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Mireia Serra-Mitjans

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    MA02 - Miscellaneous Topics in the Management of Early Stage Lung Cancer (ID 116)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 12
    • Now Available
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      MA02.01 - Reccurrence Pattern After Adjuvant Customized Chemotherapy Based on BRCA Expression Level (SCAT Trial) (Now Available) (ID 2760)

      10:30 - 12:00  |  Presenting Author(s): Bartomeu Massuti  |  Author(s): José Miguel Sanchez, Manuel Cobo, Teresa Moran, Jose Luis Gonzalez Larriba, Isidoro Barneto, Javier De Castro Carpeno, Lara Iglesias, Miguel Angel Muñoz, Guillermo López-Vivanco, Dolores Isla, Rafael López, Ramon De Las Penas, Delvys Rodriguez-Abreu, Angel Artal, Emilio Esteban, Mariano Provencio, Eva Pereira, Jose Sanchez-Payá, Rafael Rosell

      • Abstract
      • Presentation
      • Slides

      Background

      •Postop platinum-based CT improves outcomes in completely resected NSCLC with nodal involvement, (St II-IIIA). Customization is feasible in adjuvant setting (tissue availability) . Analysis of expressionin genes involved in DNA repair could be use to select CT regiment. •BRCA1 plays an important role in DNA repair pathways and functions as a differential regulator of response to cisplatin and antimicrotubuleagents. SCAT trial results found that for low BRCA1 levels subgroup Cis-Gemcitabine was superior to Cis-Docetaxel and in high BRCA1 levels subgroup Docetaxel single agent without platinum achieved similar survival to Cis-Doc. Analysis of recurrence pattern in different subgroups of the trials has been performed

      Method

      From Jun/2007 to May/2013 591 patients were screened and 500 p were included (108 in Control arm treated with Cisplatin-Docetaxel and 392 in Experimental arm treated with Cisplatin-Gemcitabine, Cisplatin-Docetaxel or Docetaxel alone according terciles BRCA1 expression level). With a cut-off September 30th 2018 and a median follow-up of 60 months, recurrence pattern are analysed in each arm and subgroup treatment and comparison are made for incidence of risk of recurrence, single/multiple recurrence, thoracic/extrathoracic and site of metastases (liver, bone, brain)

      Result

      Cumulative recurrence 232/456 evaluable patients (p) (50.8%). Recurrence were seen in 182/354 patients treated in experimental arm and in 50/102 p treated in the control arm (RR 1.04; 0.83-1.30) (p=0.672). Majority of recurrences 159/232 (68.5%) were single site recurrence. Intrathoracic recurrences in 121/232 (52%) while extrathoracic metastatic disease 111/232 (47.8%). No significant differences were seen for single/multiple, intra/extrathoracic recurrences between experimental and control arm. More frequent distant metastatic sites were: bone (42 p), brain (38 p) and liver (11 p) In the experimental group between different treatments no significant differences were found for the overall metastatic rate or for the single/multiple, intrathoracic/extrathoracic recurrences. For specific metastatic sites related to experimental treatment a significant reduction of risk of brain metastases were found in the experimental group with high level BRCA1 treated with Docetaxel single agent (p=0.0016)

      Conclusion

      For NSCLC resected patients with lymph node involvement (Stages II-IIIA) risk of recurrence remains high with cumulative rate > 50%. There were no differences in the Relative Risk (1.04) of recurrence when control and experimental arm are compared. Majority of recurrences were single site (68.5%) and intrathoracic (52%) but distant metastases developed in 47.8% os p. More frequent metastatic site was bone, followed by brain and liver. Brain metastases risk were significant lower for patients with low BRCA1 expression treated with single agent Docetaxel

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      MA02.02 - Toxicity of Lung SABR in Patients with Coexisting Interstitial Lung Disease (Now Available) (ID 586)

      10:30 - 12:00  |  Presenting Author(s): Tobias Finazzi  |  Author(s): Merle Ronden, Esther Nossent, Hilâl Tekatli, Idris Bahce, Ben Slotman, Femke Spoelstra, Suresh Senan

      • Abstract
      • Presentation
      • Slides

      Background

      Patients with lung tumors and coexisting interstitial lung disease (ILD) are at increased risk of toxicity following stereotactic ablative radiotherapy (SABR). We report on our institutional experience with SABR in such patients.

