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Toshihiko Fujita



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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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      EP1.15-13 - Prognosis of Colorectal Cancer Cases That Underwent Lung and Liver Metastasectomy and Therapeutic Outcomes of Brain Metastasis (Now Available) (ID 1331)

      08:00 - 18:00  |  Presenting Author(s): Toshihiko Fujita

      • Abstract
      • Slides

      Background

      The resectability is often debated in cases of lung and liver metastases. Further, we had reported previously that the incidence of brain metastasis is significantly higher in colorectal cancer with lung metastasis than cases with liver metastasis (lung: 7.7%, liver: 1.6%). We compared and investigated the therapeutic outcomes of cases of lung, liver and brain metastasis.

      Method

      Between 2002 and 2013, we retrospectively studied the prognosis of 90 cases of colorectal cancer cases that underwent lung metastasectomy, and 148 cases that underwent liver metastasectomy. The course of treatment in 8 cases of subsequent brain metastasis was also evaluated.

      Result

      The 5-year survival rate (5-SR)for 90 cases of lung metastasectomy overall was 66.7%. 63 cases were initial metastasis and the 5-SR was 66.7%. Out of these, there were 7 cases of synchronous metastasis with a 5-SR of 57.1%, and 56 cases of metachronous metastasis with a 5-SR of 67.9%, indicating no significant difference. The regions of secondary recurrence after lung resection were as follows: lung: 28 (cases), liver: 7, brain: 3, mediastinal lymph nodes: 5, other: 5.

      The 5-SR for 148 cases of liver metastasectomy overall was 54.7%. 141 cases were initial metastasis and the 5-SR was 55.3%. Cases who underwent lung metastasectomy had a significantly higher survival rate (p=0.0068). Out of these, 70 cases were synchronous metastasis with a 5-SR of 35.7%, and 71 cases were metachronous metastasis with a significantly higher 5-SR of 67.9% (p=0.011). The regions of secondary recurrence after liver resection were as follows: lung: 47 (cases), liver: 66,brain: 2, abdominal lymph nodes: 9, dissemination: 6, other: 7.

      While there were 5 cases of subsequent brain metastasis after lung resection, no subsequent brain metastasis was found after liver resection. All but one of the 8 cases of brain metastasis after lung resection were treated with surgery or CyberKnife. The total survival period was 1141 - 3848 days (median: 1913.5 days), and the survival period after detection of brain metastasis was 15 - 852 days (median: 401 days). In addition, all cases were experiencing associated symptoms when brain metastasis was detected, and only one patient was undergoing regular examinations to detect brain metastasis.

      Conclusion

      While appropriate surgical intervention is recommended in cases of lung metastasis and metachronous liver metastasis,it is debatable in cases of synchronous liver metastasis. Cases of lung metastasis should give attention to brain metastasis and recieve early detection and intervention.

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    EP1.18 - Treatment of Locoregional Disease - NSCLC (ID 208)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.18-01 - Effectiveness of Video-Assisted Surgery and Pre-Operative Multi-Disciplinary Support for Preserving Respiratory Function (Now Available) (ID 853)

      08:00 - 18:00  |  Author(s): Toshihiko Fujita

      • Abstract
      • Slides

      Background

      Evaluation of post-operative respiratory function after lung resection is very important because it greatly affects the quality of life (QOL).

      Method

      The predicted post-operative lung VC was calculated according to the number of 42 sub-segments of the lung. The % predicted post-operative VC (%PR) was defined as (number of resected segments)/42 × 100. The % real reduction (%RR) was defined as (pre-operative VC- post-operative VC)/ (pre-operative VC) ×100. Furthermore, we defined %PR-%RR as the index of post-operative reduction of respiratory function (RI).Using RI, we investigated the differences in respiratory function between 22 cases of open-thoracic surgery and 96 cases of thoracoscopic surgery and among 3 different pre-operative support groups, namely, no preoperative support (Non; 39 cases), pre-operative rehabilitation support (Reha; 20 cases), and multi-disciplinary support (Multi; 59 cases). Pre-operative rehabilitation support is coaching for respiratory rehabilitation provided to patients by the rehabilitation physicians and physical therapists at our outpatient clinic. In addition to rehabilitation support, multi-disciplinary support was provided by a multi-disciplinary team consisted of an anesthesiologist, a nutritionist, a pharmacist, a medical social worker, and a nurse.

