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Toshifumi Kinoshita

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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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      P1.17-16 - Correlation of Tumor Volume Reduction During Neoadjuvant Chemoradiotherapy with Pathological Complete Response of Lung Cancer (ID 11134)

      16:45 - 18:00  |  Author(s): Toshifumi Kinoshita

      • Abstract
      • Slides


      A study has reported that tumor volume (TV) reduction after neoadjuvant chemoradiotherapy (NACRT) was associated with pathological complete response (pCR) in patients with non-small cell lung cancer (NSCLC). We think that the prediction of pCR during NACRT may be able to assist clinical decisions. Therefore, we retrospectively investigated the relationship between TV reduction during NACRT and pCR.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We evaluated patients who received NACRT followed by surgery between 2007 and 2017. The eligibility criteria of this study were as follows: NACRT was performed with a dose of 50 Gy in 25 fractions with the platinum-doublet regimen, and contrast enhanced computed tomography (CECT) was obtained before and during NACRT. TVs before and during NACRT (TVpre and TVduring, respectively) were measured with the sums of the primary tumor and clinically involved lymph node volumes. Relative changes in the TVs were calculated as %(TVduring – TVpre)/TVpre. The factors affecting pCR were evaluated in a univariate analysis, by Fisher’s exact test or Wilcoxon rank-sum test, and in a multivariate analysis using the multiple logistic regression test.

      4c3880bb027f159e801041b1021e88e8 Result

      In total, 31 patients met the eligibility criteria: 52%, 42%, and 52% of patients had squamous cell carcinoma, cT3, and cN2 disease, respectively. CECT during NACRT (CECTduring) was obtained at a median dose of 40 Gy (range, 24-50 Gy). The median TVpre and TVduring were 45.1 cc (range, 11.4-584.2 cc) and 27.0 cc (range, 5.9-195.0 cc), respectively. The median relative change in the TVs was –49% (range, –83 to –10%), and after surgery, pCR was confirmed in 11 patients (35%). Relative change in the TVs (p = 0.002) and TVpre (p = 0.039) were significant factors affecting pCR in the univariate analysis. No significances were observed in histology, cT, cN, RT dose at the time of CECTduring, and TVduring factors (p = 0.458, 0.449, 1.000, 0.547, and 0.984, respectively). In the multivariate analysis, relative change in the TVs remained an independent predictor of pCR (p = 0.003). The cut-off value for the relative change in the TVs affecting pCR was –64%, which was determined by a receiver operating characteristic curve (area under the curve = 0.841): 8 of 9 patients (89%) whose tumors shrunk more than this cut-off value achieved pCR.

      8eea62084ca7e541d918e823422bd82e Conclusion

      TV reduction during NACRT seems to be associated with pCR in patients with NSCLC. A cut-off value of –64% in relative change in the TVs at a dose of around 40 Gy may be promising to predict pCR.


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