      Method

      Institutional patients undergoing lung SABR with coexisting ILD were identified. ILD subtypes were determined by a pulmonologist specializing in ILD. From late 2015, patients were routinely counseled about the increased treatment risks. Magnetic resonance (MR-)guided SABR was used to reduce target volumes from 2016. Overall and progression-free survival (OS, PFS) were estimated using the Kaplan-Meier method, and dosimetric predictors of radiation pneumonitis (RP) were analyzed based on total lung minus planning target volumes (PTV).

      Result

      Twenty-four SABR patients treated for lung cancer (n=22) or metastasis (n=2) between 2007-2018 were identified. Median patient age was 74 years, and the commonest ILD diagnosis was idiopathic pulmonary fibrosis. The commonest fractionation schemes were 60 Gy in 8 fractions (n=11), or 55 Gy in 5 fractions (n=6), and SABR was delivered on a Linac (n=17) to a motion-encompassing internal target volume, or with MR-guided SABR (n=7). At median follow-up of 36.9 months (95% CI, 15.8 to not reached), median OS and PFS were 16.6 and 13.3 months, respectively, and 12-month local control was 88.9%. Five patients (20.8%) developed grade ≥3 RP, of which 3 (12.5%) were fatal. Patients with grade ≥3 RP had a higher total lung V20Gy, and a higher ipsilateral and total mean lung dose (MLDEQD2; Fig. 1) than those without (p <.05).

      figure 1.png

      Conclusion

      Our findings confirm that ILD patients have a poor prognosis and are at high risk for developing severe RP following SABR. Treatment should be preceded by patient counseling by an experienced ILD team. Careful attention must be given to limiting lung doses, and MR-guided SABR is our preferred approach in such patients.

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      MA02.03 - Impact of Coexisting Interstitial Lung Disease on Resected Non-Small Cell Lung Cancer Patients (Now Available) (ID 1237)

      10:30 - 12:00  |  Presenting Author(s): Jin Gu Lee  |  Author(s): Seong Yong Park, Chang Young Lee, Kyoung Shik Narm, Seung Hwan Song

      • Abstract
      • Presentation
      • Slides

      Background

      Patients with interstitial lung disease(ILD) have higher incidence of lung cancer. Treatment for this group is challenging, and long term outcome is poor. We investigated the outcome of patients with lung cancer and ILD after surgical resection, along with risk factor of survival and acute exacerbation.Patients with interstitial lung disease(ILD) have higher incidence of lung cancer. Treatment for this group is challenging, and long term outcome is poor. We investigated the outcome of patients with lung cancer and ILD after surgical resection, along with risk factor of survival and acute exacerbation.

      Method

      Between Januery 2002 and August 2016, total 3413 patients underwent pulmonary resection for lung cancer, among them 74 patients had combined ILD. The demographics, operative and survival data were reviewed.

      Result

      Mean age was 68±7 years-old for 74 ILD patients. 51 (68.9%) patients received video-assisted thoracic surgery (VATS). Lobectomy and sublobar resection were performed to 58 (78.4%) and 15 (20.3%) patients, respectively. 30 (41.5%) patients experienced respiratory complication during early postoperative period. 30-, 90- days mortality and 5-year survival rate were significantly worse than patients without ILD in the same study period (8.1%, 21%, and 21.2% vs. 1.3%, 3.1%, and 73.8%, respectively, p<0.001). Patients with ILD who experienced respiratory complication showed significantly worse 5-year survival than those who has not (18.2% vs. 44.9%, p<0.001). The leading cause of death was cancer related (47.8%), followed by postoperative complications (23.9%). Among 23 patients who received adjuvant therapy, 10 patients died during or shortly after adjuvant therapy. Open thoracotomy (HR 4.02, p=0.017) was risk factor for respiratory complication. Sublobar resection showed similar survival rate in each stage (stage I, p=0.825 and stage II-III, p=0.633) and lower rate of respiratory complication than lobectomy, although statistically not significant (26.7% vs. 43.1%, p=0.246).

