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Mark Warren Clemens



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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
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      MA20.09 - Breast Implant Associated Anaplastic Large Cell Lymphoma: Outcomes of a Newly-Recognized Malignancy of the Thoracic Wall (Now Available) (ID 2746)

      11:30 - 13:00  |  Presenting Author(s): Mark Warren Clemens

      • Abstract
      • Presentation
      • Slides

      Background

      In 2016, the World Health Organization provisionally classified breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) as a novel lymphoma and the National Comprehensive Cancer Network (NCCN) established evidence-based consensus guidelines for the diagnosis and surgical management of the disease. BIA-ALCL progresses locally as a solid tumor, invading the chest wall and mediastinum and leading to respiratory compromise in advanced cases. Local disease is treated surgically while aggressive disease involving regional lymph nodes and metastasis are currently managed with systemic chemotherapy, most commonly CHOP regimens (cyclophosphamide, vincristine, doxorubicin and prednisone). The goal of this study is to evaluate the efficacy of different therapies in the treatment of BIA-ALCL with chest wall invasion.

      Method

      A prospective study of all institutional cases from 2013 to 2018 was performed for patients with advanced disease (Stage IIA-III) locally invasive into the chest wall. Pathologic findings, treatments, and outcomes were reviewed.

      Result

      Eighteen consecutive patients were identified with BIA-ALCL Stage IIA-III. The median and mean follow-up times were 42 and 27 months, respectively (range, 6 to 226 months). Patients who underwent a complete en bloc resection had better OS (P = .022) and EFS (P = .014) than did patients who received partial resection, systemic chemotherapy, or radiation therapy. Perioperative complications included one pneumothorax. Two disease recurrences (7.8%) were noted at an average of 5 months from surgery. All patients eventually achieved complete remission (100%). The median overall survival (OS) time after diagnosis was 13 years, and the OS rate was 94% and 90% at 3 and 5 years, respectively. Patients presenting with chest wall invasion demonstrated significantly longer time from diagnosis to definitive surgery (21 versus 8 months, P = 0.039). Partial tumor resection resulted in disease hyperprogression in two cases.

      Conclusion

      BIA-ALCL with chest wall invasion may be a consequence of a delay in diagnosis or treatment. Complete en bloc surgical excision is essential for curative treatment of BIA-ALCL. Patients who receive textured surface breast implants need to be advised of the risk of developing BIA-ALCL, as well as the common presenting symptoms, such as a mass or delayed onset (>1 year) of effusion. When treated appropriately and in a timely fashion, BIA-ALCL has an excellent prognosis. Future research is warranted to determine modifiable risk factors and stratification of at-risk populations.

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