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Yuko Nakayama
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MS30 - Modern Day RT in LA NSCLC: Where Is the Evidence? (ID 808)
- Event: WCLC 2018
- Type: Mini Symposium
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 13:30 - 15:00, Room 202 BD
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MS30.01 - Introduction with Poll Questions (ID 14934)
13:30 - 13:35 | Presenting Author(s): Yuko Nakayama
- Abstract
- Presentation
Abstract not provided
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P1.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 949)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.17-06 - Salvage Surgery After Chemotherapy and/or Radiotherapy Including SBRT and Proton: Consecutive Analysis of 46 Patients (ID 13342)
16:45 - 18:00 | Author(s): Yuko Nakayama
- Abstract
Background
Local recurrence after definitive chemotherapy and/or radiotherapy with curative intent is frequently experienced in patients with locally advanced lung cancer. We evaluated the frequency, feasibility, and efficacy of salvage pulmonary resection after definitive chemotherapy and/or radiotherapy.
a9ded1e5ce5d75814730bb4caaf49419 Method
We analyzed the characteristics and medical courses of consecutive patients who had undergone salvage pulmonary resection after local relapse or progression after chemotherapy, chemoradiotherapy and radiotherapy including stereotactic body radiation therapy (SBRT) and proton beam therapy (PBT). In this analysis, local relapse or progression were defined as increase in remaining tumor size or detection of new lesions by CT and/or FDG/PET-CT. Indications of resectability was assessed by multidisciplinary tumor board.
4c3880bb027f159e801041b1021e88e8 Result
Between January 2000 and January 2018, 46 patients (0.63%) received salvage surgery out of 7,290 patients underwent surgery for primary lung cancer at National Cancer Center Hospital, Tokyo, Japan. Median follow-up time was 24.5 months (range, 2-157.6). Of 46 patients evaluated, 30 (65.2%) were men, the median age was 64.5 years (range, 20-78 years), 22 (47.8%) underwent chemotherapy, 18 (39.1%) underwent resection after definitive chemoradiotherapy, 3 (6.5%) underwent resection after SBRT and 3 (6.5%) underwent resection after PBT. The number of patients undergoing salvage surgery has increased in recent years: 9 patients were between 2000 and 2009, whereas 37 patients were between 2010 and 2018. Method of surgical resection was as follows: 28 lobectomies (2 bilobectomy, 15 right upper, 1 right middle, 6 right lower, 2 left upper, 2 left lower), 10 pneumonectomies (left:right=7:3). One patient received a wedge resection, and one recieved wedge resection with chest well resection, and 2 segmentectomy and lymphadectomy for residual lymph nodes respectively. A complete resection (R0) was achieved in 42 cases (91.3%). Postoperative complications were observed in 3 patients (6.5%): prolonged air leakage, bronchopleural fistula, and atrial fibrillation. There were no post-operative deaths within 30 days after surgery. The five-year progression free and overall survival rate after surgical resection was 39.1% (95% CI.: 19.9-57.9) and 64.1% (95% CI.: 39.3-80.9), respectively.
8eea62084ca7e541d918e823422bd82e Conclusion
The frequency of salvage surgery after initial treatment has been increasing possibly due to a better treatment course using novel medical and radiation oncology technique. Salvage pulmonary resections demonstrated acceptable morbidity and mortality with promising long-term efficacy in selected patients.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)
- 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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P2.16-18 - Study of Interstitial Lung Disease and Acute Exacerbation in Patients Receiving Radiation Therapy for Lung Cancer in Japan. (ID 12699)
16:45 - 18:00 | Author(s): Yuko Nakayama
- Abstract
Background
Radiation therapy (RT) for lung cancer in patients who have interstitial lung disease (ILD) is considered to be a risk for acute exacerbation (AE).
The indication for RT in such patients is determined in each facility.
The ratio of patients with ILD who have received RT for lung cancer, the incidence of AE in such patients, and the risk factors for AE are unclear.
To clarify these, a nationwide survey was carried out by the Lung and Mediastinal Tumor Committee of the Japan Radiation Oncology Study Group (JROSG).
a9ded1e5ce5d75814730bb4caaf49419 Method
(1) Questionnaire survey on the diagnosis of ILD, determination of the indication for RT and the state of implementation.
(2) Multi-institutional retrospective cohort study in fiscal year 2014. Statistical analysis of risk factors for AE. ILD confirmation using CT images by two central radiation diagnosticians.
These two studies were included.
4c3880bb027f159e801041b1021e88e8 Result
(1) Questionnaires were returned by 47 institutes. RT was not an option for patients with ILD in 8 of the institutes. Some of the institutes excluded RT from options because of experience of severe adverse events. RT was an option even for patients with ILD depending on conditions of the case in 39 of the institutes.
In 37 of the institutes, 3.7% of lung cancer patients (78/2128 patients) in fiscal year 2014 had ILD.
(2) Sixty-seven patients were enrolled. AE occurred in 5 cases including 4 photon RT cases. AE occurred in 4 (7.7%) of 52 cases in which photon RT was performed, and there was one RT-induced AE-related death (25.0%).
Regarding risk factors for AE, in the t-test, grade of radiation pneumonitis, FEV1, and lung V30 were significant. Age, lung mean dose, lung V20, and DLco were marginally significant.
However, they were not significant in multivariate analysis.
AE occurred in 1 of 15 cases in which particle RT was performed.
In a review of CT images, 59 cases were analyzable. ILD was confirmed in 58 cases (98.3%). Diagnosis of ILD by each institute was almost the same as that in the review by central radiation diagnosticians.
Post-irradiation exacerbation of ILD (PIE-ILD) on CT was revealed in 23 (43.4%) of 53 cases. We considered that PIE-ILD does not necessarily progress to AE.
8eea62084ca7e541d918e823422bd82e Conclusion
We surveyed actual conditions of RT for patients with ILD in Japan.
RT was an option even for patients with ILD in many institutes, though cases in which it was actually implemented were limited.
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