      Conclusion

      Interstitial lung disease increased the risk of pulmonary resection for lung cancer. Thoracotomy was associated with higher rate of respiratory complication. Sublobar resection showed similar survival with lower respiratory complication rate compared to lobectomy. Adjuvant therapy should be considered after careful weighing of risk and benefit.

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      MA02.04 - Discussant - MA02.01, MA02.02, MA02.03 (ID 3718)

      10:30 - 12:00  |  Presenting Author(s): Yaxing Shen

      • Abstract

      Abstract not provided

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      MA02.05 - Patient Selection and Early Clinical Outcomes of MR-Guided SABR in 54 Lung Tumors (Now Available) (ID 1318)

      10:30 - 12:00  |  Presenting Author(s): Tobias Finazzi  |  Author(s): Cornelis Haasbeek, Femke Spoelstra, Miguel Palacios, Marjan Admiraal, Anna Bruynzeel, Ben Slotman, Frank Lagerwaard, Suresh Senan

      • Abstract
      • Presentation
      • Slides

      Background

      Magnetic resonance (MR-)guided stereotactic ablative radiotherapy (SABR) with daily replanning was performed for patients in whom treatment delivery was challenging due to tumor location, motion or pulmonary comorbidity. We describe patient characteristics and early clinical outcomes using this novel approach.

      Method

      50 consecutive patients (54 lung tumors) underwent MR-guided SABR at a single center between 2016-2018 for either primary lung cancer (n = 29 tumors) or lung metastases (n = 25). Patients had one or more factors predisposing to toxicity, including a central tumor location (n = 27 patients), previous thoracic radiotherapy (n = 17), and interstitial lung disease (n = 7). A daily 17-second breath-hold MR scan was acquired in treatment position, followed by on-table plan adaptation. Gated delivery was performed using repeated breath-holds under continuous MR-guidance. Local control, overall (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method, with PFS defined as time to disease progression or death from any cause.

      Result

      Breath-hold SABR delivery was well tolerated, with all but one patient completing the planned schedule. With daily replanning, a biologically equivalent dose (BED10Gy) ≥100Gy to 95% of the planning target volume was delivered in 51 tumors (94%). Median follow-up was 15.8 months (95% CI, [11.4-22.5]). Local control, OS and PFS at 12 months were 93.4%, 86.7% and 58.4%, respectively (Fig. 1). In-field recurrences developed in 2 patients who were re-irradiated for a local recurrence after previous SABR, and one marginal recurrence was observed. Overall rates of any grade ≥2 and ≥3 toxicity were 24% and 4%, respectively. No grade ≥4 toxicity was seen. Commonest toxicities were grade ≥2 radiation pneumonitis (8%) and chest wall pain (8%; including one rib fracture).

      figure 1.png

      Conclusion

      Early follow-up of the largest patient cohort to date undergoing thoracic MR-guided SABR indicates low toxicity rates, and promising local tumor control.

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      MA02.06 - Dose-Volume Factors Predicting Airway Stenosis After SBRT for Ultra-Central Lung Tumors (Now Available) (ID 1454)

      10:30 - 12:00  |  Presenting Author(s): Andrew Jackson  |  Author(s): Chunyu Wang, Ellen Yorke, Daphna Geldblum, Aditya Apte, Jie Yang, Andreas Rimner, Abraham J Wu

      • Abstract
      • Presentation
      • Slides

      Background

      The safety of SBRT is uncertain for ultra-central tumors (near the proximal airways or esophagus). One potential toxic effect of ultra-central SBRT is stenosis of the proximal airways, which can lead to airway obstruction and lung collapse. Predictors of such toxicity in this population are urgently needed. We therefore studied dose-volume correlates of airway stenosis after ultra-central SBRT.

