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N. Alevizopoulos



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    Poster Display session (Friday) (ID 65)

    • Event: ELCC 2018
    • Type: Poster Display session
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 4/13/2018, 12:30 - 13:00, Hall 1
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      177P - Clinicopathologic characteristics in large cell neuroendocrine carcinomas of the lung (LCNCL): The experience of one center (ID 596)

      12:30 - 13:00  |  Author(s): N. Alevizopoulos

      • Abstract

      Background:
      LCNCL is a newly recognized clinicopathologic entity, characterized by the cell morphology and the immunohistochemical evidence of neuroendocrine markers. The optimal treatment for LCNCL is not yet established. The aim of our study was to describe the clinicopathologic findings, the outcome and treatment toxicity in LCNCL patients (pts).

      Methods:
      Twenty-five pts (4%), smokers (>40 pack/year), with LCNCL, among 585 with small cell lung cancer (SCLC), were admitted & treated consecutively in our Unit between 1/1996–12/2017. Patients’ characteristics are shown in the Table. The presenting symptoms, at diagnosis were cough ± heamoptysis ± fever, dyspnea, Superior Vena Cava Syndrome (SVC), bone pain ± subcutaneous nodules & chest pain in 8 (32%), 5 (20%), 4 (16%), 3 (12%) pts, while 5 (20%) absolutely asymptomatic, were diagnosed during routine check-up. Paraneoplastic tetraplegy & myopathy had 1 (4%) and 1 (4%) pts. Eight (32%) pts underwent curative surgery (5 lobectomy, 3 pneumonectomy), while the diagnosis in other pts was established by biopsy of enlarged cervical lymph nodes in 2 (8%), liver biopsy in 1 (4%), adrenal biopsy in 1 (4%) and confirmed by bronchoscopy in all cases. 17 stage IV pts had, at presentation, metastases in: liver, bones, adrenals, CNS, lung and breast in 7 (41%), 8 (47%) 5 (29%), 4 (24%) & 1 (6%) cases.

      Results:
      All pts received Cisplatin-Etoposide ± mediastinal ± cranial RT. Response Rate was documented in 20 (80%), median PFS was 8 (2-93+) months (mo) and OS 12 (4-93+) mo. In median follow up of 1 (1+−93+) mo, 22 (88%) died. Still alive are 3 (12%) patients. One (4%) patient, pT2N2 IIIA underwent left upper lobectomy & then received adjuvant chemotherapy + mediastinal RT + prophylactic cranial irradiation (PCI). He is still alive after 93+ mo. The other 2 with stages IIIA and IV with limited bone disease are in very good partial response for 33+ and 36+ mo. The mPFS and mOS for stages ≤ IIIA and IIIB + IV are 9 vs 3 and 16 vs 6 mo. Grade III & IV febrile leukopenia, thrombocytopenia & anemia had 4, 2 and 2 patients respectively.

      No of pts25
      Median (m) age66 (33–77)ys
      Men/Female19/6
      ECOG
      04 (16%)
      114 (56%)
      23 (12%)
      34 (16%)
      40 (0%)
      Histology
      pure LCNCL21 (84%)
      Mixed LCNCL-SCLC4 (16%)
      cStage
      Ib1 (4%)
      IIa1 (4%)
      IIb1 (4%)
      IIIa4 (16%)
      IIIb1 (4%)
      IV17 (68%)
      Ki-67 (%)60 (40–90%)
      NSE (+)25 (100%)
      TTF-1 (+)24 (96%)
      Chromogranine/Synaptophysin (+)24 (96%)
      CK7 (+)25 (100%)
      CD56 (+)25 (100%)


      Conclusions:
      (1) LCNCL is an unusual type of lung carcinoma with strong correlation with smoking. (2) Surgery seems to be beneficial for early stage disease, but on it's own it doesn't appear to be sufficient & adjuvant chemotherapy consisting of Cisplatin/Etoposite±RT is considered mandatory.

      Clinical trial identification:


      Legal entity responsible for the study:
      Vaslamatzis Michael Head of the Oncology Department Evangelismos General Hospital

      Funding:
      Has not received any funding

      Disclosure:
      All authors have declared no conflicts of interest.