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Alper Toker
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EP1.15 - Thymoma/Other Thoracic Malignancies (ID 205)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.15-11 - Outcomes of Thymoma and Determinants of Survival: 16 Years Experience of a Tertiary Cancer Center (Now Available) (ID 1065)
08:00 - 18:00 | Author(s): Alper Toker
- Abstract
Background
We aimed with this study to explore the demographics and clinical outcome of patients with thymoma.
Method
A total of 203 patients with thymoma (Masaoka stage II-IV) treated from 2002-2018 were included in this retrospective analysis. IBM-SPSS statistical software version 20 for Windows (IBM, NY) was used for analysis. Survival analysis were estimated by the Kaplan–Meier method and compared by the log-rank test. p<0.05 was considered statistically significant. Cox-regression tests used for multivariate analysis.
Result
Male:female ratio was 105:98 with median age 49 years (Range 11-77). At presentation, patients with stage II, III and IV disease were 90, 67 and 45, respectively. A total of 123 patients(60,6%) had myasthenia gravis, and 56,1% of these patients had presented with myasthenia related symptoms. Majority of the patients were operated with sternotomy(n=103), and mean hospital stay was 8,34 days (Table 1). A total of 76 patients had received adjuvant radiotherapy, and 31 patients and 35 patients had received adjuvant and neoadjuvant chemotherapy, respectively. At mean follow-up of 218,6 months(95%CI:201,8-235,3), 5-year and 10-year OS rates were 93,8% and 89,2%. 30 patients had recurrence after surgery, and 5-year and 10 year DFS rates were 76,5% and 68,3%. Masaoka-Koga stage(p<0.0001), postoperative hospital stay more than 10 days(p=0,004) and needing neoadjuvant chemotherapy(p=0,003) were significant effects on DFS. Among patients who had given neoadjuvant chemotherapy, comparing cisplatin with etoposide or doxorubicin based combinations did not change DFS(p=0,34) or OS (p=0,48). Adjuvant radiotherapy and chemotherapy also have no survival effect on DFS and OS. On univariate analysis, age(p=0.013), Masaoka-Koga stage(p=0.001), postoperative hospital stay more than 10 days(p=0,006) and having recurrence(p=0,013) were significant effects on OS. Stage (p=0,001) and age (p=0.007) retained its prognostic significance on multivariate analysis (Table 2).
Table1: Patient demographics and summary of the treatment approachs. Age n = 203
<=50
>50
111 (% 54,7)
92 (% 45,3)
Gender n = 203
Male
Female
105 (% 51,7)
98 (% 48,3)
Myasthenia Gravis n = 203
Yes
No
123 (% 60,6)
80 (% 39,4)
Acetylcholine Receptors n=123
Yes
No
113 (% 91,87)
10 (% 8,13)
Masaoka Stage of Thymoma
n = 202
II
III
IV
Unknown
90 (% 44,3)
67 (% 33)
45 (% 22,2)
1 (% 0,5)
Pathology n = 203
Type A
Type AB
Type B1
Type B2
Type B3
Mixed
Micronodular Thymoma
Unknown
15 (% 7,4)
20 (% 9,9)
40 (% 19,7)
67 (% 33,0)
32 (% 15,8)
25 (% 12,3)
1 (% 0,5)
3 (% 1,5)
Surgery type
VATS (Thoracoscopic)
Sternotomy
Thoracotomy
RATS
Inoperable
54 (% 26,6)
103 (% 50,7)
37 (% 18,2)
5 (% 2,5)
4 (%2)
Treatment Modality
Neoadjuvant Chemotherapy
Adjuvant Chemotherapy
Adjuvant Radiotherapy
35 (% 17,6)
31 (% 15,6)
76 (% 38,2)
Table 2: Five-year overall survival and recurrence-free survival estimates in patient subgroups 5-Year Survival Rate
OS
P
RFS
P
Age
≤50
%96,6 +/- 1,9
0,013
%77,8 +/- 4,5
0,510
>50
%84,2 +/- 4,7
%75 +/- 5,4
Gender
Male
%91,5 +/- 3,4
0,852
%76,5 +/- 5
0,687
Female
%90,9 +/- 3,3
%76,5 +/- 4,9
Masaoka stage
2
%96 +/- 2,3
0,001
%93,1 +/- 3
<0,001
3
%88,4 +/- 5
%77,8 +/- 6,4
4
%85,4 +/- 6,2
%42,1 +/- 8,8
Myasthenia Gravis
Yes
%93,1 +/- 2,6
0,648
%80 +/- 4
0,358
No
%87,3 +/- 5
%69,4 +/- 6,7
Diagnosed before 2008
Yes
%97,3 +/- 2,7
0,544
%80 +/- 6,8
0,247
No
%89,1 +/- 2,8
%75,4 +/- 4,1
Chemotherapy
No
Neoadjuvant
Adjuvant
%93 +/- 2,4
%86,9 +/- 7,2 %75 +/- 15,3
0,74
%86,4 +/- 3,2
%47,7 +/- 10
%21,8 +/- 13,4
<0,001
Radiotherapy Type
No
Neoadjuvant
Adjuvant
%90,3 +/- 3,3
%50 +/- 3,5 %93,5 +/- 3,2
0,588
%79,6 +/- 4,5
-
%74,9 +/- 5,5
0,436
Time of initiation of adjuvant therapy
Early
Late
%90,9 +/- 8,7
