Virtual Library

Start Your Search

Hiroshi Date



Author of

  • +

    IBS13 - How to Identify and Manage Toxicity in Stage III (Ticketed Session) (ID 44)

    • Event: WCLC 2019
    • Type: Interactive Breakfast Session
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Now Available
    • +

      IBS13.02 - Surgical Management for Perioperative Complications in Advanced Lung Cancer After Chemoradiotherapy (Now Available) (ID 3355)

      07:00 - 08:00  |  Presenting Author(s): Hiroshi Date

      • Abstract
      • Presentation
      • Slides

      Abstract

      Complete resection of residual lung tumor after induction or definitive chemoradiotherapy may be indicated for selected patients with advanced lung cancer. However, perioperative complication is a great concern. Here, we present videos of four cases requiring surgical intervention for perioperative complications.

      Case 1

      A 59-year-old man was diagnosed with squamous cell carcinoma invading right diaphragm, left atrium and subcarinal lymph node (cT4N2M0). After induction chemoradiotherapy, he was downstaged to cT4N1M0 and underwent right thoracotomy. We realized that the tumor was invading liver through diaphragm. During partial hepatectomy, IVC was injured and massive bleeding occurred. Cardiopulmonary bypass was established and left lower lobectomy with combined resection of diaphragm, liver and left atrium was performed.

      Case 2

      A 50-year-old man was diagnosed with unresectable left upper lobe squamous cell carcinoma invading aorta and #6 lymph node (cT4N2M0). Definitive chemoradiotherapy significantly shrank the tumor. One year later, he was referred to us for salvage surgery. At thoracotomy, we found no fissure between the left upper and lower lobes. The left basal bronchus was accidentally stabled by false recognition of lingula bronchus. The staple lines were removed, and the basal bronchus was reconstructed by end-to-end anastomosis. Then the left upper lobectomy with combined resection of aortic adventitia was performed.

      Case 3

      A 69-year old man was diagnosed with right lower lobe adenocarcinoma with right #2 lymph node metastasis (cT2N2M0). After induction chemoradiotherapy, he underwent uneventful left lower lobectomy with extensive hilar and mediastinal lymph node dissection. He developed radiation pneumonitis and received steroid treatment. On day 52, he readmitted due to sever cough, fever and purulent sputum. Bronchoscopic examination showed left lower bronchial fistula (Figure 1). He underwent urgent right middle lobectomy. The stamp of the bronchus intermedius was covered with omental flap. figure 1.jpg

      Case 4

      A 55-year-old man underwent a right upper sleeve lobectomy for T2N1M0 squamous cell carcinoma originating in the right upper lobe and developed a symptomatic anastomotic stenosis at two months postoperatively (Figure 2a). He required repeated bronchoscopic dilations to relieve his symptoms, which at 1 year postoperatively were complicated with a perforation of the right middle lobe bronchus. Emergent completion pneumonectomy and auto-transplantation of the right lower lobe were performed. Satisfactory bronchial healing was obtained (Figure 2b).figure 2.jpg

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    MA06 - Challenges in the Treatment of Early Stage NSCLC (ID 124)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
    • +

      MA06.06 - A Phase III Study of Adjuvant Chemotherapy in Patients with Completely Resected, Node-Negative Non-Small Cell Lung Cancer  (Now Available) (ID 285)

      13:30 - 15:00  |  Author(s): Hiroshi Date

      • Abstract
      • Presentation
      • Slides

      Background

      Post-operative UFT (tegafur/uracil) has been shown to prolong survival of Japanese patients with completely resected, p-stage I (T1> 2 cm) non-small cell lung cancer (NSCLC). This trial, the Japan Clinical Oncology Group (JCOG) 0707, aimed at estimating the efficacy of S-1 (tegafur/gimeracil/oteracil) compared to UFT as adjuvant therapy in this population.

      Method

      Eligible patients had received complete resection with lymph node dissection for p-stage I (T1-2N0M0, T1> 2 cm, by 5thEdition UICC TNM) NSCLC, within 56 days of enrollment. Patients were randomized to receive: oral UFT 250mg/m2/day for 2 years (Arm A), or oral S-1 80mg/m2/day for 2 weeks and 1 week rest, for 1 year (Arm B). The initial primary endpoint was overall survival (OS). Based upon the monitoring in Jun. 2013, which showed the combined OS of the 2 arms better than expected (4-year OS of 91.6% vs. presumed 5-year OS of 70-76.5%), it was judged to be underpowered. The study protocol was amended so that the primary endpoint is relapse-free survival (RFS). With the calculated sample size of 960, this study would detect the superiority of Arm B over Arm A with power 80% and one-sided type I error of 0.05, assuming the 5-year RFS of 75% in Arm A and the hazard ratio of 0.75.

