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Yeon Sil Kim
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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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P2.06-01 - Short-Term Outcome of Entire Pleural Intensity-Modulated Radiotherapy in a Neoadjuvant Setting for Malignant Mesothelioma (ID 13114)
16:45 - 18:00 | Author(s): Yeon Sil Kim
- Abstract
Background
The purpose of this study is to evaluate the safety and efficacy of the tri-modality treatment with neoadjuvant intensity-modulated radiotherapy (IMRT) for a resectable clinical T1-3N0-1M0 malignant pleural mesothelioma (MPM).
a9ded1e5ce5d75814730bb4caaf49419 Method
A total of ten malignant mesothelioma patients who received neoadjuvant radiotherapy between March 2016 and April 2018 were reviewed. Patients received 25Gy in five fractions to entire ipsilateral hemithorax including clinically suspicious lymph nodes. All patients were treated with helical tomotherapy.
4c3880bb027f159e801041b1021e88e8 Result
All of the patients were men with a median age of 60 years. Epitheloid subtype was found in nine patients (90%) and type was unknown in one patient (10%). All patients received neoadjuvant chemotherapy with Alimta-cisplatin(AP) regimen. Nine patients (90%) completed 25Gy/5fxs radiotherapy and one (10%) completed 20Gy/4fxs. IMRT was well tolerated with only one acute grade 3 radiation pneumonitis. Surgery was performed one week (1 - 15 days, median 7.5) after completing IMRT. Extrapleural pneumonectomy (EPP) was performed in three patients (30%), and pleurectomy and decortications (PD) in six (60%). There was no grade 3+ surgical complication except one patient died from septic shock after EPP in one-month. Based on operative findings and pathologic stagings, adjuvant chemotherapy was delivered in six patients (60%), and one (10%) was decided to start adjuvant radiotherapy. After a median follow-up of 10.6 months (range 1.7 - 24.2), there is no evidence of local recurrence or distant metastasis.
8eea62084ca7e541d918e823422bd82e Conclusion
Neoadjuvant intensity-modulated radiotherapy (IMRT) can be safely delivered with a favorable radiation complication. An optimal strategy has to be made in resectable MPM patients who would benefit from neoadjuvant radiation and surgery. Further studies need to look at long-term outcomes.
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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P2.16-04 - Prognostic Value of Lymphovascular Invasion and Its Effect on Patterns of Recurrence in T1-3N0 Non-Small Cell Lung Cancer (ID 13180)
16:45 - 18:00 | Presenting Author(s): Yeon Sil Kim
- Abstract
Background
The purpose of this study is to clarify the prognostic value of lymphovascular invasion (LVI) in patients with surgically resected T1-3N0 non-small cell lung cancer (NSCLC) according to the eighth edition of the TNM Classification of the American Joint Committee on Cancer (AJCC).
a9ded1e5ce5d75814730bb4caaf49419 Method
A total of 442 NSCLC patients who received curative surgery and were confirmed with pathologic T1-3N0 between March 2000 and August 2015 were reviewed. The pathological stages were re-evaluated according to the eighth edition of the TNM Classification of the AJCC.
4c3880bb027f159e801041b1021e88e8 Result
The 5-year recurrence-free survival (RFS) rate for total cohort was 69.7%, and the 5-year overall survival (OS) rate was 78.0%. LVI was present in 89 patients (19.9%). The presence of LVI decreased the 5-year RFS rate significantly (47.5% vs. 72.3%, p < 0.001) and the 5-year OS rate (62.5% vs. 81.1%, p < 0.001). The differences between LVI group and non-LVI group were more remarkable in T2a-bN0 staged patients compared with T1a-c staged patients (T1a-c patients: 63.6% vs. 78.0%, p = 0.004; T2a-b patients: 31.7% vs. 64.9%, p = 0.027, respectively). Multivariate analysis revealed that the presence of LVI was a significant predictor for RFS (p < 0.001) but an insignificant factor for OS. In T2a-bN0 staged patients, the 5-year OS rate was significantly lower in patients with LVI than in patients without LVI (50.0% vs. 74.4%, p = 0.045), whereas T1a-c staged patients did not show a significant difference in 5-year OS according to the presence of LVI (p = 0.196).
8eea62084ca7e541d918e823422bd82e Conclusion
LVI is a significant associated factor for RFS in patients with stage T1-3N0 NSCLC. Prognostic impact of LVI is more remarkable in patients with more than T2N0 stage compared to patients with the T1N0 disease.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)
- 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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P2.17-25 - Post-Treatment Neutrophil to Lymphocyte Ratio in Locally Advanced NSCLC Patients Treated with Concurrent Chemoradiotherapy (ID 12815)
16:45 - 18:00 | Author(s): Yeon Sil Kim
- Abstract
Background
We aimed to investigate the relationship between NLR and prognosis in patients with locally advanced NSCLC who received concurrent chemoradiotherapy as the first line treatment.
a9ded1e5ce5d75814730bb4caaf49419 Method
We retrospectively analyzed 62 patients with locally advanced NSCLC treated with definitive CCRT between 2008 and 2016 at Seoul St. Mary’s hospital. We excluded patients who received induction chemotherapy to eliminate their influence on NLR. CCRT consisted of weekly chemotherapy using paclitaxel/carboplatin, docetaxel/cisplatin, docetaxel/carboplatin, and etoposide/cisplatin. Radiotherapy was performed with intensity-modulated radiotherapy (IMRT) or three-dimensional conformal RT (3D-CRT). The median radiation dose was 66 Gy in 33 fractions (range, 52 – 70 Gy). The pre-CCRT NLR was calculated from the nearest CBC within 1 week before CCRT and post-CCRT NLR was calculated using CBC 4 weeks after CCRT. Change of NLR before/after CCRT was also analyzed. The maximally selected log rank test was used to acquire the most significant NLR level related with overall survival (OS).
4c3880bb027f159e801041b1021e88e8 Result
The pre-, post-CCRT NLR, and NLR change (post-CCRT NLR/pre-CCRT NLR) cut-off levels were 1.9, 3.15, and 1.6, respectively. The median follow up duration was 11 months (range, 2–71 months). The 3-year OS, loco-regional progression free survival (LRPFS), and distant metastasis free survival (DMFS) were 45.4%, 9.3%, and 6.2%, respectively. The post-CCRT NLR and NLR change were significantly associated with OS and LRPFS. The high post-CCRT NLR group (> 3.15) showed significantly worse OS and LRPFS compared to the low post-CCRT NLR group (≤ 3.15) (3-year OS: 21.2% vs. 46.9%, p=0.005; median LRPFS: 7.7 months vs. 11.3 months, p=0.04). The high NLR change group (> 1.6) had significantly worse OS and LRPFS than the low NLR change group (≤ 1.6) (3-year OS: 32.7% vs. 36.9%, p=0.026; median LRPFS 7.7 months vs. 10.4 months, p=0.025). The pre-CCRT NLR showed a marginally significant difference in OS (3-year OS: 29.1% vs. 56.9%, p=0.062). There was no correlation between NLR and DMFS.
8eea62084ca7e541d918e823422bd82e Conclusion
The pre-, post-CCRT high NLR and increased NLR after CCRT are associated with poor prognosis of survival in patients for locally advanced NSCLC. An elevated NLR after CCRT might be an indicator of an increased risk of loco-regional failure. Further studies are needed to confirm the predictive value of NLR and the treatment strategies using NLR.
6f8b794f3246b0c1e1780bb4d4d5dc53
