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Pınar Akın Kabalak



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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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      P2.16-01 - Prognostic Significance of Preoperative Consolidation to Maximum Tumor Diameter Ratio and Suv-Max in Pathological Stage I Lung Adenocarcinoma (ID 14027)

      16:45 - 18:00  |  Presenting Author(s): Pınar Akın Kabalak

      • Abstract
      • Slides

      Background

      Findings on computed tomography like tumor size, amount of consolidation and ground glass opacity, size of the solid component, maximum standardized uptake value by 18F-fluorodeoxyglucose positron emission tomography/CT and the ratio of the size of solid attenuation to the maximum tumor dimension (consolidation/ tumor [C/T] ratio) are predictive for pathologic subtypes and prognosis after resection.

      There are many number of study about clinical early stage lung cancer in terms of C/T ratio. We aimed to investigate prognostic value of C/T ratio and SUVmax among patients with pathological stage I lung adenocarcinoma

      a9ded1e5ce5d75814730bb4caaf49419 Method

      258 patients were reviewed by using institution's records who had undergone surgery for early stage lung adenocarcinoma. Only patients with pathological stage I (T1a, T1b and T2a without lymph node metastasis) were included. Synchronous tumor, oligometastatic disease and history of other organ malignancy was exclusion criteria. Seventh TNM edition was used. Totally 168 patients’ demographic data, surgery types, clinical and pathological stage, pre-operative SUVmax and C/T ratio was recorded. Differences between patients with recurrence after surgery and without recurrence was demonstrated. Survival rates were analysed by divided into 3 groups according to C/T ratio (0.25-0.5, 0.5-0.75, 0.75-1.0) and cut-off value 50% of C/T ratio.

      4c3880bb027f159e801041b1021e88e8 Result

      Two groups (C/T<0.5 and C/T=0.5-1) did not differ according to comparable factors like visceral pleural invasion, subtype of adenocarcinoma, median SUVmax. Median follow up time was 35 months. 54 patients were died of whom 8 (68%) patients were in C/T ratio<0.5 and 46 patients (67.8%) were in C/T=0.5-1 group. OS was 44.9±5.07 and PFS was 50.8±5.42 in C/T<0.5 group. OS was 69.7±3.34 and PFS was 77.2±3.23 in C/T=0.5-1 group (p>0.05). Three-year survival rate was 50% for C/T <0.5 and 72% for C/T=0.5-1 group (p>0.05). Mean SUVmax is 8.05±6.04 for C/T<0.5 and 10.07±6.85 for C/T≥50% (p= 0.43). Existence of visceral pleura invasion was higher in patients with C/T≥50% (69 patients vs 6 patients, p=0.05). In univariate analyses age, gender and SUVmax value and in multivariate analyses only surgery type and SUV max value were predictors for OS (Surgery type: HR:1.33 (1.04-1.70), p=0.02 and SUVmax: HR:1.04(1.00-1.08), p=0.04).For PFS, only surgery type had significance both unıvariate and multivariate analyses (Univariate: HR: 1.47 (1.15-1.89), p=0.002 and multivariate: HR: 1.67 (1.25-2.23), p=<0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      In pathological stage 1 lung adenocarcinomas, SUVmax and surgery type are important predictors for OS. For PFS only surgery type has significance. Even visceral pleura invasion rates are higher in C/T≥0.5 group, SUVmax is superior to the C/T ratio for predicting prognosis particularly for solid type lung cancer.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.08 - Oligometastatic NSCLC (Not CME Accredited Session) (ID 974)

    • 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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      P3.08-01 - Treatment Outcomes in Oligometastatic Disease of Non Small Cell Lung Cancer: A Single Center Experience (ID 12795)

      12:00 - 13:30  |  Presenting Author(s): Pınar Akın Kabalak

      • Abstract
      • Slides

      Background

      Even if oligometastatic disease is staged as 4, survival rates are higher when curative approaches are performed for both primary tumour and metastasis. We analysed our institution data of oligometastatic disease.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      52 NSCLC patients with limited metastasis were retrospectively analysed. All treatment modalities (surgery, CRT, supportive-care, palliative chemotherapy) were compared in terms of survival. Curative treatment was defined as surgery or CRT (concurrent or sequential).

      4c3880bb027f159e801041b1021e88e8 Result

      figure 1.jpgResults: Median overall survival (OS) was 35.2±4.1 months. Surgery was superior to CRT in terms of OS (36.7 months vs. 27.4 months, p>0.05). Progression free survival (PFS) was 29.4±3.9, survival after first progression (SAFP) was 15.6±2.8 months. Patients performed metastasectomy had higher SAFP rates than others with significance (20.07±3.8 months vs. 7.9±1.7 months p=0.046). Adenocarcinoma was related better SFAP than non-adenocarcinoma group (23±4.1 vs 6.4±1.5, p=0.002). The 1- and 2-year OS were, 67% and 50.4%, respectively. Among curative treatment group, while patients under age 65 (n=25) had 31 months OS, patients above 65 (n=13) had 22 months (p=0.88).figure 2.jpg

      8eea62084ca7e541d918e823422bd82e Conclusion

      Conclusion: Our study revealed that in well-selected NSCLC patients with limited metastasis survival rates can reach up to 3 years even in geriatric population. And clinical N staging and co-morbidity are well known prognostic factors.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.13 - Targeted Therapy (Not CME Accredited Session) (ID 979)

    • 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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      P3.13-02 - Lymphocytic Plevral Effusion Due to Crizotinib Usage: First Case in Literature (ID 13008)

      12:00 - 13:30  |  Presenting Author(s): Pınar Akın Kabalak

      • Abstract
      • Slides

      Background

      Crizotinib is an ALK inhibitor and used for treatment in advanced stages lung adenocarcinoma patients with ALK (+). Most common side effects are; gastrointestinal disorder and visual side effects. Drugs are one of the reasons of effusion. For accurate diagnosis patients’ drug history should be questioned in details. To the best of our knowledge pleural effusion due to crisotinib treatment does not exist in current literature.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      41 years old female patient’s admitted to outpatient clinic with chest pain. There was a right hilar lesion and pleural effusion on right hemithorax (Figure 1A). Thorax tomography revealed 5 cm mass lesion in right middle lobe. Transthoracic needle aspiration biopsy reported as adenocarcinoma. Tissue was positive for ALK-rearrangement and first line crizotinib initiated. In the third month of treatment bilateral pleural effusion more in the right was occurred (Figure 1B and 1C). Primary lesion was regressed (Figure 1D). Efusion on left hemithorax was serous and exudate. Any malignant cells were observed. It was drained with pleural catheter and performed talk pleuredesis. There were lymphocytic cell predominance. Others reasons were excluded. Crizotinib treatment was interrupted, in 15th day of crizotinib free observation fluid’s amount decreased. To increase the rate of recovery methylprednisolone 40 mg/day is added.

      4c3880bb027f159e801041b1021e88e8 Result

      figure 1.pngCrizotinib started again with frequent clinical, radiological follow-up. Fluid’s amount did not increase when steroid dose was tapered. While patient take 16 mg/day crizotinib, it has been seen that left pleural fluid disappeared and right pleural thickening appeared due to talc pleuredesis (Figure 1E and 1F).

      8eea62084ca7e541d918e823422bd82e Conclusion

      To the best our knowledge there is not case report with pleural effusion related to ALK TKI treatment. Our case is the first to demonstrate the relationship between ALK TKI treatment and pleural effusion. The case which response to the treatment newly formed pleural effusion’s source may have thought as medication.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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