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Hirotoshi Horio
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P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)
- 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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P3.01-112 - The Prognosis of Lung Cancer Patients with Unexpected Malignant Pleural Effusion and Without Pleural Dissemination Detected at Thoracotomy (ID 11313)
12:00 - 13:30 | Author(s): Hirotoshi Horio
- Abstract
Background
Generally, primary lung cancer patients with malignant pleural effusion are not candidate for surgery. But in cases, we have no choice but to perform the surgery for biopsy, prevention for obstructive pneumonitis. We analyzed the surgery for lung cancer patients with unexpected malignant pleural effusion retrospectively.
a9ded1e5ce5d75814730bb4caaf49419 Method
We retrospectively reviewed the patients with unexpected malignant pleural effusion and without pleural dissemination detected at thoracotomy underwent surgery in our hospital from 2003 to 2017. Pleural effusion was almost small amount (<50ml), and we included the cases that pleural effusion was malignant in the final report however it was suspicious in intraoperative report. Patient demographics, comorbidity, pathological findings, surgical approach, number of lymph nodes harvested, overall survival were evaluated retrospectively. Overall survivals were analyzed with the Kaplan–Meier method and prognostic factors were analyzed with the Cox proportional hazards model.
4c3880bb027f159e801041b1021e88e8 Result
24 patients underwent resection for NSCLC. The median age was 71 years old (56-79 years old) and 7 cases were male. Pleural effusions of all patients were taken before resection and submitted for rapid diagnosis. The reason we performed surgery was because we judged that we could perform surgery because of pulmonary nodule diagnosis and prevention of obstructive pneumonitis and so on. Surgical procedures were lobectomy in 15 cases, segmentectomy in 1, wedge resection in 8. The median size of resected nodule was 2.7cm (1.1cm-10.0cm). Histological types of lung cancer were adenocarcinoma in 21 cases, squamous cell carcinoma, adenosquamous carcinoma and small cell carcinoma each in 1. There was no surgical-related death or severe complications. The median follow-up time was 40 months and median survival was 66 months. At 5 years after pulmonary resection, 9 patients (38%) were dead. 5-year survival was 59.7% and 70.0% at cT1-2N0 patients, respectively. In a previous report, 5-year survival on resected stage I patients was almost 75%, and it is almost as good prognosis as our cT1-2N0 patients. Univariate analysis of gender, age, lymph node dissection, pathological findings (PL, ly, v, histology), surgical procedure and Brinkman Index were performed. Only PL0 or 1 was revealed as a prognostic factor (HR=0.12, p=0.049).
8eea62084ca7e541d918e823422bd82e Conclusion
The prognosis after surgery of lung cancer patients with unexpected malignant pleural effusion and without pleural dissemination may be better than expected and PL0 or 1 was thought as a prognostic factor. Thus, subsequent analysis should be performed to identify patients who could benefit from surgery.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 983)
- 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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P3.17-05 - Multimodality Treatment for Superior Sulcus Non-Small-Cell Lung Carcinomas (ID 12826)
12:00 - 13:30 | Author(s): Hirotoshi Horio
- Abstract
Background
Superior sulcus tumor (SST), to this day remain a complex and challenging condition. The SWOG9416 (Intergroup0160) and the JCOG9806 trial culminated in showing that trimodality therapy with chemotherapy, radiation and surgery provided optimal outcomes. Since that time, the treatment of SST is evolving and preoperative chemoradiotherapy is increasingly used. Dramatic survival benefit, however, has not been reported recently. We reviewed our experience with patients undergoing thoracotomy for lung cancers invading the superior sulcus.
a9ded1e5ce5d75814730bb4caaf49419 Method
Analysis of all consecutive patients in our retrospective database, who had potentially resectable SST (cT3-T4) and were treated with multimodality treatment. In the induction chemoradiotherapy cases, surgery with attempted complete resection was performed in patients showing response or stable disease on computed tomography after multidisciplinary discussion.
4c3880bb027f159e801041b1021e88e8 Result
From 2009 to 2017, 10 patients, included 9(90%) men and 1(10%) women with a median age of 63 years, underwent thoracotomy. Pathology revealed Ad.5(50%), Sq.4(40%) and La.1(10%) patient(s). The majority (80%) underwent preoperative therapy; chemoradiation in 7(70%) (i.e. CDDP+S-1+concurrent RT 66Gy in 5, CDDP+VNR+concurrent RT 45Gy in 2) and radiation alone in 1(10%) patient(s). Two cases(20%) did not have any preoperative treatment although they received adjuvant chemotherapy using platinum doublet (CDDP+VNR in 1(10%) and CDDP+DTX in 1(10%) patient). Clinical stages were IIB(T3N0) in 5(50%), IIIA(T3N1 or T4N0) in 4(40%), and IIIB(T3N2) in 1(10%) patient(s). Of 8 patients with induction therapy, down stage was obtained in 2(20%); c-T3N1 to yc-T3N0 in 1 and c-T3N2 to yc-T3N0 in 1 patient. Complete resection was achieved in all patients (100%) and pathologic therapeutic response was Ef3,Ef2,Ef1b in 4,3,1 patient(s), respectively. Operative mortality was 0%. With a mean observation time of 20 M, 8(80%) were alive and 2(20%) were dead. Of these one died from cancer relapse in small intestine and the other from diabetes mellitus. Actuarial 5-year overall survival (OS) was 43.8% and cancer specific survival (CSS) was 87.5%. In patients with induction chemoradiotherapy, 5-year OS and CSS were both 83.3%.
8eea62084ca7e541d918e823422bd82e Conclusion
In selected patients with SST, multimodrity treatment was feasible with acceptable morbidity and mortality. The complete resectability was high, and long-term survival was promising especially in whom underwent induction chemoradiotherapy followed by surgery. Our results may provide a benchmark against which new treatment regimens can be evaluated. The potential benefit of preoperative chemoradiotherapy must be assessed by whether it leads to higher rates of complete resection and a lower risk of local relapse. Further evaluation and long term follow up would be necessary.
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