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María Rosa López-Lisbona



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    OA01 - Advanced Diagnostic Approaches for Intrathoracic Lymph Nodes and Peripheral Lung Tumors (ID 117)

    • Event: WCLC 2019
    • Type: Oral Session
    • Track: Interventional Diagnostics/Pulmonology
    • Presentations: 1
    • Now Available
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      OA01.03 - Probability Model for Malignancy in Hilar and Mediastinal Lymph Nodes in Lung Cancer Based on PET-CT and EBUS (Now Available) (ID 133)

      10:30 - 12:00  |  Author(s): María Rosa López-Lisbona

      • Abstract
      • Presentation
      • Slides

      Background

      The mediastinal lymph nodes (LN) staging is routinely performed by PET-CT and EBUS- TBNA. Nevertheless, there are no studies that explore the diagnostic capacity of both techniques together. This study aims is to find an algorithm based on combined PET-CT and EBUS image variables together with clinical criteria that provides the most accurate probability of malignancy for each LN explored.

      Method

      Retrospective study of mediastinal staging of non-small cell lung cancer, based on PET-CT and EBUS-TBNA. The LN were identified by level (N1, N2 and N3) and by anatomical region (AR) (subcarinal, not subcarinal, and hilar). Standardized Uptake Value (SUV) was determined for each sampled LN (maximum, medium and peak) as well as for pulmonary mass, liver, and blood pool. The ultrasound features collected were: diameter in the short axis (DSA), morphology, border, ecogeneicity and presence of the vascular hilium. For the construction of the predictive algorithm a mixed model of logistic regression of Firth was used.

      Result

      116 consecutive patients were included and a total of 358 LN were evaluated. The set of variables that presented the best discrimination were: age, DSA, SUVmax and AR. The model determines the probability for malignancy for each LN, using the following formula = (-9.26) constant + (-0.21) Age + (4.29) SUVmax + (0.52) DSA + AR. The discrimination power of the model measured by the Area Under the Roc curve was = 0.95.

      distribution density of diameter (mm) and suvmax of positive and negative lymph nodes  .png

      Conclusion

      The model including age, DSA, SUVmax and AR provide the probability of malignancy for each LN with the highest accuracy. All other variables can be discarded when combining PET-CT and EBUS image features.

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    P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.18-13 - Endobronchial Brachytherapy: A Single Institutional Experience (ID 1853)

      10:15 - 18:15  |  Author(s): María Rosa López-Lisbona

      • Abstract

      Background

      High Dose Rate Endobronchial Brachytherapy (HDR-EB) allows treatment of endobronchial lung cancer with minimal radiation of surrounding tissues. It can be both applied as radical intent in local disease or as palliation in metastatic or non-curative setting. The aim of this study is to describe clinical characteristics, complications and survival of a cohort patients treated with HDR-EB as radical intent.

      Method

      Retrospective analysis of consecutive patients undergoing radical HDR-EB in our centre since 2010. Clinical, functional and survival variables were recorded, as well as those related to radiation. HDR-EB was performed after placement of the afterloading catheter in the target bronchus with a flexible bronchoscope. All treatment was delivered weekly. Simulation CT and dosimetry was performed before each fraction. Dose was 5Gy/fr, prescribed at 100% of the implant.

      Result

      16 patients were analysed, 15 (94%) males, age 69 (+/-8) years-old, 3 (19%) were active and 13 (81%) former smokers. Lung function was FEV1 62.3% (+/- 21%), DLCO 60.5% (+/- 13%). Pathological diagnose included in-situ carcinoma (n=1, 6%) and invasive squamous cell carcinoma (n=15, 94%). T staging was T1 in 10 (62.5%) patients, T2 in 3 (18.8%) patients and T4 in 1 (6.3%) patient. All patients had N0 staging. 2 patients had exclusive endobronchial disease.

      6 patients received 3 (n=3, 18.6%) and 4 (n=3, 18.6%) fractions after external beam radiotherapy as a boost. 10 patients received 5 (n=2, 12.5%) or 6 (n=8, 50%) fractions as exclusive radical HDR-EB.
      2 complications were reported: obstructive pneumonitis (n=1) and bronchial stenosis (n=1). Neither deaths nor haemoptysis occurred in relation with the technique. Mean follow-up was 29 (+/- 21) months. Mean overall survival was 29.0 (+/- 22) months. Mean disease free-survival was 24.9 (+/- 21) months. 4 (25%) progressions were observed, of which 3 (19%) were local progression.
      Patients who received boost strategy HDR-EB showed an increased overall survival compared to radical intent (38.2 vs 24.8, p>0.05) and a increased median free-survival; which showed no statistical significance.

      comparison between radical strategy vs boost strategy in overall-survival and free-survival.png

      Conclusion

      HDR-EB is a safe technique applicable in radical intention. Longer survival has been described in patients who received boost strategy. Prospective studies are needed to determine long-term benefits.