      Method

      88 patients with tumors abutting the proximal bronchial tree (PBT) or PTVs overlapping esophagus (n = 76 and 23; 11 met both criteria) were included. 53 (60%) had primary/locally recurrent lung cancer, and 35 had lung metastases. All had 5, 8 or 15 fractions of image-guided radiotherapy with BED ≥84Gy (α/β=10). The lobar bronchi (LB) were contoured from the takeoff from the main bronchus to the bifurcation into segmental bronchi. The primary endpoint was grade 2 or higher lobar bronchial stenosis (LBS), defined as radiographic evidence of narrowing or complete obstruction of at least one lobar bronchus (CTCAE v4). Dose-volume histograms (DVHs) using linear-quadratic equivalent doses in 2 Gy fractions were calculated for the LB with α/β = 3 Gy. Mean equivalent doses (MEDs) to the LB were tested for correlation with LBS using a Cox proportional hazards model, and the log rank test with patient data split at the median value of the MEDs to the LB. Statistical significance was defined as p < 0.05.

      Result

      Median follow up was 14.3 months. There were 24 cases of LBS (27%). Median time to onset of LBS2+ was 8.6 months after end of treatment (range 2-19 months). LBS was significantly correlated with MED to the LB (p = 0.02). Incidence of LBS was significantly different in patients with MED to the LB < or > the median value of 35.4 Gy (p = 0.004 log-rank test), with actuarial rates of 19% and 55% respectively at 14 months, and 19% and 70% respectively at 24 months; and with raw rates of 15.9% and 38.6% respectively.

      Conclusion

      We observed a high rate of lobar stenosis after ultra-central SBRT. Incidence of lobar stenosis was significantly correlated with dose to the lobar bronchi. In particular, mean equivalent dose to the lobar bronchi was significantly correlated with LBS. Our analysis suggests that limiting the mean equivalent dose to the lobar bronchi to < 35.4 Gy results in a two year actuarial incidence of LBS of <19%, and a raw incidence <16%.

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      MA02.07 - A Phase I Trial of an Immune Checkpoint Inhibitor Plus Stereotactic Ablative Radiotherapy in Patients with Early Stage Non-Small Cell Lung Cancer (Now Available) (ID 1967)

      10:30 - 12:00  |  Presenting Author(s): Megan Eileen Daly  |  Author(s): Arta Monir Monjazeb, Amin Mirhadi, David Eastham, Frances Lara, Jonathan Wesley Riess, Ellen A Wiegner, Karen Kelly

      • Abstract
      • Presentation
      • Slides

      Background

      Stereotactic ablative radiation therapy (SABR) is the standard-of-care for medically inoperable, early stage non-small cell lung cancer (NSCLC), but regional and distant failures remain problematic. Based on in vivo preclinical data showing synergy between radiation and immune checkpoint inhibitors (ICI) and the known efficacy and mild toxicity profile of ICI in Stage III and IV NSCLC, we conducted a phase I study to determine the safety, tolerability and maximum tolerated dose of neoadjuvant, concurrent, and adjuvant atezolizumab with SABR for high risk early stage NSCLC (NCT02599454).

      Method

      Eligible patients had histologically confirmed T1-3 NSCLC with one or more features predictive of increased recurrence risk: diameter ≥1 cm, SUV ≥6.2 on FDG PET, or moderately/poorly differentiated histology. Patients were medically inoperable or refused surgery, and had a Zubrod PS ≤2. Patients received 6 cycles of atezolizumab IV in 21 day cycles. A 3+3 dose finding design was employed with three dose levels: 3 mg/kg, 10 mg/kg, and 1200 mg flat dosing. SABR was delivered starting cycle 3 to 50 Gy over 4-5 fractions. Patients were restaged after cycle 2, prior to SABR. Dose limiting toxicity (DLT) was assessed during the first 9 weeks of treatment.

