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Robert A Ramirez
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P1.12 - Small Cell Lung Cancer/NET (Not CME Accredited Session) (ID 944)
- 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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P1.12-06 - Pulmonary Neuroendocrine (Carcinoid) Tumors: CommNETs/NANETS Endorsement and Update of the ENETs Best Practice Consensus (ID 13029)
16:45 - 18:00 | Author(s): Robert A Ramirez
- Abstract
Background
The lung is the most common single site of origin of neuroendocrine cancers, and lung neuroendocrine tumor (LNET) incidence and prevalence is rising. There is a lack of both LNET-specific data and up to date clinical guidance. Management of LNETs often relies on extrapolation from other tumor sites. The Commonwealth Neuroendocrine Tumour Collaboration (CommNETS) and North American Neuroendocrine Tumor Society (NANETS) sought to consider current data and provide updated guidance on LNET diagnosis and management.
a9ded1e5ce5d75814730bb4caaf49419 Method
The latest best practice consensus on LNETs was published by the European Neuroendocrine Tumor Society (ENETS) in 2015. A review of content and methods using the AGREE II Rigour of Development subscale (www.agreetrust.org) confirmed the quality of the ENETS initiative, providing a basis for endorsement and update. A systematic literature search was conducted and a 22 member, multidisciplinary CommNETS/NANETS expert panel endorsed or modified recommendations from a patient-centered perspective. All statements were graded using Oxford criteria (CEBM.net).
4c3880bb027f159e801041b1021e88e8 Result
A total of 230 studies were identified for consideration by the panel. Recommendations were modified or added to reflect clinical data not available in 2015. Out of the 52 ENETS statements, 40% were endorsed, 58% were modified or updated, one was removed and four were added. Themes identified in the consensus update include new statements, practice changing modifications, augmented grades of recommendation and statement refinements, each addressing specialties ranging from epidemiology, pathology and diagnosis to treatment and follow-up (Table 1). The importance of LNET directed research and patient-centered care throughout the treatment trajectory is also emphasized, along with directions for future research.
8eea62084ca7e541d918e823422bd82e Conclusion
Ongoing collaboration is essential for future development of updated LNET clinical guidance and to direct research efforts in a patient-centered context. Our consensus update demonstrates international collaboration to develop guidance on clinical management of malignancies for which limited data are available.
6f8b794f3246b0c1e1780bb4d4d5dc53Table 1. Themes in CommNETS/NANETS Lung NET Consensus Update
New statements
Epidemiology
Highlights marked increase in the incidence and prevalence of lung NETs
Radiation Therapy
Guidance on use of palliative EBRT for patients with symptomatic locally advanced or metastatic disease
Medical Therapy
Recommendation of pre-surgical prophylaxis with SSAs for patients with carcinoid syndrome
Indicates lack of benefit of anti-angiogenics in lung NET
Practice changing statement modifications
Diagnosis
Indicates limited clinical value of chromogranin A in lung NET diagnosis and disease state characterization
Surgery
Indicates that cytoreductive surgery of the liver may be expanded to patients with non-aggressive tumors, including those with more limited extra-hepatic disease
Statements with augmented recommendations
Surgery
The grades of recommendation for complete anatomic resection and systematic nodal dissection for peripheral tumors and for preference of lung parenchymal-sparing surgery over pneumonectomy were each augmented to Grade B
Medical Therapy
The grades of recommendation for PRRT and mTOR inhibitors statements were augmented to Grades B and A, respectively
Statement refinements
Pathology
Refined to reflect new standards for classification (WHO 2015) and staging (UICC/AJCC 8th edition)
Tailored to highlight need for endobronchial biopsy or surgical resection for sufficient sampling to differentiate TC from AC
Diagnosis
Radiological imaging statements were modified to simplify guidance and clarify differences in requirements for diagnostic compared to liver imaging, and to guide application of various nuclear imaging techniques
Bronchoscopy statements were simplified to highlight efficacy and safety of bronchoscopy
Surgery
Surgery for localized disease statements modified to reflect equivalence of sublobar resection and lobectomy, especially for typical carcinoid tumors
Endobronchial resection statements were revised to reflect need to limit procedure to high risk patients or as a bridge to surgery
Medical Therapy
Follow-up statement was revised to better define and direct post-treatment surveillance for lung NETs patients who receive medical therapy
AC; atypical carcinoid; EBRT, external beam radiotherapy; NET, neuroendocrine tumor; PRRT, peptide receptor radionuclide therapy; SSA; somatostatin analog; TC, typical carcinoid
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P2.12 - Small Cell Lung Cancer/NET (Not CME Accredited Session) (ID 961)
- 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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P2.12-07 - Utility of Stereotactic Body Radiotherapy in Pulmonary Carcinoid Tumors (ID 14162)
16:45 - 18:00 | Presenting Author(s): Robert A Ramirez
- Abstract
Background
Pulmonary carcinoid (PC) tumors are rare malignant neoplasms, accounting for approximately 2% of all lung cancers. While most patients with PC undergo surgical resection, some patients either decline surgery or are not surgical candidates. Stereotactic body radiotherapy (SBRT) is primarily used in patients with early stage, inoperable non-small cell lung cancer or patients who refuse surgery. We sought to determine the role of SBRT in patients with PC.
a9ded1e5ce5d75814730bb4caaf49419 Method
The records of all patients with PC seen at our clinic were retrospectively reviewed. Demographics, pathologic characteristics, and treatment data were collected. Only patients meeting the World Health Organization criteria for typical and atypical carcinoids were included. Radiographic evaluation of all patients was performed at 3-month intervals.
4c3880bb027f159e801041b1021e88e8 Result
Of the 251 patients with PC who were retrospectively reviewed, 3 patients were identified who underwent SBRT at our institution. All patients were female with a median age of 72 years. All patients received SBRT consisting of 50 Gy over 5 fractions. Median follow up time was 7 months. Median decrease in tumor size following SBRT was 29%. No adverse events from SBRT were reported.
8eea62084ca7e541d918e823422bd82e ConclusionPatient ID
1
2
3
Tumor Locality
LLL
RUL
RML
T-stage
T1b
T1b
T1b
N-stage
N0
N0
N0
M-stage
M1b
M1b
M1b
AJCC Stage Group
IV
IV
IV
Histology
Atypical
Typical
Typical
Ki-67 Index
5%
<1%
12% (liver)
Decrease in Tumor Size (cm)
0.9 (32%)
0.5 (22%)
0.7 (29%)
Duration of response (months)
7
3
5
Length of Follow up (months)
8
7
6
Our study demonstrates that SBRT is safe and feasible in patients with PC tumors. SBRT may represent a treatment option in patients with PC who are deemed inoperable due to comorbid conditions or decline surgery. Larger studies are needed to further determine the role of SBRT in PC.
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