%89,1 +/- 6,1
0,867
%65,3 +/- 14,3
%72,8 +/- 8,5
0,853
Pathology Type
Type A
Type AB
Type B1
Type B2
Type B3
Mixed Hystology
%88,9 +/- 10
%100
%91,8 +/- 4,5
%93,2 +/- 3,9
%84,9 +/- 8,5
%85 +/- 7,7
0,506
%83,6 +/- 10,3
%87,1 +/- 8,6
%77,4+/- 7,1
%76,7 +/- 6,3
%77,8 +/- 9,3
%57,2 +/- 11,7
0,538
Hospitalisation Days
<10 days
%95,7 +/- 1,9
0,006
%87,1 +/- 3,1
0,004
>=10days
%78,9 +/- 7,2
%56,9 +/- 8,9
Recurrence
Yes
%88,9 +/- 6
0,013
NA
-
No
%91,7 +/- 2,6
NA
Conclusion
Masaoka-Koga clinical stage and age are the important prognostic factors predicting OS. Postoperative hospital stay is related to DFS and OS.
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MA20 - Thymic Tumors: From Molecular to Clinical Results and New Challenges in Other Rare Thoracic Tumors (ID 149)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 1
- Now Available
- Moderators:Kazuya Kondo, Edith Michelle Marom
- Coordinates: 9/10/2019, 11:30 - 13:00, San Francisco (2009)
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MA20.07 - Thymomectomy and Total Thymectomy or Simple Thymomectomy for Early Stage Thymoma Without Myasthenia Gravis: An ESTS Thymic Working Group Study (Now Available) (ID 1683)
11:30 - 13:00 | Author(s): Alper Toker
- Abstract
- Presentation
Background
Resection of thymic tumors has traditionally included removal of the tumor and the thymus gland (thymothymomectomy). Nevertheless, in recent years, some authors questioned the need to remove the thymus gland in non-MG thymomas, suggesting that resection of the tumor (simple-thymomectomy) is enough from an oncological point of view in Stage I (TNM stage classification) thymoma patients. The aim of our study was to compare short- and long-term outcome of thymothymomectomy vs. simple-thymomectomy using European Society of Thoracic Surgeons (ESTS) Thymic Database.
Method
We investigated 1131 patients with thymic epithelial tumors included in the ESTS-Thymic Database. Three-hundred twenty-four clinical stage I (cT1N0M0, according to the 8th edition of the UICC/AJCC TNM stage classification) without Myasthenia Gravis (non-MG) thymoma cases were evaluated from 23 contributing centers (2000-2017), of which 300 (93%) thymothymomectomy and 24 (7%) simple-thymomectomy. Surgical upstaging was evaluated. In pathological stage I, we compared the completeness of resection, the rate of complications, the 30-day mortality, the overall survival and the disease-free survival (DFS).
Result
Overall, we observed an upstaging to stage III in 10 (3%) patients. We did not observe any significant difference between the two techniques in terms of the completeness of resection, the rate of complications and the 30-day mortality. The 5-year overall survival rate was 94% in the thymothymomectomy group and 56% in the simple-thymomectomy group (Figure 1 - P= 0.0004). The 5-year DFS was 95% in the thymothymomectomy group and 82% in the simple-thymomectomy group (Figure 1 -P= 0.013).
Conclusion
Patients affected by stage I TNM non-MG thymoma submitted to thymothymomectomy presented a significantly better DFS and overall survival than those submitted to simple-thymomectomy. Thymothymomectomy should be considered the procedure of choice in Stage I TNM non-MG thymomas, also considering the not negligible rate of pathological upstaging.
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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
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P2.17-23 - The Role Adjuvant Chemotherapy in Resected Stage 1 NSCLC with High Risk Factors: A Turkish Oncology Group Study (Now Available) (ID 2301)
10:15 - 18:15 | Author(s): Alper Toker
- Abstract
Background
Adjuvant chemotherapy is accepted as a standard treatment for suitable patients who have undergone surgery for T2N0 non-small cell lung cancer with tumors larger than 4 cm. Despite similar relapse rates, the benefit of adjuvant chemotherapy for smaller tumors with high risk features is not clear. In this retrospective analysis our aim was to evaluate the prognostic impact of adjuvant platin-based chemotherapy in high-risk stage 1 NSCLC patients.
