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Richard Hritcu
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EP1.01 - Advanced NSCLC (ID 150)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.01-82 - 10 Years Single Center Experience with Resection of the Superior Vena Cava in Locally Advanced Non-Small Cell Lung Cancer (Now Available) (ID 2814)
08:00 - 18:00 | Author(s): Richard Hritcu
- Abstract
Background
In patients with locally advanced T4 non-small cell lung cancer (NSCLC) invading the superior vena cava (SVC), combined multimodality treatment including surgery is indicated. However, this treatment approach warrants careful patient selection and adequate postoperative management. We aim to review our institutional experience with SVC resection in advanced NSCLC.
Method
Between 2006 and 2017, surgery for NSCLC including SVC resection has been performed in 21 patients at our department. We defined “SVC resection” as resection of the SVC and replacement with ring-enforced tube grafts and “SVC reconstruction” as partial resection with direct closure or reconstruction with a bovine pericardial patch. Clinical parameters and long-term outcome were analyzed.
Result
Overall, 15 male and 6 female patients have been included. Induction treatment was performed in 16 patients, 8 patients received chemoradiation therapy and the other 8 patients had chemotherapy alone. Pulmonary resection included 8 sleeve pneumonectomies, 4 pneumonectomies, 3 lobectomies and 4 sleeve-lobectomies of the right upper lobe, 1 extraanatomical resection of the right upper lobe and one mediastinal tumor debulking. Two patients required cardiopulmonary bypass during surgery. An additional extended resection including chest wall (n=1), phrenic nerve (n=3), pericardium or right atrium (n=4) was performed in 8 patients. Overall 5 patients underwent SVC reconstruction whereas 16 patients had complete SVC resection and replacement. The 90-day-mortality rate was 4.8% (n=1). Major complications occurred in 8 patients (38%) with no difference between patients undergoing SVC resection or reconstruction. Oncological long-term outcome will be presented at the conference.
Conclusion
Our results suggest that an extended resection including SVC replacement or reconstruction is a feasible and safe procedure for carefully selected patients with NSCLC and SVC involvement with acceptable postoperative morbidity and mortality rates.
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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
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.15-11 - Favorable Long Term Survival After Initially Palliative Resection for a Giant Primary Rib Osteosarcoma with Severe Mediastinal Shifting (Now Available) (ID 2440)
10:15 - 18:15 | Author(s): Richard Hritcu
- Abstract
Background
Osteosarcoma is the most common malignancy of the bone with high morbidity and mortality. Treatment of choice is chemotherapy (CHT) followed by surgery and adjuvant CHT. Primary rib osteosarcoma is a rare disease. We present a case of a young patient with a giant primary rib osteosarcoma undergoing palliative resection.
Method
A 29-year-old woman presented with dyspnea and pain in the left chest wall in August 2012. Computed tomography (CT) showed a large lesion destructing the 3rdleft rib with extension to the left upper lobe. Biopsy revealed an osteoplastic osteosarcoma and staging examinations showed no distant metastases (DM).
Result
CHT by the EURAMOS-1-protocol was started but was discontinued by the patient after 1 cycle due to side effects. 1.5 years later without any treatment or follow up, the patient was re-admitted with massive thoracic pain, severity of dyspnea and in a very limited general condition. CT showed a major tumor progression with severe mediastinal shift and total atelectasis of the left lung. Due to extreme large tumor size and lack of treatment alternatives, surgery in palliative intent was performed: clamshell incision, complete resection of the tumor including chest wall reconstruction. The postoperative course was challenging but she recovered well and was discharged after several months with no evidence of disease in combined positron-emission-tomography/CT. Thereafter, the patient again refused any further treatment and checkups. 4.5 years later she presented again with local recurrence in the left chest wall and in excellent overall condition without evidence for DM. Accordingly, a re-thoracotomy, partial resection of ribs 6-9, left diaphragm and pericardium and reconstruction was performed. The postoperative course was without complications and the surgery was well-tolerated.
Conclusion
This case report shows an unexpected favorable outcome after resection in palliative intent for a giant primary rib osteosarcoma with severe mediastinal shifting. Currently, 7 years after diagnosis, the patient is free from disease.