      Result

      From April 2016-June 2018, a total of 15 patients enrolled, with 12 evaluable for DLT assessment. Three patients chose to discontinue treatment due to travel issues (1 pt), a COPD exacerbation (1 pt) and grade 2 liver function tests (LFTs) (1 pt). One patient on dose level 2 developed DLT, a grade 3 rash requiring discontinuation of protocol therapy. No other DLTs occurred, resulting in a recommended dose of 1200 mg for future studies. Eleven patients completed protocol treatment. Other grade 3 toxicities include transient lymphopenia in 4 patients. One patient each developed grade 2 pneumonitis, grade 2 hypothyroidism, and grade 2 hyperthryoidism. Three patients had a radiographic partial response and 1 patient had a minor response following 2 cycles. No patient had progressive disease prior to SABR. Results of correlative blood and tissue studies will also be reported.

      Conclusion

      Neoadjuvant, concurrent, and adjuvant atezolizumab in combination with SABR for early stage NSCLC is well-tolerated, with radiographic PR prior to SABR in 25% of our cohort. Overall efficacy data is premature. Enrollment to an expansion cohort is ongoing, and this combination will be tested in an upcoming randomized phase III trial SWOG/NRG S1914.

      This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Lung Cancer Research Program under Award no. W81XWH-15-2-0063.

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      MA02.08 - Discussant - MA02.05, MA02.06, MA02.07 (ID 3719)

      10:30 - 12:00  |  Presenting Author(s): Mireia Serra-Mitjans

      • Abstract
      • Slides

      Abstract not provided

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      MA02.09 - Prognostic Impact of Immune Cell Biomarkers in Surgically Resectable Non-Small Cell Lung Cancer (Now Available) (ID 2646)

      10:30 - 12:00  |  Presenting Author(s): Stephanie Tuminello  |  Author(s): Rajwanth Veluswamy, Francesca Petralia, Pei Wang, Raja Flores, Maaike Van Gerwen

      • Abstract
      • Presentation
      • Slides

      Background

      Immune cells within the tumor microenvironment (TME) play an important role in the development, progression and eventual outcomes of non-small cell lung cancer (NSCLC). The relative balance of immune effector and regulatory cell subpopulations may tilt the TME to be either detrimental or supportive of tumorogenesis and will have a profound impact on the tumor’s eventual destiny. In early-stage lung cancer, the role of individual immune cell subtypes in the TME on survival outcomes following surgical resection is unknown.

      Method

      This project made use of The Cancer Genome Atlas (TCGA) Program data. We computed sample-specific scores for different immune cells using xCell, a new model for estimating different immune cell types from RNAseq data, for all stage I-IIIA NSCLCs. Then, we assessed the association between each cell type and survival with Cox Regression, while adjusting for important clinical variables (i.e., stage, age, gender, smoking status). We stratified the analysis according to histological subtype.

      Result

      There were 910 surgically resected early-stage NSCLC analyzed, of which 438 were adenocarcinomas (LUADs) and 472 were squamous cell (LUSC) samples. Higher levels of natural killer cells, neutrophils, and mast cells within tumors were associated with significantly improved survival in LUAD patients, whereas no immune cell type was associated with survival for LUSC patients or the combined analysis.

      Figure 1: Adjusted Survival According to Estimated Immune Cell Infiltration

      figure 1 adjusted survival according to estimated immune cell infiltration.png

      Hazard ratios are adjusted for stage, gender, age and smoking status

      Conclusion

      Innate and adaptive immune cells within the TME may have prognostic value in early-stage NSCLC patients undergoing surgical resection. However, the role of individual immune cells may vary according to histological subtype. Prospective research should continue to assess the association of the immune cell composition of the TME with clinical outcomes.

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      MA02.10 - Different Prognostic Impact of Lymphovascular Invasion Between Lobectomy and Sublobar Resection in Stage IA Non-Small Cell Lung Cancer: A Propensity Score–Matched Analysis (Now Available) (ID 2905)

      10:30 - 12:00  |  Presenting Author(s): Jae Kwang Yun  |  Author(s): Geun Dong Lee, Yooyoung Chong, Yong Ho Jeong, Sehoon Choi, Hyeong Ryul Kim, Yong-Hee Kim, Dong Kwan Kim, Seung-Il Park

      • Abstract
      • Presentation
      • Slides

      Background

      Lymphovascular invasion (LVI) has been reported as a risk factor in patients with stage I Non-Small Cell Lung Cancer (NSCLC). Although lobectomy is a standard treatment, sublobar resection may be performed in patients with stage IA NSCLC. This study aimed to evaluate the prognostic effect of LVI in stage IA patients who underwent lobectomy and sublobar resection.

