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Paulo Calvinho



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    EP1.11 - Screening and Early Detection (ID 201)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.11-11 - Familial Lung Cancer: A Call for Action (Now Available) (ID 1843)

      08:00 - 18:00  |  Author(s): Paulo Calvinho

      • Abstract
      • Slides

      Background

      Lung cancer (LC) is the most deadly of all cancers mostly due to the fact that the disease is often detected at an advanced stage with less effective treatment options. While 80% of lung cancers can be directly attributable to tobacco smoking, the disease has been increasing in non smokers raising awareness to other risk factors that could be screened for and controlled in order to achieve higher rates of early stage diagnosis.

      Method

      A retrospective analysis of the electronic records of LC patients followed in our district hospital between May 2012 and December 2018 was conducted. Patients with family history of cancer were selected and their demographic characteristics, smoking status, co morbidities and LC characteristics were analyzed.

      Result

      A total of 524 patients were followed, 33 of whom with a positive family history of cancer (20 men and 13 women, median age of 61.7years old at diagnosis +- 12.8 years). Only 9 were never smokers and 63.6% (21) were diagnosed following the investigation of symptoms. The majority (24) had an adenocarcinoma subtype (3 EGFR mutations, 1 ALK translocation and 2 HER2 amplification were identified).

      Twenty patients (60.6%) had a family history of LC and the most frequent family member affected were parents (father: 14; mother: 11) and siblings (11). Cancer affected at least 2 family members of 15 patients. At the time of diagnosis 19 of the 20 patients with LC family history had an ECOG Performance Status of 0-1 and 8 (40%) had advanced stage disease.

      We found no significant difference in stage at diagnosis, smoking status or symptoms at diagnosis between patients with and without a LC family history of malignancy (p=0,120, p=0,117 and p=0,814 respectively).

      Conclusion

      Studies demonstrating evidence of familiar aggregation of LC suggest a possible genetic susceptibility to this malignancy. Identication of individuals at particularly high risk of lung cancer due to this type of susceptibility would contribute to early detection and possibly to prevention through targeted and intense anti-smoking efforts. Perhaps due to the small dimension of our study population, our patients were not diagnosed in early stages of the disease despite a positive family history of lung cancer. This raises the question whether this particular group of people should be selected for specific cancer screening to allow for the possibility of curative treatments.

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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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      EP1.15-15 - Single-Center Retrospective Analysis of Operated Thymomas (Now Available) (ID 2890)

      08:00 - 18:00  |  Author(s): Paulo Calvinho

      • Abstract
      • Slides

      Background

      Thymoma is the most common thymic neoplasm. In the majority of cases, patients are asymptomatic and the diagnosis is incidental. Surgery is the gold-standard treatment whenever possible. The objective of this study was to evaluate retrospectively the surgical outcomes in patients with stage Masaoka-Koga I to IVa thymomas at our department.

      Method

      A review of 50 cases of thymomas submitted to surgical excision at our Thoracic Surgery Department was made by accessing their clinical records, in a six-year period, from January 2012 to December 2018.

      Result

      From the 50 patients, 38% were males, with an average age of 58 years old, ranging from 15 to 85.

      In a relatively high percentage of patients, the thymic malignancy was accidentally found in a CT-scan. 24 of the cases were associated with Myasthenia Gravis.

      All the patients had a CT-scan prior to surgery but just 3 had done a PET-CT scan that seemed to be reserved to those of a higher stage.

      The histological diagnosis was done by CT-controlled biopsy in 14 cases and in the rest the diagnosis was done by the analysis of the extracted specimen. There were 4 type A thymomas, 12 type AB, 5 type B1, 17 type B2, and 10 type B3, one sclerosing thymoma and one micronodular thymoma with lymphoid stroma. The majority (54%) were in Masaoka-Koga stage II. There were 11 patients at stage I, 9 at stage III and only 3 at stage IV.

      Only 3 patients did neoadjuvant treatment, 21 patients had adjuvant radiotherapy, 2 patients had adjuvant chemotherapy and 3 had both.

      The surgical approach was sternotomy in 76% of cases, videothoracoscopy in 18%, thoracotomy in 2%, sternotomy plus thoracotomy in 2%, hemiclamshell in 2%. In all cases was done an en bloc resection, which in some involved lung resection (16), pericardial resection (9), vascular resection (8) and diaphragm resection (1).

      There was no surgical mortality, but 10 patients had phrenic nerve paralysis and 2 had a myasthenic crisis.

      The mean of hospital stay was 7 days (+- 8), comprising between 2 and 56 days.

      After a mean follow-up of 29 months (+- 20 months), there were 2 disease-related deaths and 4 recurrences (2 pleural, one diaphragmatic and one lung and mediastinal). The time to recurrence ranged from 4 to 74 months. There was a 100% survival rate at the post-operative period and overall survival at 5 years of 81%. Regarding the Masaoka classification, the 5-year-survival rate was shown to be of 100% in stage I, 96% in stage II, 44% in stage III and 100% in stage IV. On the other hand, the analysis by the WHO classification showed a 5-year-survival of 100% in thymoma A and AB groups, 40% in thymoma B1 group, 75% in thymoma B2 group and 67% in thymoma B3 group.

      Conclusion

      Even though thymic malignancies are rare tumors, thymomas are commonly approached by the Thoracic Surgeon. Surgical resection is the mainstay of treatment, but a multimodality approach is crucial in specific cases.

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