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Paul Emile Van Schil



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    MA25 - Oligometastasis: Defining, Treating, and Evaluating (ID 929)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Oligometastatic NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 13:30 - 15:00, Room 203 BD
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      MA25.02 - Searching for a Definition of Synchronous Oligometastatic (sOMD)-NSCLC: A Consensus from Thoracic Oncology Experts (ID 13452)

      13:40 - 13:45  |  Author(s): Paul Emile Van Schil

      • Abstract
      • Presentation
      • Slides

      Background

      Recent prospective single centre studies reported improved outcomes in patients with sOMD-NSCLC who were treated with radical intent. Since then sOMD has been perceived as a separate disease entity. However, a clear definition of sOMD-NSCLC is lacking. We aimed to develop a definition and diagnostic criteria of sOMD-NSCLC following a consensus process.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A European multidisciplinary consensus group was established with representatives from different scientific societies. Consensus questions were extracted from a survey, case series and a systematic review. The questions were discussed, and the statement formulated during a consensus meeting in Dublin (23.01.18).

      4c3880bb027f159e801041b1021e88e8 Result

      Summary of consensus statement

      Defining sOMD-NSCLC

      Definition of sOMD is relevant for patients in whom a radical treatment is technically feasible with acceptable toxicity, taking into account all sites, that may modify the course of the disease leading to a long-term disease control.

      All sites must be technically and safely treatable.

      The maximum number of metastases/organs meeting the criteria involved will depend on the possibility of offering a treatment strategy with radical intent, taking into account local control and toxicity. Based on the systematic review, a maximum of 5 metastases and 3 organs is proposed.

      Diffuse serosal metastases and bone marrow involvement are excluded.

      Mediastinal lymph node (MLN) involvement should be considered as locoregional disease in the definition of sOMD-NSCLC.

      MLN involvement is of importance in determining if a radical local treatment of the primary tumour may be applied and the MLN will not be counted as a metastatic site.

      Staging of sOMD-NSCLC

      PET-CT and brain imaging are considered mandatory.

      In case of a solitary liver metastasis a dedicated MRI of the liver and for a solitary pleural metastasis, thoracoscopy and biopsies of distant ipsilateral pleural sites are advised.

      Staging of the mediastinum requires a minimum of a FDG-PET scan, with pathological confirmation preferred if this influences the treatment strategy.

      Pathological proof is required unless the MDT decides that the risk outweighs the benefit. Pathology proof is advised for single metastatic location and if it may change the therapeutic strategy, confirmation of the MLN involvement is recommended.

      8eea62084ca7e541d918e823422bd82e Conclusion

      A multidisciplinary consensus statement on the definition and staging of sOMD-NSCLC was formulated taking into account results of a European survey, a systematic review and case discussion. This statement might be helpful to standardise inclusion criteria in future clinical trials. However, the definition of sOMD may change over time when more prospective data will become available.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    MS21 - Giants in Thoracic Oncology (ID 869)

    • Event: WCLC 2018
    • Type: Mini Symposium
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 15:15 - 17:00, Room 105
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      MS21.01 - Surgery and its Evolution (ID 13372)

      15:15 - 15:25  |  Presenting Author(s): Paul Emile Van Schil

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    P2.06 - Mesothelioma (Not CME Accredited Session) (ID 955)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.06-36 - EORTC 1205: Randomized Phase II Study of Pleurectomy/Decortication Preceded or Followed by Chemotherapy in Early Stage MPM (ID 11962)

      16:45 - 18:00  |  Author(s): Paul Emile Van Schil

      • Abstract
      • Slides

      Background

      Case series show a prolonged survival in resectable malignant pleural mesothelioma (MPM) with a combined modality approach of surgery and chemotherapy.

      Extrapleural pneumonectomy is the most commonly used surgical procedure in MPM, but is associated with a significant morbidity; the MARS trial (Treasure, Lancet Oncol 2011) suggests no outcome benefit and a possible harm to the patient.

      Retrospective studies suggest a better outcome with lung sparing resection (extended pleurectomy/decortication, e-P/D), but the procedure lacks uniformity and standardization. The optimal sequence of surgery and chemotherapy, the latter given either adjuvant or neo-adjuvant has not yet been determined.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      EORTC 1205 is a phase II, randomized (1:1) multi-centre trial comparing both approaches. Primary end-point is the successful completion of the multimodality treatment within 20 weeks. Secondary end-points are PFS, OS, treatment-failure-free survival (TFFS), toxicity/safety, operative mortality/morbidity and surgical quality and uniformity indicators.

      Patients with pathologically proven malignant pleural mesothelioma of all histological subtypes, early stage (cT1-3 N0-2 M0 according to TNM 7), WHO-PS 0-1 and fit for chemotherapy and surgery are eligible.

      No previous treatment, including prophylactic track irradiation, is allowed, except for diagnostic thoracoscopy with talc pleurodesis, which must be performed before randomization.

      Patients are randomized between arm A - immediate surgery (extended pleurectomy/decortication), followed by 3 cycles of cisplatin 75 mg/m² plus pemetrexed 500 mg/m² on day 1 q3w, or arm B - deferred surgery, preceded by 3 cycles of chemotherapy.

      4c3880bb027f159e801041b1021e88e8 Result

      Currently 4 of 6 planned sites have opened and 10 patients have been randomized in 2 centres.

      Arm A (n=5)

      Arm B (n=5)

      Male/female

      4/1

      4/1

      Median age

      59.4 years [54.6-76.9]

      67.1 years [58.8-69.1]

      Median PS

      1 [0-1]

      0 [0-1]

      Stage I/II/III

      3/2/0

      3/0/2

      8eea62084ca7e541d918e823422bd82e Conclusion

      EORTC 1205 addresses the issue of optimally sequencing chemotherapy and e-P/D and will rigorously record the quality of the latter in a multicentre setting. Accrual is ongoing according to expectation. Updated interim results will be presented at the WCLC meeting.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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