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Walter Klepetko



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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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      P2.06-21 - Low Intratumoral Platinum Concentration is Associated with Unfavorable Clinical Outcome in Malignant Pleural Mesothelioma (ID 12883)

      16:45 - 18:00  |  Author(s): Walter Klepetko

      • Abstract
      • Slides

      Background

      Malignant pleural mesothelioma (MPM) is a rare but devastating malignancy characterized by poor prognosis. Systemic anti-MPM therapy is based on platinum compounds. Unfortunately, however, chemoresistance is a major obstacle in the treatment of MPM. Although inadequate intracellular drug uptake is one of the most frequent causes of platinum resistance, the impact of tumor tissue and circulating platinum concentrations on clinical outcome in MPM patients remains unclear.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Spatial distribution and average tumor concentration of platinum was assessed by laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) in tumor samples of MPM patients (n=26) receiving platinum-based induction chemotherapy followed by surgical resection. Circulating platinum concentration was also analyzed by ICP-MS in serum samples (n=29) taken prior to surgery. Tumor and serum drug levels were correlated with various clinicopathological parameters.

      4c3880bb027f159e801041b1021e88e8 Result

      Patients with low average tissue platinum concentrations had significantly shorter overall survival. Interestingly, the spatial distribution of platinum was very heterogenous in the tissue samples. The drug accumulated in collagen-rich, post-necrotic scar tissue compartments, while its level was relatively low in the viable tumor areas. Circulating cisplatin levels negatively correlated with the time between the last chemotherapy cycle and blood sampling.

      8eea62084ca7e541d918e823422bd82e Conclusion

      By using an innovative technique for lateral trace element distribution analysis, we demonstrate here for the first time that low tissue platinum uptake is associated with significantly worse clinical outcome in MPM and, furthermore, that relatively higher platinum levels are confined to areas of intratumoral scar tissue. Our results suggest that insufficient drug uptake might be an important factor of cisplatin resistance in the clinics. Further studies are needed to clarify the significance of heterogeneous intratumoral platinum distribution.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.16-26 - Anatomic Segmentectomy in Stage I Non-Small-Cell Lung Cancer Reveals Equivalent Long-Term Outcomes Compared to Lobectomy (ID 14402)

      12:00 - 13:30  |  Author(s): Walter Klepetko

      • Abstract
      • Slides

      Background

      Lobectomy represents the prefered surgical procedure for patients with early stage non-small cell lung cancer (NSCLC). The choice for the right surgical procedure for stage I patients remains controversial. Aim of our study is to analyze short term and long term outcome of patients undergoing anatomic segmentectomy compared to lobectomy.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      In this retrospective cohort study we included all patients with stage I NSCLC undergoing anatomic segmentectomy or lobectomy from 2006 until 2013 at your institution. A Propensity Score analysis was carried out with respect to age, gender, cardiovascular comorbidities, lung function (FEV1 >60%) and histology (adenocarcinoma vs squamous cell carcinoma). Overall survival and disease free survival as well as morbidity were endpoints of the study

      4c3880bb027f159e801041b1021e88e8 Result

      In total, 385 patients with peripheral located stage I NSCLC who neither underwent neoadjuvant nor adjuvant treatment were identified in our database. After applying propensity core matching, 47 patients underwent anatomic segmentectomy and lobectomy was performed in 47 patients. Of these 94 patients, 76 (81%), were in stage IA and 18 (19%) in stage IB. Adenocarcinoma was the histology in 67 (71%) patients and 27 (29%) patients had squamous cell lung cancer. 25 (27%) patients were operated by VATS and 69 (73%) patients underwent thoracotomy. In all patients, the postoperative complication rate was 11,7% and mean hospital stay was 9 days. There were no significant differences with regard to postopertative morbidity, 30- and 90-day mortality between the anatomic segmentectomy group and lobectomy group. 3- and 5-year overall survival (OS) were 79% vs. 84% and 69% vs. 76%., respectively. There was no significant difference between both groups regarding overall survival (p=0.302) and disease free survival (p=0.603). Interestingly , there was no significant difference in OS und disease free survival in both groups when tumor size was bigger than 2 cm( p=0.728 and p=0.432).

      8eea62084ca7e541d918e823422bd82e Conclusion

      The benefit of lobectomy over anatomic segmentectomy in patients with stage I NSCLC is still not clear. In our cohort, oncologic short- and long-term outcome of anatomic segmentectomy was comparable to outcome after lobectomy. However, the results of prospective randomized studies are warranted to clarify the value of sublobar resections for stage I NSCLC.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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