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D. Fennell

Moderator of

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    Epidemiology and outcomes (ID 57)

    • Event: ELCC 2018
    • Type: Poster Discussion session
    • Track:
    • Presentations: 9
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      Invited Discussant 215PD and 216PD (ID 681)

      14:45 - 15:45  |  Presenting Author(s): D. Fennell

      • Abstract
      • Slides

      Abstract not provided

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      Invited Discussant 35PD, 36PD, 71PD, 72PD and 200PD (ID 680)

      14:45 - 15:45  |  Presenting Author(s): A. Dingemans

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      200PD - High physician confidence does not predict rate or type of treatment change for cases discussed at a thoracic multidisciplinary cancer conference: A case series in a tertiary cancer center (ID 602)

      14:45 - 15:45  |  Presenting Author(s): C. Fahim  |  Author(s): J. Agzarian, W. Hanna, R. Juergens, Y. Shargall, M. Simunovic

      • Abstract
      • Slides

      Background:
      Multidisciplinary cancer conferences (MCCs) aim to improve the management of patients with cancer. We evaluated the rate and type of decision change that occurred at a thoracic MCC.

      Methods:
      The MCC took place from June-December 2017 at a Canadian tertiary cancer center and involved surgeons, oncologists, pathologists and radiologists. Cases were brought forward by treating physicians. Using a standardized MCC intake form, physicians articulated a clinical question, original treatment plan, and confidence in the original plan (rated on a 1–5 scale). Major changes were classified as: change from upfront surgery to neoadjuvant treatment, definitive chemotherapy/radiation, or Stereotactic Body Radiation Treatment/Radiofrequency Ablation (SBRT/RFA); change from neoadjuvant or definitive chemotherapy/radiation or SBRT/RFA to surgery; or palliation/observation instead of definitive treatment. Minor changes included additional imaging, further staging investigations, repeat consultations, or changes in planned oncologic or surgical approach. Data were reported as frequencies. Chi-square tests were used to compare groups at a p < 0.05 significance level.

      Results:
      A total of n = 116 cases were reviewed at the MCC. Ninety-six percent of cases required a re-review of imaging or pathology (111/116). Sixty percent (70/116) of cases resulted in a treatment change, with 41% (29/70) and 59% (41/70) of changes considered major and minor, respectively. High physician confidence in the original plan did not significantly correlate with the rate of change (53% no change; 47% change, p = 0.073) or type of change (30% major; 70% minor, p = 0.098). The most common major change was use of neoadjuvant or definitive chemotherapy/radiation instead of upfront surgery (38%, 11/29). Minor changes primarily involved further staging investigations (56%, 23/41).

      Conclusions:
      Sixty percent of cases discussed at the thoracic MCC resulted in a treatment change, with 41% considered major changes. High physician confidence did not significantly correlate with the rate or type of change. These data support the continued implementation and use of MCCs.

      Clinical trial identification:


      Legal entity responsible for the study:
      McMaster University

      Funding:
      Has not received any funding

      Disclosure:
      All authors have declared no conflicts of interest.

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      215PD - Survival patterns in patients with malignant pleural mesothelioma using multimodality therapy (ID 525)

      14:45 - 15:45  |  Presenting Author(s): M. Hassan  |  Author(s): I. Uthman

      • Abstract

      Background:
      Malignant pleural mesothelioma (MPM) is no more considered a rare disease and its incidence is escalating. It became a must to develop innovative modalities for better survival rates. Up to date, there is no agreement on the effectiveness of multimodality in MPM patients. This study assesses the value of multimodality therapy and identify the demographic and pathological characteristics associated with better outcome.

      Methods:
      Using SEER database, we extracted the data of 681 patients with MPM from 2004 to 2013. We included all age groups and races, AJCC stages I-IV and all histopathological variants. Patients were divided into four groups according to the received intervention: surgery alone, surgery followed by radiotherapy, surgery and chemotherapy, and triple modality (combination of surgery, chemotherapy, and radiotherapy).

