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Benny Weksler
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MS03 - Workup and Management of Small Anterior Mediastinal Masses/Lesions (ID 66)
- Event: WCLC 2019
- Type: Mini Symposium
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 1
- Now Available
- Moderators:Meinoshin Okumura, Pier Luigi Filosso
- Coordinates: 9/08/2019, 13:30 - 15:00, Amsterdam (2011)
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MS03.03 - Minimally Invasive Surgical Strategies and Considerations for Small Anterior Mediastinal Lesions (Now Available) (ID 3451)
13:30 - 15:00 | Presenting Author(s): Benny Weksler
- Abstract
- Presentation
Abstract
Minimally Invasive Surgical Strategies and Considerations for Small Anterior Mediastinal Lesions
Thymomas are the most common anterior mediastinal masses. These are slow growing relatively indolent tumors that are often curable with surgical resection. Thymomas are often detected in asymptomatic patients who had a computed tomography of the chest for other reasons. Until recently, the surgical standard of care for curative surgery was resection of the thymus en-bloc with the mass through an open sternotomy. Advances in video surgery have allowed resection of the thymus and the anterior mediastinal masses through small incisions.
Currently, there are multiple minimally invasive approaches to the anterior mediastinum, including thoracoscopy though the chest wall, thoracoscopy through a subxiphoid incision, and robotic assisted thoracoscopy. Although data comparing the techniques is sparse, there is no reason to believe that one has oncologic or survival advantages over the other. Data comparing minimally invasive approaches with open approaches have shown better short-term outcomes such as postoperative complications and blood loss, and similar long-term survival.
Several authors have questioned the need for a complete thymectomy in patients with small anterior mediastinal lesions, hence the term thymomectomy. Thymomectomy involves the removal of the thymoma only, with margins around it, but without a formal complete thymectomy. Data comparing complete thymectomy with thymomectomy is sketchy and likely unreliable. Another area of intense investigation is the role of nodal dissection or sampling in the surgical management of thymomas. Data from multiinstitutional database suggests that the incidence of nodal metastases is higher than previously thought. Although data is lacking, removal of enlarged nodes, or sampling of nodes in the anterior mediastinum is likely indicated.
In summary, small anterior mediastinal masses can be removed using minimally invasive techniques. The need for complete thymectomy, and nodal sampling are areas of investigation. Until more data is available, complete thymectomy with nodal sampling appears prudent.
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P1.12 - Small Cell Lung Cancer/NET (ID 179)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.12-20 - Surgical Resection Versus Stereotactic Body Radiation Therapy for T1-2 N0 Typical Bronchopulmonary Carcinoid Tumors (ID 33)
09:45 - 18:00 | Author(s): Benny Weksler
- Abstract
Background
There is an ongoing debate of surgical resection versus stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer. However, no study to date has compared these modalities for early-stage bronchopulmonary carcinoid tumors.
Method
The National Cancer Database was queried for histologically-confirmed T1-2N0M0 typical carcinoid tumors. Additional exclusion criteria were lack of treatment, conventionally-fractionated radiotherapy, or postoperative radiotherapy. Multivariable logistic regression ascertained factors associated with SBRT delivery. Cox proportional hazards modeling examined factors associated with overall survival (OS). Kaplan-Meier OS analysis was performed following propensity matching.
Result
Of 6,276 patients, 98.7% underwent resection (most commonly bi/lobectomy (67%) or sublobar resection (31%)) and 1.3% underwent SBRT (median dose/fractionation of 50 Gy in 4 fractions). Patients receiving SBRT were older, had greater comorbidities, and lower income (p<0.05 for all). Median follow-up had not been reached. SBRT was associated with poorer OS on Cox multivariate analysis (p<0.001). Following propensity matching, median OS was not reached in either group; respective mean and 5-year OS were 95.6 months and 87%, versus 68.8 months and 79% (p<0.001). Differences between cohorts persisted when removing patients who underwent SBRT specifically owing to surgical contraindications (p<0.001).
Conclusion
Surgical resection should remain the cornerstone of therapy for early-stage bronchopulmonary carcinoid tumors. For inoperable cases, SBRT also produces acceptable survival and should be preferred over conventionally-fractionated radiotherapy. However, because causation cannot be implied in any retrospective comparison of surgery versus SBRT, investigations evaluating cancer-related endpoints are required to corroborate these results.
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P2.15 - Thymoma/Other Thoracic Malignancies (ID 185)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.15-13 - The Role of Adjuvant Therapy for Atypical Bronchopulmonary Carcinoids: A Population-Based Analysis (ID 32)
10:15 - 18:15 | Author(s): Benny Weksler
- Abstract
Background
Atypical bronchopulmonary carcinoid tumors are rare but carry high recurrence rates following resection. The role of adjuvant therapy remains unclear owing to a lack of high-volume data. To address this knowledge gap, we examined predictors of adjuvant therapy and effects on outcome.
Method
We queried the National Cancer Database for patients with resected stage I-III atypical carcinoid. Adjuvant therapy was defined as chest radiation, chemotherapy, or a combination thereof. Multivariable logistic regression identified predictors of adjuvant therapy. Multivariable Cox regression evaluated predictors of survival. Propensity matching accounted for indication biases.
Result
Overall, 533 stage I/II and 129 stage III patients were identified. Predictors for adjuvant therapy in stage I/II disease were stage II, positive margins, lymph node ratio (LNR) of 1-25%, and more remote year of treatment. Predictors for adjuvant therapy in stage III were female gender and LNR of 26-50%. Median overall survival in stage I/II and III was 116 months and 61 months, respectively. Predictors for survival in stage I/II were age, margins, comorbidity score, and LNR; factors for stage III disease were LNR and more remote year of treatment. Delivery of adjuvant therapy was not independently associated with survival in either stage I/II or III patients. Furthermore, propensity matched analysis did not reveal a benefit to adjuvant therapy.
Conclusion
This study shows no clear survival benefit with adjuvant radiotherapy and/or chemotherapy, even in stage III disease. Although this implies that adjuvant therapy should not be routinely delivered, individualized judgment is still recommended.