      Result

      The %PR for lobectomy was 9.31 and that of segmentectomy was 2.48; there was a significant difference between them (p = 0.0151). The average RI for open-thoracotomy and video-assisted thoracotomy was -0.80 and 9.16, respectively. Pulmonary function was significantly preserved in patients with thoracoscopic surgery compared with that in patients with open-thoracic surgery (p = 0.00221). With respect to pre-operative support, the average RI for the Non, Reha, and Multi groups was 5.31, 8.79, and 11.61, respectively. There were significant differences among the three groups (p = 0.00991).

      Conclusion

      It is difficult to evaluate the respiratory function after lung resection, because the resected lung volume and pre-operative respiratory function may vary among patients. To reduce the fluctuation according to the resected lung volume in each case, the ratio of predicted % reduction and real % reduction (RI) was used to compare the preserved degree of respiratory function for each classified group.

      The comparison of RI, calculated from the pre-operative and 1-year post-operative VC, proved the preservation of respiratory function by thoracoscopic surgery and pre-operative support.

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    P2.11 - Screening and Early Detection (ID 178)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.11-21 - Usefulness of Diffusion-Weighted Whole-Body Imaging with Background Suppression in the Postoperative Follow-up Period (Now Available) (ID 1185)

      10:15 - 18:15  |  Author(s): Toshihiko Fujita

      • Abstract
      • Slides

      Background

      Diffusion-weighted whole-body imaging with background suppression (DWIBS), a magnetic resonance diffusion-weighted imaging method of the whole body, has recently been adopted as a method for detecting malignant lesions, but there have been few reports discussing the usefulness of this technique with respect to the detection of recurrent postoperative lesions. Herein, we describe the usefulness of DWIBS for identifying recurrence, following surgery for primary lung cancer.

      Method

      We performed a retrospective investigation of the accuracy of detection of recurrent lesions using DWIBS in 76 patients (46 men, 30 women) between November 2016 and October 2018, who were being followed up after primary lung cancer surgery. Diagnosis of recurrence was made after comprehensive imaging findings, clinical findings, and histopathological findings. While performing DWIBS, photographs were taken using a SIEMENS MAGNETOM Skyra 3.0T device and no contrast agent was used. The b factors were set to 0 and 1000, and high signal and low apparent diffusion coefficient (ADC) values ​​in the diffusion weighted image (b = 1000) were evaluated visually.

      Result

      The mean period from surgery to DWIBS was 1243 days (range: 116-3557 days) and the median period was 999 days. Of the 76 cases considered, recurrence was observed in 32 cases, of which DWIBS detected the lesion in 24 cases (75%). Of the 44 non-recurrent cases, 18 exhibited a strong signal in DWIBS. Of these 18 cases, 12 were false positives and 6 were primary lesions. Accuracy was 73.6%, sensitivity was 78.9%, and specificity was 68.4%, respectively. The breakdown of the location of lesions identified through DWIBS that were indicative of recurrence was as follows: Lymph nodes: 15 and bones: 8; with others located in the lungs, liver, and pancreas. In addition, the breakdown of the location of lesions identified in the chest through DWIBS that were not indicative of recurrence was as follows: Pulmonary recurrence: 6, hilar lymph node recurrence: 1, and mediastinal lymph node recurrence: 1. The reasons for performing DWIBS were elevated tumor marker values in 33 cases and whole-body testing for recurrence via computed tomography (CT) in 24 cases.

      Conclusion

      We believe that DWIBS is a useful technique when performing whole-body malignancy screenings after surgery for primary lung cancer. As this technique is less sensitive in identifying small recurrent lesions in the chest, it may be necessary to make a comprehensive diagnosis based on other findings as well, such as contrast-enhanced CT and PET results.

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