      Results:
      Out of 681 patients, 176 (25.8%) had surgery alone, 74 (10.9%) had surgery followed by radiotherapy, 307 (45.1%) had surgery and chemotherapy, and 124 (18.2%) had a combination of surgery, chemotherapy, and radiotherapy. Highest one-year survival rates were observed among patients had the triple modality (79.6%, p value 0.000) in comparison to surgery alone (37.9%), surgery followed by radiotherapy (70.3%) and combined surgery and chemotherapy (62.2%). There is a statistically significant relationship between receiving the triple modality and each of the race, age, histopathology and nodal involvement.Table:One year survival rates among patients received the triple modality

      VariablesSurvival ratesNP value
      Sex
       Male76.8%970.504
       Female89.9%27
      Age
       20–39100%10.000**
       40–5994.1%31
       60–7976.5%88
       >8026.9%4
      Race
       White79.7%1150.017*
       Black100%3
       Other67.5%6
      Histopathology
       Sarcomatoid15.0%70.000**
       Epithelioid81.9%93
       Biphasic89.1%24
      N Stage
       N077.7%630.02*
       N187.0%35
       N273.7%22
       N3100%3
      AJCC Stage
       II82.4%210.50
       III85.5%57
       IV71.0%46


      Conclusions:
      Survival rates of MPM patients are the highest when receiving combination of surgery, chemotherapy, and radiotherapy. Further investigations are needed to study the long-term outcomes.

      Clinical trial identification:


      Legal entity responsible for the study:
      Mariam Hassan

      Funding:
      Has not received any funding

      Disclosure:
      All authors have declared no conflicts of interest.

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      216PD - Should radical surgery be performed in non-epithelioid malignant pleural mesothelioma? (ID 508)

      14:45 - 15:45  |  Presenting Author(s): L. Lang-Lazdunski  |  Author(s): N. Tokaca, K.R. Lal, J. Steele, T. Newsom-Davis, D. Landau, J. Spicer, S. Popat

      • Abstract
      • Slides

      Background:
      Non-epithelioid malignant pleural mesothelioma (MPM) has a bad prognosis. We wished to evaluate the impact of multimodality therapy on survival in non-epithelioid MPM.

      Methods:
      Analysis of a prospective database of MPM patients operated on since September 2004. All patients had extended pleurectomy/decortication (ePD) and hyperthermic povidone-iodine pleural lavage (HPL), prophylactic radiotherapy and systemic platinum-based chemotherapy. All patients were followed up until death. PET–CT was used routinely to monitor patients. Survival and prognostic factors were analysed by the Kaplan–Meier method, log–rank test and Cox regression analysis.

      Results:
      139 patients had ePD and HPL. Median age was 64 years and 80% of patients were male.17% of patients had received systemic chemotherapy prior to surgery. 90–day mortality was nil and 39.6% of patients experienced postoperative complications. 9 patients had reoperation within 30 days. Final histopathology showed epithelioid type in 96 patients and non–epithelioid type in 43. Staging (8th ed. TNM classification) was as follows: I, 7.2%; II, 24.4%, III, 54%, IV, 14.4%. Five patients did not receive adjuvant chemotherapy and 4 received less than 4 cycles in total. All other patients received 4–6 cycles of chemotherapy. All patients received prophylactic radiotherapy (21 Gy). 52% of patients received second–line therapies. Two patients had cyberknife therapy and 3 patients had late reoperations for focal relapse. Median follow–up is 50 months and 92 patients have died. Median overall survival is 35 months (95% CI 26.3–43.7) for epithelioid histology versus 18 months (95% CI 15.1–20.9) for non-epithelioid histology (p = 0.000037). Macroscopic complete resection and epithelioid histology are independent prognostic factors of long–term survival at multivariate analysis.

      Conclusions:
      Multimodality therapy including ePD and HPL is safe and well-tolerated. Most patients can receive further therapies when disease progresses. Patients with epithelioid histology achieve prolonged survival. Patients with non-epithelioid histology have a modest survival benefit and radical surgery should be offered only to those with early-stage disease.

      Clinical trial identification:


      Legal entity responsible for the study:
      Dr. Loic Lang-Lazdunski

      Funding:
      Has not received any funding

      Disclosure:
      All authors have declared no conflicts of interest.

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      35PD - Magnitude of exposure to biomass fuel smoke and risk of lung cancer in women: Cases and controls study (ID 311)

      14:45 - 15:45  |  Presenting Author(s): R. Baez-Saldana  |  Author(s): U. Rumbo-Nava, A. Canseco-Raymundo, P. Castillo-Gonzalez, S. Leon-Duenas, R. Rivera-Rosales, C. Luna-Rivero

      • Abstract
      • Slides

      Background:
      Although smoking is the major risk factor for lung cancer worldwide, approximately 1.5% of annual lung cancer deaths are attributed to exposure to carcinogens from indoor solid fuel use. Biomass fuels is classified as a probable carcinogen. Data on lung cancer risk associated with the exposition magnitude of biomass fuel smoke in women are limited. The objective was to estimate the risk of lung cancer in women according to the magnitude of exposure to biomass cooking fuel smoke.

