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Susumu Kanazawa
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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: 2
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.17-15 - Perioperative Prognostic Nutrition Index for Induction Chemoradiotherapy Followed by Surgery in Locally Advanced Non-Small Lung Cancers (ID 13055)
16:45 - 18:00 | Author(s): Susumu Kanazawa
- Abstract
Background
The perioperative nutritional and immunological statuses significantly associated the clinical outcome of the surgery, especially for the extended surgery. Induction chemoradiotherapy (iCRT) followed by surgery is one of treatment options for locally advanced (LA) non-small cell lung cancers (NSCLCs) although there is a risk for increasing postoperative complications. A prognostic nutritional index (PNI), calculated using serum albumin levels and peripheral lymphocyte count, has been used to predict the clinical outcome of various cancers including early stage NSCLCs but not LA-NSCLC after iCRT. In this study, we investigated the impact of PNI on clinical outcome of iCRT followed by surgery in the patients with LA-NSCLCs.
a9ded1e5ce5d75814730bb4caaf49419 Method
During 1999 to 2016, 173 patients underwent iCRT followed by surgery in Okayama University Hospital. Among them, 128 patients who matched to inclusion criteria were studied. We retrospectively calculated the PNI at (1) pre-iCRT (median 5 days before administration), (2) pre-operation (Ope) (median 5 day before surgery), and (3) post-Ope (median 30 days after surgery) and reviewed the medical records.
4c3880bb027f159e801041b1021e88e8 Result
The median age was 62 years old (range 31 – 79) and 100 patients were male. Seventy patients were adenocarcinomas and 46 were squamous cell carcinomas. Clinical stages were IIA / IIB (n = 15), IIIA (n = 87), IIIB (n = 25), and IV (n = 1). Main regimen of iCRT was CDDP / DOC with concurrent radiotherapy (46 gray). Treatment responses were CR/PR (n = 99), SD (n = 27), and PD (n = 2). Lung resections were lobectomy (n = 109), bi-lobectomy (n = 14), and pneumonectomy (n = 5) and additional procedures were performed in 93 patients. Based on the invasiveness of surgery, we categorized into three groups: 1) highly invasive group (n = 60), 2) intermediate group (n = 33), and 3) standard group (n = 35). Pathological complete responses were present in 37 patients. The PNI were significantly decreased during treatment course [49 (24 – 71) in pre-ICRT, 44 (30 – 58) in pre-Ope, and 41 (22 – 58) in post-Ope]. Among the entire cohort, the perioperative PNI values showed some effect on overall survival. However, among the highly invasive group, the poor preoperative PNI values significantly correlated with worse overall survival.
8eea62084ca7e541d918e823422bd82e Conclusion
Peri-treatment nutritional evaluation using PNI is important to predict clinical outcome of the patients who received the iCRT followed by surgery with LA-NSCLCs especially when highly invasive surgery is required.
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P1.17-17 - The Impact of Induction Chemoradiotherapy Followed by Surgery for N1 Involved Non-Small Cell Lung Cancer (ID 12046)
16:45 - 18:00 | Author(s): Susumu Kanazawa
- Abstract
Background
Induction chemoradiotherapy (iCRT) followed by surgery is usually selected for locally advanced non-small cell lung cancer (NSCLC) patients with mediastinal lymph node (LN) metastasis or invasion to adjacent organs, whereas it is occasionally performed for clinical N1 (cN1) NSCLC patients harboring such as a centrally located primary tumor or a bulky LN to improve local control rate and secure a cancer-free surgical margin. However, the survival benefit of iCRT followed by surgery for NSCLC patients with N1 LN involvement remains controversial. Furthermore, the accuracy of the radiological examination for N1 metastasis is unsatisfactory. In this study, we investigated the clinical outcomes of surgery with or without iCRT based on the estimation of the pretreatment LN metastatic status from fibrotic or necrotic changes of resected LNs in the cN1 NSCLC patients.
a9ded1e5ce5d75814730bb4caaf49419 Method
cN1 NSCLC patients who underwent complete resection with or without iCRT at our institution between January 1999 and December 2016 were subjected. We divided the enrolled patients into two groups as the primary surgery (PS) group and the iCRT followed by surgery (IC) group. As for IC group, we determined the pretreatment LN metastatic status based on the pathological features of resected LNs. We compared the clinical outcomes of pretreatment N1 involved patients with or without iCRT.
