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Vijayraj S Patil
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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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P2.17-15 - Mediastinoscopic Assessment of N2 Disease and Optimisation of Surgical Treatment of N2 Disease in NSCLC (ID 14234)
16:45 - 18:00 | Author(s): Vijayraj S Patil
- Abstract
Background
N2 disease in NSCLC carries a dismal prognosis and is usually considered outside the surgical spectrum. N2 disease however is not a homogenous entity. We propose that careful mediastinoscopic assessment of lymph nodes allows better selection of cases for neoadjuvant chemotherapy and potentially surgery, thereby optimising treatment and survival.
a9ded1e5ce5d75814730bb4caaf49419 Method
We conducted a retrospective analysis of a prospectively maintained database of patients who underwent cervical mediastinoscopy for NSCLC from Jan 1st 2010 to Dec 31st 2016. Data was retrieved regarding the number of patients diagnosed as N2, number of stations involved, eventual surgical resection, final histopathology and survival. Treatment decisions were based on institutional protocols - initial mediastinoscopic assessment of resectability and histopathology of mediastinal lymph nodes. No invasive restaging was performed after neoadjuvant therapy
4c3880bb027f159e801041b1021e88e8 Result
During the study period 127 patients were diagnosed with N2 disease on staging cervical mediastinoscopy. 51 of these patients eventually underwent surgery after neoadjuvant chemotherapy. The remaining patients were excluded for reasons including bulky unresectable disease, progression on chemotherapy and unsuitability for pulmonary resection. 2/51 patients were found unresectable at surgery and the remaining 49 patients were evaluated in this study. The median age was 56 years (SD - 11.1) and the male/female ratio was 35/14. Adjuvant therapy was decided based on the final histopathology and 23/49 patients received postoperative radiotherapy. Patients were followed up for a median of 27 months (Range - 2 to 71 months). The estimated median overall survival of the whole cohort was 43.26 months. Patients with single station nodal involvement(31) on mediastinoscopy fared better than those with multistation involvement(18), 71.7 months vs 32.3 months, but the difference was not statistically significant (p=0.07). Patients with no residual disease(28) in mediastinal lymph nodes in the final histopathology following neoadjuvant chemotherapy survived longer than those with residual disease(21), 71.7 months vs 43.2 months, however the difference was not statistically significant (p=0.17). 23/26 recurrences were systemic and could be salvaged with chemotherapy. There was only one mediastinum only recurrence.
8eea62084ca7e541d918e823422bd82e Conclusion
Cervical mediastinoscopy and assessment of resectability of mediastinal lymph nodes helps in optimising treatment of N2 disease. Surgery has an important role in a carefully selected subset of patients with N2 disease as a part of multimodality management and provides excellent survival. Patients with multistation lymph nodes and residual lymphadenopathy after chemotherapy also have a reasonable prognosis and if completely resectable and should not be denied surgery.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.12 - Small Cell Lung Cancer/NET (Not CME Accredited Session) (ID 978)
- 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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P3.12-15 - 68 Ga DOTA PET/CT in Staging of Broncho-Pulmonary<br /> Carcinoid Tumors. Is there a Real Benefit? (ID 13229)
12:00 - 13:30 | Author(s): Vijayraj S Patil
- Abstract
Background
The staging of well differentiated bronchopulmonary neuroendocrine tumours (carcinoids) is complicated by the unpredictable incidence of nodal and distal metastases. PET CECT, which has become the standard for staging of lung cancers has proven ineffective in the staging of carcinoid tumours. 68 Ga DOTA NOC PET/CT which depends on radio-tracer uptake in somatostatin receptors appears to be an attractive modality for the staging of these neuroendocrine tumours
a9ded1e5ce5d75814730bb4caaf49419 Method
We performed a retrospective analysis of patients who underwent 68 Ga DOTA NOC PET/CT followed by surgical resection from October 2014 to March 2018. Data was retrieved regarding demographics, standardized uptake value (SUV), surgery performed and final histopathology report including degree of differentiation, nodal positivity and Mib index. The study included only patients who underwent resection since the focus of the study is on correlation with histopathological features. An attempt was made to correlate the SUV with diagnosis of typical vs atypical carcinoid, nodal metastases and Mib index
4c3880bb027f159e801041b1021e88e8 Result
During the study period 42 patients underwent surgical resection following DOTA PET. All details of imaging including SUV were available for 38 patients, while complete histopathological details was available for 42 patients. DOTA PET was not able to differentiate between typical and atypical carcinoids (35 vs 3) based on SUV. The mean SUV of typical carcinoids was 45.2( SD-42.77) whereas that of atypical carcinoids was 34.3(SD-39.7) and the difference was not statistically significant (p=0.6). 6/42 cases had nodal metastases of which DOTA PET could corrrectly identify only 1. There were 2 false positive reports and 5 false negative reports, (sensitivity 16.6% and specificity 94.1%). The mean SUV of the false positive nodes(n= 2 cases) was 7 which calls into question the specificity of the tracer. No corelation between SUV and Mib index could be demonstrated, p=0.8
8eea62084ca7e541d918e823422bd82e Conclusion
In this study 68 Ga DOTA NOC PET CECT could not help in predicting the histopathological nature of carcinoid tumours, atypical vs typical, presence of nodal metastases or Mib index. This study is limited by the small numbers enrolled, a larger series may help us in coming to a more definitive conclusion
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