      Method

      We retrospectively reviewed data from 2134 patients with stage IA NSCLC from 2007 to 2016. By using the Cox proportional hazard regression model, we calculated the prognostic impact of LVI quantitatively. To reduce the effects of observed confounding between LVI-positive and negative patients, propensity score matching (PSM) was applied in patients with lobectomy and sublobar resection, respectively.

      Result

      Among patients with stage IA NSCLC (n=2134), 184 (8.6%) were pathologically diagnosed with LVI, which were 144 (8.9%) in lobectomy group (n=1614) and 40 (7.7%) in sublobar resection group (n=520). In multivariable analysis, LVI was a significant risk factor for both overall survival (OS) and recurrence-free survival (RFS) (OS: hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.39–2.96; p < .001; RFS: HR, 2.31; 95% CI, 1.68–3.17; p < .001). After PSM, the prognostic impact of LVI was shown much greater in patients with sublobar resection (HR = 1.77 and 2.51 for OS and RFS) than those with lobectomy (HR = 4.93 and 4.25 for OS and RFS).

      Conclusion

      The presence of LVI significantly affected OS and RFS in stage IA NSCLC patients. Survival outcomes were more affected by the presence of LVI in patients with sublobar resection than those with lobectomy. Subsequent completion lobectomy could be considered in patients diagnosed with LVI after sublobar resection.

      figure_revised.jpg

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      MA02.11 - Adjuvant Chemotherapy Following SBRT for Early Stage Non-Small Cell Lung Cancer (NSCLC) in Older Patients (Now Available) (ID 1981)

      10:30 - 12:00  |  Presenting Author(s): Apar Kishor Ganti  |  Author(s): Adams Kusi Appiah, Vinicius Ernani, Chi Zhang, Weining Zhen, Alissa Marr, Lynette Smith

      • Abstract
      • Presentation
      • Slides

      Background

      Adjuvant chemotherapy following surgery has been shown to be beneficial in NSCLC >4 cm in size, regardless of age. We have recently shown that adjuvant chemotherapy improves overall survival following stereotactic body radiotherapy (SBRT) in patients with tumors ≥4 cm in size. We aim to evaluate the role of adjuvant chemotherapy following SBRT in older patients (>70 years) with early stage NSCLC.

      Method

      Patients (>70 years) diagnosed with clinical stages I-II NSCLC (AJCC 7th Edition) from 2004 to 2013, who received SBRT, were identified using the National Cancer Database (n=7,934). The Kaplan-Meier method was used to estimate overall survival (OS) distributions and the log-rank test was used to compare distributions by treatment strategy. Clinical stages I and II were subdivided according to the TNM staging and log-rank tests was used to compare survival distributions by treatment strategy within each subgroup.

      Result

      There were 3991 male patients (50.3%), and 6219 (78.4%) had stage I disease. Among stage I patients, 670 (10.8%) received adjuvant chemotherapy (defined as chemotherapy within 90 days of completion of SBRT), compared to 742 stage II patients (43.3%) received adjuvant chemotherapy. Median OS was better with SBRT in patients with stage I disease (25.2 vs. 19.9 months; p<0.001); while patients with stage II NSCLC had better OS with SBRT + chemotherapy (19.9 vs. 14.6 months; p<0.001). On multivariate analysis, after adjusting for age, gender and facility type, patients with stage I NSCLC who received SBRT alone had better overall survival [HR for death: 0.79 (95% CI, 0.73, 0.87)]. SBRT alone was associated with an increased risk of death in patients with stage II disease [HR: 1.37 (95% CI, 1.23, 1.53). When patients with N0 disease were evaluated based on tumor size, those with tumors ≥4 cm had better OS with SBRT + chemotherapy (18.5 vs. 15.5 months; p=0.003). In contrast, patients with tumors <4 cm did better with SBRT alone (median OS of 24.1 vs. 20.3 months; p<0.001)slide1.jpg

      Conclusion

      Adjuvant chemotherapy following SBRT is associated with improved OS in patients >70 years of age and tumors ≥4 cm in size or lymph node involvement.