4c3880bb027f159e801041b1021e88e8 Result
Among 127 cN1 NSCLC patients, 40 patients were considered as pretreatment N1 involvement, consisting of 26 and 14 patients in the PS and IC groups, respectively. The central type tumor and the continuous type of LN, which frequently required the extended surgical procedures, were significantly more frequent in the IC group than in the PS group (P < 0.01). Although there was no significant difference in the recurrence pattern between the two groups, none of patients developed local recurrence in the IC group. Regarding the patients with a centrally located tumor or a bulky LN (> 2.0cm), the 5-year recurrence-free survival was significantly better in the IC group than in the PS group (74.1% vs, 36.4%; P =0.03).
8eea62084ca7e541d918e823422bd82e Conclusion
Our study demonstrated that iCRT followed by surgery could suppress the disease recurrence in the N1-involved NSCLC patients especially for the patients harboring a centrally located tumor or bulky LNs at N1 level, suggesting that these patients may be good candidates for iCRT followed by surgery to avoid extended resections and to suppress the local recurrence.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)
- 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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P2.01-71 - Clinical Outcome of Induction Chemoradiotherapy Followed by Surgery for the Patients with cN2 Non-Small Cell Lung Cancer (ID 13091)
16:45 - 18:00 | Author(s): Susumu Kanazawa
- Abstract
Background
The treatment strategy for clinical N2 (cN2) non-small cell lung cancer (NSCLC) is still controversial, because its clinical outcome is unsatisfactory and cN2 NSCLC harbors various conditions. In this study, we investigated the clinical outcome of induction chemoradiotherapy (iCRT) followed by surgery in the patients with cN2 NSCLC.
a9ded1e5ce5d75814730bb4caaf49419 Method
During 1999 to 2016, 92 patients with cN2 NSCLC were surgically treated after iCRT in our hospital. Overall survival (OS) and relapse-free survival (RFS) were evaluated by the Kaplan-Meier method with log-rank test (univariate analyses) and by the cox proportional hazard model (multivariate analyses).
4c3880bb027f159e801041b1021e88e8 Result
Median follow-up was 49.3 months (range 3.0 - 216). Median age was 62 (21 - 79). Sixty-nine patients (75%) were male. Fifty-four and 38 patients were cStageIIIA and IIIB, respectively. Forty-six (50%) patients were adenocarcinoma. As for iCRT, the CDDP plus DTX regimen was applied for most of patients (96.7%), and the median radiation dose was 46Gy (36 - 60). Complete/major/minor pathological responses were exhibited in 29/36/27 patients, respectively. pCR was observed in 22 patients. The 5-year rates of OS and RFS were 64.1% and 48.1%, respectively. The patients with lower-lobe origin, cStage IIIA (UICC8th), poor radiological response (progressive or stable disease), minor pathological response, re-operation within 30days after surgery, or recurrence showed significantly worse OS than the others. In addition, the patients with lower lobe origin, cStageIIIA, multi-station N2, poor radiological response, or minor pathological response showed significantly worse RFS. The multivariate analysis revealed that the patients with lower-lobe origin tumors and multi-station N2 showed significantly worse OS [Hazard Ratio (HR) 2.55, 95% confidence interval (CI) 1.11 - 5.71, P= 0.028] and RFS (HR 2.45, 95%CI 1.34 - 4.69, P= 0.003), respectively. Adenocarcinoma, lower-lobe origin, multi-station N2, cStageIIIA, poor radiological response, and minor pathological response significantly correlated to recurrence. Among them, adenocarcinoma (odds ratio (OR) 3.27, 95%CI 1.21 – 8.89, P= 0.02), lower-lobe origin (OR 5.22, 95%CI 1.48 – 18.40, P= 0.01), and multi-station N2 (OR 3.63, 95%CI 1.32 – 9.88, P= 0.012) independently correlated to recurrence.
8eea62084ca7e541d918e823422bd82e Conclusion
iCRT followed by surgery may be one of the feasible treatment options for the patients with cN2-NSCLCs, especially for those which harbor non-lower lobe origin and multi-station N2 .
6f8b794f3246b0c1e1780bb4d4d5dc53