      Methods:
      We designed a hospital-based case-control study. We included 136 cases of primary lung cancer anatomopathologically confirmed and 137 hospital controls of which 50 (27%) had interstitial lung diseases, 46 (25%) pulmonary tuberculosis, 43 (24%) pneumonia, 33 (18%) pulmonary embolism and 11(6%) had ear, nose and throat ailments. Exposure to wood smoke was assessed as a continuous variable based on the calculation of hour-years (years of exposure multiplied by average hours of exposure per day), as a categorical variable broken down in three categories (<100, 101–299, and >300 hour/years), and as any or none. We used unconditional logistic regression to compute odds ratio (OR) and 95% Confidence Intervals (95% CI) for lung cancer risk associated with biomass cooking fuel smoke exposure, adjusting for potential confounders (tobacco use, age, gender, and socioeconomic level. We repeated the same analysis but only including non-smoking women.

      Results:
      Cases were older than the controls, 65 vs. 62 years old (p < 0.05) with higher rate of exposure to wood smoke (REWS), 144 vs 88 hour-years (p < 0.05), and the risk of lung cancer increased linearity with hour-years, OR 1.02 (95% CI 1.00–1.00) p = 0.019. Crude and adjusted odds ratios for an exposure >100 hour-years were OR 1.66 (95% CI 0.76–3.64) and OR 2.19 (95% CI 0.89–5.40) respectively, and for >300 hour-years OR 1.78 (IC95% 0.77–4.13) and OR 3.01 (95% CI 1.12–8.36). The association persisted after adjusting for sex, smoking, socioeconomic status and housing with asbestos sheet roof. In non-smoking women at an REWS >300 hour-years the risk increased to an OR 5.71 (95% CI 1.33–24.60).

      Conclusions:
      These results provide novel evidence that the magnitude of exposure to biomass smoke in hour-years may play a crucial role in the chain of causation of lung cancer. The size of the pooled effect shows that the risk of lung cancer is higher in non-smoking women.

      Clinical trial identification:


      Legal entity responsible for the study:
      Instituto Nacional de Enfermedades Respiratorias

      Funding:
      Has not received any funding

      Disclosure:
      All authors have declared no conflicts of interest.

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      36PD - New demographic characteristics of lung cancer patients in East Asia? Practice of low-dose spiral computed tomography screening in Shanghai major hospitals (ID 272)

      14:45 - 15:45  |  Presenting Author(s): X. Luo

      • Abstract

      Background:
      We investigated the efficacy of early lung cancer screening with low-dose spiral computed tomography(LDCT) based on the current situation of hospital health service, with integration of superior resources of medical institutions at top levels in Shanghai.

      Methods:
      From November 2012 to November 2017, we screened 6303 (male 2516; female 3787) individuals in three major hospitals in Shanghai City, for early diagnosis of lung cancer with LDCT combined with multidisciplinary comprehensive treatment pattern including minimally invasive surgery, exploring the medical service network covering prevention, diagnosis, treatment, rehabilitation and follow-up.

      Results:
      Screening resulted in a diagnosis of primary lung cancer in 126 participants. The detection rate is 170.9/100,000 among the male participants, and 219.2/100,000 among the female participants (P = 0.180). The detection rate is 207.6/100,000 among the non-smoker participants, and 183.5/100,000 among the smoker participants (P = 0.524). The detection rate is 181.7/100,000 among the participants above 60 years old, and 200.5/100,000 among the participants between the age of 22 and 40 (P = 0.703).

      Conclusions:
      Lung cancer patients in East Asia presents new demographic characteristics: the detection rates among females, non-smokers, and people between the age of 22 and 40 are at least not lower than the traditional-sense high risk population. Females, non-smokers, and people between the age of 22 and 40 should not be excluded from screening with LDCT.

      Clinical trial identification:


      Legal entity responsible for the study:
      Fudan University Shanghai Cancer Center

      Funding:
      Has not received any funding

      Disclosure:
      All authors have declared no conflicts of interest.

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      71PD - Emergency department incidental lung nodule follow up: A best practice initiative (ID 340)

      14:45 - 15:45  |  Presenting Author(s): K..A. Lee

      • Abstract
      • Slides

      Background:
      Early detection of lung nodules may lead to prompt diagnosis and treatment of lung cancer, improving patient outcomes. We instituted and evaluated a lung nodule best practice initiative that would coordinate between the emergency department (ED) visits where a long nodule was detected and follow up care post discharge.

      Methods:
      CT scan of the chest was assessed after completion of ED evaluation. If a lung nodule was detected; patient was made aware of the findings by ED clinician. Documentation supported by ED clinician choosing a box reporting lung nodule detected prior to discharge in the ED electronic medical record (EMR). A daily email was automatically generated to the thoracic nurse navigator (TNN). TNN called the patients to offer: appointment to the lung nodule clinic, assignment with primary physician, or patient declined options. TNN documented conclusion in EMR. A certified letter was sent to the patient as a recommendation and summary.

