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Emilia Naseva



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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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      P3.08-12 - Long-Term Outcome After Adrenalectomy for Isolated Adrenal Metastasis in Otherwise Operable Patients With NSCLC - Two Institutions Study (ID 12418)

      12:00 - 13:30  |  Author(s): Emilia Naseva

      • Abstract
      • Slides

      Background

      Isolated adrenal metastasis (IAM) from non-small cell lung cancer (NSCLC) is a rare event and the management in such patients remains controversial. Our objective is to evaluate the long-term outcome after resection of IAM in operable NSCLC patients as a part of multimodality treatment.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Twelve patients (mean age 58.4 years) underwent adrenalectomy for NSCLC IAM. IAMs were synchronous (7) and metachronous (5), 4 of them were contralateral and 8 ipsilateral. Locoregional pStages I-II were found in 11 patients and pStage IIIA - in 1 patient. One-stage left lower lobectomy and left adrenalectomy through phrenotomy was performed in 1 patient. In 10 cases the curative lung resection was carried out first, followed by adrenalectomy via laparotomy (3), transperitoneal laparoscopy (1) and retroperitoneal endoscopic adrenalectomy (REA) (5). Two years after left lower lobectomy, the metachronous ipsilateral adrenal and contralateral lung metastases were eradicated by REA (first stage) and right polysegmentectomy S7-S10 in 1 patient from this subset. In the last case REA was performed at a first stage, followed by right lower lobectomy. The mean interval between the lung resection and the adrenalectomy was 6 months. All patients were followed up for the mean period of 42 months. The survival was studied by Kaplan-Meier method. Log-Rank test for comparisons was applied.

      4c3880bb027f159e801041b1021e88e8 Result

      There was no perioperative mortality. The mean overall survival (OS) time is 42.0 months (95% CI 33.8-50.3). One-year and 3-years OS rate is 90.9% and 64.6%, respectively. Six patients are still alive until the last follow-up, four of them are with progression. One of the patients underwent radio- and immunotherapy with good response for local recurrence 20 months after left upper lobectomy. Brain metastases were found in one patient 2 years after initial surgery, which were treated by stereotactic radiosurgery and metastasectomy. Preaortic intraabdominal metastatic lymph node was extirpated in one patient 19 months after left pneumonectomy. One patient underwent irradiation for local recurrence on the bronchial stump 27 months after left pneumonectomy. Mean progression free survival (PFS) time is 25.1 months (95% CI 19.9-30.4). One-year and 2-years PFS rate is 80.0% and 40%. There is no significant difference in mean OS and PSF time between synchronous vs metachronous IAM (p=0.208; p=0.364), ipsilateral vs contralateral IAM (p=0.366; p=0.156) and laparoscopic vs conventional adrenalectomy (p=0.163; p=0.754).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Long term survival is possible after resection of IAM in carefully selected NSCLC patients with early locoregional stages without involvement of mediastinal lymph nodes.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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