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      MA02.12 - Discussant - MA02.09, MA02.10, MA02.11 (ID 3720)

      10:30 - 12:00  |  Presenting Author(s): Yaxing Shen

      • Abstract

      Abstract not provided



Author of

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    MA02 - Miscellaneous Topics in the Management of Early Stage Lung Cancer (ID 116)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
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      MA02.08 - Discussant - MA02.05, MA02.06, MA02.07 (ID 3719)

      10:30 - 12:00  |  Presenting Author(s): Mireia Serra-Mitjans

      • Abstract
      • Slides

      Abstract not provided

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    MA08 - Pawing the Way to Improve Outcomes in Stage III NSCLC (ID 127)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Now Available
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      MA08.09 - Results of Trimodality Therapy for Patients with cN2 Lung Cancer Diagnosed by Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA) (Now Available) (ID 1295)

      15:15 - 16:45  |  Author(s): Mireia Serra-Mitjans

      • Abstract
      • Presentation
      • Slides

      Background

      After a properly performed transcervical lymphadenectomy, invasive restaging of the mediastinum is unnecessary because 
there is no material left for a new biopsy. Therefore, when video-assisted mediastinoscopic lymphadenectomy (VAMLA) is used at primary staging, the only parameters to select patients for lung resection after induction therapy are: the stability of the primary tumor and the absence of extrathoracic disease assessed by PET-CT. The aim of this study is to analyze the results of those patients with cN2 NSCLC diagnosed by VAMLA who underwent trimodality treatment in terms of feasibility and survival.

      Method

      Prospective observational single-center study of 250 patients (206 men; median age, 65.7; range, 42-86) with NSCLC cN0-1 (by PET-CT) who underwent VAMLA from 01-2010 to 12-2017. Patients with cN2 diagnosed by VAMLA who underwent trimodality treatment (cisplatin-based chemotherapy concomitant with radical radiotherapy [mean 54Gy, range 40-70Gy] plus lung resection) were analyzed. Follow-up was completed in March 2019. Median follow-up for surviving patients was 39.5 months (range, 8-108). Survival analysis was performed by the Kaplan-Meier method; the log-rank test was used for comparisons. Patients who died within 90 days after resection were excluded from survival analyses. A p-value of less than 0.05 was considered significant. The IBM SPSS Statistics for Mac, version 20.0 was used.

      Result

      The rate of unsuspected N2-3 disease in the whole series was 14.5% (35 patients). 28 patients out of 35 were considered for trimodality treatment. The results of restaging based on the PET-CT were: disease progression in 8 (28.5%) (mostly distant metastases), and stability of the primary tumor or partial response in 20 patients (71.5%). Of 20 patients without progression, 13 (46.5%) underwent lung resection; the remaining 7 were considered unfit for surgery. Three- and 5-year survival rates for those candidates for chemoradiotherapy (n=28) were: 91.7% and 80.2%, respectively, for patients in whom complete lung resection was achieved; 34.3% and 0%, respectively, for those considered unfit for surgery; and 19% and 0%, respectively, for those with progression after chemoradiotherapy (p < 0.0001)(Figure 1).

      figure1.jpg

      Conclusion

      The use of VAMLA to select patients for trimodality treatment is feasible. Based on the results obtained (high rate of unsuspected cN2 diagnosed by VAMLA and prolonged survival of those patients in whom the trimodality treatment was accomplished), VAMLA should be included in the current staging algorithms, especially for those tumors with intermediate risk of N2 and normal mediastinum by PET-CT.

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