Author of

• 32016

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  EP1.08 - Oligometastatic NSCLC (ID 198)

  • Event: WCLC 2019
  • Type: E-Poster Viewing in the Exhibit Hall
  • Track: Oligometastatic NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall

  • 32018

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    EP1.08-02 - Surgical Indication for Postoperative Regional Lymph Node Oligo-Recurrence in Non-Small Cell Lung Cancer (ID 220)

    08:00 - 18:00  |  Presenting Author(s): Yukio Watanabe
    • Abstract

    Background
    

    Currently, evidence-based guidelines for therapy to treat regional lymph node (LN) oligo-recurrence in post-resection non-small cell lung cancer (NSCLC) are limited. We investigated the clinical outcome of surgery for LN oligo-recurrence in post-resection NSCLC.

    Method
    

    From 2008 to 2017, 14 patients received R0 resection for regional LN oligo-recurrence after initial NSCLC R0 surgery. Eligible patients met these criteria: A, no recurrences without regional LN by PET-CT and brain-MRI; B, LN recurrence within 3 regions. We investigated the characteristics of surgically curable NSCLC patients with postoperative regional LN oligo-recurrence, including recurrence-free survival (RFS) and overall survival (OS).

    Result
    

    Ten patients were male and 4 were women. The median age was 69 years (62-86). Pathological findings in initial surgery was as follow; adenocarcinoma in 9, squamous cell carcinoma in 5, pathological stage I in 6, II in 4, and IIIA. The regional number of LN recurrence was as follow; 1 region in 11, 2 regions in 1, and 3 regions in 2. The median number of pathological metastatic LN were 2 (1-8). The median size of LN oligo-recurrence was 19 mm (14-38). All the oligo-recurrence LN had uptake in PET-CT. All the recurrent LN site was out of the dissection range at initial surgery. The median period from the initial surgery to oligo-recurrence was 18.1 months (7.0-66.5). The median operation time was 134 minutes (52-452), and median bleeding volume was 15 ml (2-2593). SVC reconstruction was performed in 1. Postoperative complication was detected in 3 cases; arrhythmia in 2 and graft occlusion in 1. There were no cases of perioperative death. EGFR mutation was detected in 4 cases. After LN dissection, 9 patients were followed up without treatment, and the other 5 patients underwent chemotherapy. Six patients (42.8%) out of 14 were recurrence-free after LD dissection. Compared recurrence-free patients with recurrence patients after LN dissection, pathological only one LN of oligo-recurrence (p < 0.01) and EGFR wild type (p = 0.04) were significant in the recurrence-free group. LN oligo-recurrence in only one region also tended to be more frequent in the recurrence-free group (p = 0.09). Pathological N or stage in initial surgery, size of LN oligo-recurrence, recurrence-free interval after initial surgery were no significant difference between recurrence-free and recurrent group. The median RFS and OS after LN resection in all 14 patients was 24.2 and 66.3 months. The 2-year and 5-year RFS rates after LN resection were 52.7% and 35.2%. Eight patients were recurrence after LN dissection; 4 were locoregional and the others were distant. Of the 8 relapsed patients, only 2 patients survive with EGFR-TKI.

    Conclusion
    

    Surgery for postoperative regional LN oligo-recurrence in NSCLC should be indicated for the patients with only one LN of oligo-recurrence in only one region or EGFR wild type.