      Results:
      287 patients were listed on the ED lung nodule report from 11/1/2016–12/31/2017. 45 patients listed did not have a true nodule and were excluded, resulting in 242 patients. 12 (4.9%) patients were referred to the Lung Center Nodular Clinic. 176 (72.7%) patients were referred to other physicians, such as pulmonary and primary care physicians. 78% of incidental pulmonary nodules from the ED was referred for follow up. 54 patients either declined follow up or were unable to be reached. There were 2 days of blank reports from the ED. A review of both RAD (report from radiology) and ED reports were compared for the week 11/20–11/27/17. 31 patients with nodules on RAD reports were missing from the ED version: 18 from the day shift and 13 on night shift. These missing patients indicate many more nodule patients were not accurately reported. Since the ED account relies on manual check box, the TNN now runs ED reports against the RAD versions for correct number of patients with incidental pulmonary nodules.

      Conclusions:
      Many incidental lung nodules are discovered nationwide through the emergency department. Many of these go without follow up. We demonstrate an initiative that implements a verifiable system along the pathway in the emergency department through discharge home.

      Clinical trial identification:


      Legal entity responsible for the study:
      Jupiter Medical Center, Dept of Thoracic Surgery

      Funding:
      Has not received any funding

      Disclosure:
      The author has declared no conflicts of interest.

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      72PD - MR imaging radiomics of NSCLC brain metastases: A potential targetable imaging biomarker for EGFR status (ID 319)

      14:45 - 15:45  |  Presenting Author(s): A. Mahajan  |  Author(s): K. Prabhash, A. Ghaytidak, V. Noronah, A. Joshi, V. Patil

      • Abstract
      • Slides

      Background:
      Brain is a common site of metastases with EGFR mutated lung cancer. Oral targeted therapies have broadened the treatment options in the advanced setting with the potential for periods of long term response. Literature on MR imaging metrics or feature analysis of NSCLC brain metastasis as a biomarker for predicting EGFR mutation is limited and less investigated. The purpose of the study was to study MRI imaging biomarkers of brain metastases NSCLC and their correlation with molecular subtyping (EFGR status). To correlate these imaging features with response to therapy and clinical outcomes.

      Methods:
      We analyzed clinical data on 75 patients who were tested for EGFR mutation and underwent brain MR imaging at diagnosis. Multiparametric MRI was performed in all cases. The associations between EGFR mutation status and clinical features, specifically age, sex, smoking, TNM stage, and imaging variables, as well as brain metastasis, were analyzed using logistic regression analysis. Clinical factors known to be associated with EGFR mutation status in NSCLC patients and staging factors of TNM were included in the logistic regression multivariate analysis.

      Results:
      38 EGFR positive and 37 EGFR negative cases. EGFR positive showed early and wide spread development of brain metastasis (within 6 months after 1st presentation) (p-0.00). Statistically significant difference (p-0.00) was observed in border/margins on T2W imaging, fuzzy and infiltrative borders in EGFR positive while well defined in EGFR negative. Lesions in EGFR wild group showed focal restriction on DW images (p-0.001). In EGFR wild cases showed good response to WBRT (p < 0.00). Incidence of recurrent metastatic disease, meningeal involvement was significantly higher in EGFR positive (p-0.00, 0.04). On multivariate analysis, statistically significant association was found between T2 border, number, restricted diffusion, meningeal positivity and TTP (p < 0.05).

      Conclusions:
      EGFR positive brain metastases have characteristic MR imaging features that can be potential non-invasive diagnostic, predictive and prognostic imaging biomarkers. These MR based Radiogenomic imaging biomarkers have potential role in personalized therapy of EGFR positive brain metastasis in NSCLC.

      Clinical trial identification:


      Legal entity responsible for the study:
      IEC TMH

      Funding:
      Has not received any funding

      Disclosure:
      All authors have declared no conflicts of interest.

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Author of

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    Epidemiology and outcomes (ID 57)

    • Event: ELCC 2018
    • Type: Poster Discussion session
    • Track:
    • Presentations: 1
    • +

      Invited Discussant 215PD and 216PD (ID 681)

      14:45 - 15:45  |  Presenting Author(s): D. Fennell

      • Abstract
      • Slides

      Abstract not provided

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    Mesothelioma: New roads through understanding biology (ID 24)

    • Event: ELCC 2018
    • Type: Educational session
    • Track:
    • Presentations: 1
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      Molecular targets: The basics (ID 98)

      09:00 - 10:30  |  Presenting Author(s): D. Fennell

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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