant difference in local control(p=0.002) and CSS(p=0.027) among the primary tumors or lung metastases(Figure 1).According to RTOG,≤G2 lung and skin acute toxicity was 5% and 3% respectively.Lung late toxicity ≤G2 was 22.4%. No patients developed >G2 toxicities. Figure 1



      Conclusion:
      With a 2-year LC rate >95% with limited toxicity, SBRT confirms as state-of-the-art treatment for medically inoperable early stage NSCLC and effective options for oligometastatic patients.

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