      Result

      From Nov. 2008 to Dec. 2013, 963 patients were enrolled (Arm A : 482, Arm B : 481): median age 66 (range: 33 to 80), male 58%, adenocarcinoma 80%, p-T1/T2 46%/54%. Only 2 received pneumonectomy. >Grade 3 toxicities (hematologic/nonhematologic) were observed in 15.9 (1.5/14.7) % in Arm A, and in 14.9 (3.6/12.1) % in Arm B, respectively. 60.0% of the patients in Arm A and 54.7% of them in Arm B completed the protocol treatment (p=0.10). There were 4 cases of deaths during protocol treatment, probably of cardio-vascular origin, with 1 in Arm A and 3 in Arm B. At the data cut-off of Dec. 2018, the hazard ratio (HR, Arm B vs. Arm A) of RFS was 1.06 (95% confidence interval (C.I.): 0.82-1.36), showing no superiority of S-1 over UFT. The HR of OS was 1.10 (95% C.I.: 0.81-1.50). The 5-year RFS/OS rates were 79.4%/88.8% in Arm A and 79.5%/89.7% in Arm B, respectively. Pre-specified subset analyses for gender, age, smoking, stage, tumor side, lymph node dissection area, pleural invasion and histology revealed no remarkable results; S-1 arm was not superior to UFT arm in each analysis. Of the 77 and 85 OS events for Arm A/Arm B, 45 each (58%/53%, respectively) were due to the NSCLC. During the follow-up period, secondary malignancy was observed in 85 (17.8%) and 84 (17.8%) in Arm A and Arm B, respectively.

      Conclusion

      Post-operative adjuvant therapy with oral S-1 was not superior to that with UFT in stage I (T>2 cm) NSCLC after complete resection. UFT remains standard in this population. Future investigation should incorporate identification of high-risk population for recurrence, since survival of each arm was so good with substantial number of OS events due to other causes of deaths in this trial.

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    P2.03 - Biology (ID 162)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Biology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
    • +

      P2.03-09 - Arf6-Related Invasive Pathway Deteriorated Patients’ Prognosis in Mutant EGFR Lung Adenocarcinoma (ID 2937)

      10:15 - 18:15  |  Author(s): Hiroshi Date

      • Abstract

      Background

      Arf6-related pathway has been reported to be activated in the downstream of EGF stimulation and to play pivotal roles in invadopodia formation and integrin recyclying leading to cancer invasion and metastasis. EGFR is well known to be constitutively activated without EGF stimulation in lung cancer harboring the mutations in its kinase domain. Here, we have examined the clinicopathological significance of Arf6-related pathway especially in mutant EGFR (mEGFR) lung adenocarcinomas.

      Method

      Clinical samples were obtained from the 239 cases of resected lung adenocarcinoma which were consecutively operated from January 2001 to December 2007 in Kyoto University Hospital. Then, tissue microarrays (TMAs) were made from all the cases. Using DNA samples extracted from fresh frozen tumors, EGFR mutations were detected by SSCP or direct sequencing methods as previouly published.

      Immunohistochemical stainings were performed on TMAs against the molecules of Arf6-related pathway: Grb2, GEP100, Arf6, AMAP1, EPB41L5. The positivity of all molecules was judged according to their H-scores: intensities multiplied by percentages. Clinicopathological data were integrated and reviewed. Statistical analyses for overall (OS) or disease-free survival (DFS) were performed by Kaplan-Meirer methods and log-rank tests. Categorical data were analysed by Pearson’s test. Cox hazard models were applied for multivariate analyses. P-values less than 0.05 were considered significant.

      Result

      Among all cases, mEGFR was found in 113 cases, whereas 118 cases had wild type EGFR (wtEGFR) mutations. Common mutations in EGFR were detected in 104 cases (92.0%). Positivity of each molecule in mEGFR cases was the following: Grb2/ GEP100/ Arf6/ AMAP1/ EPB41L5; 11.9/ 27.7/ 48.2/ 52.7/ 56.3%. Positivity in all molecules showed no significant difference between exon 19 and exon21 mutation cases.

      Visceral pleural involvments were significantly increased in AMAP1- or EPB41L5-positive groups and lymph node metastases were significantly increased in Grb2- or EPB41L5-positive groups.

      Univariate analyses showed that 5-year OS rates were significantly low in Grb2 or AMAP1 positive groups specific to mEGFR cases (Grb2-/+: 89.0 vs 69.2%; p=0.0051, AMAP1-/+: 94.1 vs 80.3%; p=0.0057), whereas it was significantly low in EPB41L5 group specific to wtEGFR cases (-/+: 85.1 vs 62.7%; p=0.017).

      For DFS, all molecules were the significant recurrent factors specific to mEGFR cases (Grb2/ GEP100/ Arf6/ AMAP1/ EPB41L5; p=0.0023/ 0.0033/ 0.0411/ 0.0023/ 0.0263), whereas no molecule was significant specifc to wtEGFR cases.

      Multivariate analyses specific to mEGFR cases showed that Grb2 and AMAP1 were the independent prognostic factors for OS and Grb2 was the only independent recurrent factor.

      Conclusion

      Arf6-related invasive pathway was significantly associated with poor prognosis specific to mEGFR adenocarcinoma. Grb2 and AMAP1 were the strong worsening effectors on the prognosis. Inhibition of this pathway should be a novel targeted therapy in mEGFR lung adenocarcinoma.