Method
This cooperative group study included 250 NSCLC patients who underwent curative surgery for stage 1 NSCLC with tumor size 2-4 cm and adverse prognostic factors consisting of visceral pleural invasion(VPI), lympho-vascular invasion(LVI), high grade, presence of solid-micropapillary(SMP) components or STAS. Records of patients were analyzed to investigate the prognostic impact of adjuvant chemotherapy in this cohort. DFS was defined as the time from surgery to the last follow-up, until relapse or death, CSS;time from surgery to death related to cancer or last known contact, OS;time from diagnosis to death or last known contact. Statistical analysis was performed using SPSS 20.0 software(SPSSInc,Chicago,USA).
Result
Median age at presentation was 63 years (range 18-90). The mean tumor size was 29.4 ± 7.4 mm. The frequency of patients with specified risk factors were: VPI: n: 92 (36.8%); LVI: n: 91 (36.4%); Grade 3:n: 49 (19,6%); SMP:n: 76 (30.4%); STAS:n: 15 (6%). A total of 51 patients had received adjuvant platin-based chemotherapy. There were significantly more patients who received chemotherapy in the younger age group (<65 ears old, ≥65 years old) and those with larger tumors (2 – 3 cm, 3 – 4 cm).
During a median follow-up period of 91.8 months; 79 patients(31.6%) experienced recurrence, 62 patients(24.8%) have died, 144 patients(57.6%) were alive without disease and 24 patients (9.6%) were alive with disease.
5-year and 10-year OS rates were 72.7%(± 3,5) and 46.8%(± 8), respectively. There was a significant improvement in DFS with adjuvant chemotherapy, especially in groups with VPI (93.3% vs 53.6%, p:0.016) and SMP (92.3% vs 57.3%, p:0.03). There was also a non-significant trend for improved CSS and OS among patients who received CT.
Table 1. Effects of chemothrapy on survival. Chemotherapy Group
Events/N Median 5-years DFSNon - treatment Group
Events/N Median 5-years DFSP Value DFS 12/51 NE % 74.9 ± 6.3 81/190 71.1 months % 54 ± 4.2 0,032* CSS 4/49 NE % 89 ± 5 41/179 91.8 months % 76.9 ± 3.8 0,078 OS 10/49 NE %77.4 ± 6.4 51/179 88.9 months % 72.1 ± 4 0,541 *All values are stratified, respecting to significant confounding factors such as age, gender and tumor size.
Conclusion
Adjuvant platin-based chemotherapy should be considered for this subset of patients having high grade tumors, or those with VPI, LVI or solid-micropapillary components. Prospective, randomized trials incorporating clinical and molecular risk factors are required to clarify the role of adjuvant chemotherapy for stage 1 NSCLC patients.
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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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P2.18-16 - VATS Lobectomy and Chest Wall Resection for NSCLC (ID 1034)
10:15 - 18:15 | Author(s): Alper Toker
- Abstract
Background
The classic surgical approach in patients with NSCLC invading the chest wall is lobectomy and chest wall resection by thoracotomy in the majority of patients. However, this approach can be performed by video-assisted thoracoscopic surgery (VATS) or robotic surgery (RATS) as a result of increased experience and technological developments. The aim of this study was to evaluate the feasibility of the technique and its results in patients undergoing lung and chest wall resection by means of minimally invasive surgery.
Method
The data of patients who underwent anatomical lung resection using VATS or RATS for NSCLC in three academic hospitals between 2013-2018 were prospectively recorded and reviewed retrospectively. Fourteen patients, all but three males with a median age of 62 ± 6.0 years, undergoing lung and chest wall resection were included in the study. Surgical results were evaluated.
Result
Neoadjuvant/induction treatment was chemo-radiotherapy in three and chemotherapy in two patients. The preferred surgical technique was RATS in two patients, and multiportal VATS in 10 and uniportal VATS approach in two patients. Upper lobectomy was performed in 11 patients, lower in two patients and upper lobe posterior segmentectomy in one patient. Standard small incision for chest wall resection was performed in four, Hybrid approach in 10 patients. Five patients had one, 6 patients had two, two patients had three and one patient had four ribs resections. Chest wall reconstruction was not necessary in any of the patients. The mean operation time was 96.4 ± 21.8 minutes. Complications were observed in 5 (35.7%) of the patients without mortality. The most common complication was prolonged, >5 days, air leak in four patients (28.6%). Ten patients (71.4%) were classified as T3N0, one patient (7.1%) as T4N0, one patient (7.1%) as T4N1, and two patients (14.1%) as T3N0M1. Surgical margins were reported as tumor-free (R0) in all patients. Adjuvant chemotherapy was given in eight patients (57.1%). The two-year survival rate was 66.8%.
Conclusion
Lobectomy and chest wall resection with minimally invasive surgery is a safe and feasible method in patients with NSCLC with chest wall invasion. Compared with thoracotomy, it provides equivalent oncologic outcomes as well as less postoperative pain, smaller incision, and faster recovery.