  • +

    P2.05 - Interventional Diagnostic/Pulmonology (ID 168)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Interventional Diagnostics/Pulmonology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
    • +

      P2.05-08 - Diagnostic Yield of EBUS-TBNA in Evaluation of PD-L1 Expression for Advanced Non-Small Cell Lung Cancer (ID 1825)

      10:15 - 18:15  |  Author(s): Hiroshi Date

      • Abstract
      • Slides

      Background

      Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) plays a major role in mediastinal staging for advanced non-small cell lung cancer, but the amount of obtained tissue is limited compared to surgical biopsy. The purpose of this study was to assess the diagnostic yield of EBUS-TBNA in evaluating PD-L1 expression in positive mediastinal lymph nodes.

      Method

      A retrospective chart review was performed on our prospectively maintained database to identify patients who underwent EBUS-TBNA to evaluate PD-L1 expression in mediastinal lymph nodes associated with advanced non-small cell lung cancer between April 2017 and March 2019. Relevant factors were extracted and compared between those whose PD-L1 expression was able to be evaluated and those whose PD-L1 expression was not.

      Result

      Thirty-six patients were identified. The PD-L1 expression was able to be evaluated in 30 (83%) of 36 patients. There were tendencies for a greater diameter (p=0.19) and higher standard uptake value (SUV) in positron emission tomography (p=0.22) of biopsied lymph nodes, and a greater number of biopsies (p=0.28) in those whose PD-L1 expression was be able to be evaluated. Among 30 patients with evaluable PD-1 expression, the degree was high expression (tumor proportion score (TPS) ≧ 50%) in 7 patients (23%), low expression (TPS 1-49%) in 10 patients (33%), and no expression (TPS < 1%) in 13 patients (44%).

      image.png

      Conclusion

      Evaluation of PD-L1 expression was feasible in more than 80% patients undergoing EBUS-TBNA for positive mediastinal lymph nodes associated with advanced non-small cell lung cancer. EBUS-TBNA appeared to play an important role in evaluating PD-L1 expression. A larger lymph node, and a lymph node with higher SUV, and a greater number of punctures appeared favorable in evaluation of PD-L1 expression.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    P2.17 - Treatment of Early Stage/Localized Disease (ID 189)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
    • +

      P2.17-26 - Indocyanine Green Virtual Assisted Lung Mapping (ICG-VAL-MAP): Anyone Can Perform a Successful Preoperative Marking for a Small Lung Nodule (Now Available) (ID 2320)

      10:15 - 18:15  |  Author(s): Hiroshi Date

      • Abstract
      • Slides

      Background

      As a preoperative marking of small pulmonary nodules, we developed Virtual Assisted Lung Mapping (VAL-MAP), which is consisted of preoperative simulation using three-dimensional CT images and transbronchial dye marking using indigocarmine (IC). Between 2012 and 2016, we performed VAL-MAP in more than 200 cases in a single institution; however, we sometimes came across a situation, in which an identification of marked IC was difficult at post-marking CT and/or during surgery. Herein, we have developed a new VAL-MAP (ICG-VAL-MAP) using indocyanine green (ICG) and contrast agent. The purpose of this study was to prospectively evaluate the visibility of newly-developed ICG-VAL-MAP in an identification of ICG at post-marking CT as well as during surgery.

      Method

      Between January in 2017 and February in 2019, we performed ICG-VAL-MAP, using ICG and contrast agent in addition to IC as a marker for preoperative nodule identification, in 88 patients at our institution. Preoperative marking was performed on the same day as surgery or 1 day before surgery. During surgery, fluorescence endoscope system was used for identification of marked ICG.

      Result

      Targeted lesions were 105 nodules with the diameter ranging from 2 to 38 mm (median 8 mm). The depth of the lesion from the pleural surface ranged from 0 to 49 mm (median 8 mm). Total marking numbers were 208 (IC: 99, ICG: 109). At post-marking CT, IC was easily identified in 78 markings (78%), difficult to be identified in 10 markings (10%), and unable to be identified in 11 markings (11%). On the other hand, ICG was easily identified in all markings at post-marking CT. During surgery, IC was easily identified in 74 markings (74%), slightly identified in 4 markings (4%), and unable to be identified in 21 markings (21%). On the other hand, ICG was easily identified in 108 markings (99%) during surgery. Only in 1 case, ICG marking was accidentally placed far from a pleural surface, but ICG was slightly identified in a collapsed lung during surgery. In summary, ICG was significantly easily identified than IC during surgery (P<0.0001) as well as at post-marking CT (P=0.0002). There were no significant perioperative complications related to ICG-VAL-MAP. All nodules were identified intraoperatively and an appropriate surgical resection was conducted in each patient. In details, 53 wedge resections, 48 segmentectomies and 2 lobectomies were performed. Furthermore, all nodules were diagnosed pathologically (74 primary lung cancer, 24 metastatic lung cancer, and 7 benign nodule).

      Conclusion

      We confirmed that ICG-VAL-MAP was a novel and promising technique with better visibility than conventional VAL-MAP for the complete resection of small pulmonary nodules.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.