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Byung Jo Park
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P19 - Locoregional and Oligometastatic Disease - Oligometastatic Disease (ID 129)
- Event: WCLC 2020
- Type: Posters
- Track: Locoregional and Oligometastatic Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P19.03 - Operative Outcomes of Local Consolidation with Cytoreductive Surgery for Oncogenic-Driven Advanced NSCLC (ID 1875)
00:00 - 00:00 | Presenting Author(s): Byung Jo Park
- Abstract
Introduction
With the advent of targeted therapy, the survival in oncogenic-driven advanced non-small cell lung cancer (NSCLC) has been improved. Still, all patients who received the targeted therapy finally recur due to resistance to the targeted agent. The local consolidative therapy with targeted therapy has been studied recently, but these studies mainly focused on radiation therapy, and the role of surgery has not been studied yet. This retrospective study was performed to investigate the operative outcomes for oncogenic-driven advanced NSCLC after targeted therapy as a form of local consolidation.
Methods
Between March 2018 and July 2020, 44 patients received the pulmonary resection and mediastinal lymph node dissection for stage IIIB-C or IV NSCLC after targeted therapy. In some patients, the other metastatic lesions were treated with radiation therapy or surgery prior to pulmonary resection. The operative outcomes were analyzed retrospectively.
Results
The median age of patients was 59 years-old (range, 28~75), with 15 (34.1%) male patients. The initial stages were as following; 4 IIIBs, 1 IIIC, and 39 IVs. The initial mutations were 30 EGFRs, 8 ALKs, and 1 ROS1. The initial metastasis sites were as following; 10 brains, 6 bones, 7 lymph nodes, 6 intrathoracic organs, and 17 multiple organs. The median interval from the initiation of targeted therapy to the operation was 10.7 (range, 2.1~46.3) months. The types of operations were as follows; 37 lobectomies, 2 bi-lobectomies, 3 segmentectomies, and 2 wedge resections. The complete resection was achieved in 40 (90.9%) patients. There was no operative mortality. Complications were developed in 15 patients: 5 prolonged air leakages, 3 chyle leakages, 2 vocal cord palsies, 1 broncho-pleural fistula, 1 acute kidney injury, 1 acute lung injury, 1 pneumonia, and 1 pneumothorax. Four patients showed complete remission on the surgical specimen. The median postoperative follow-up periods were 7.8 months (0.4~28.8). During the follow-up periods, 14 patients suffered from the disease progression: 6 lung lesions, 4 brains, 1 bone, 1 pleura, and 2 others. Two patients died during the follow-up periods. Among 32 patients with EGFR mutation, 12 patients showed additional mutations, such as T790M, and targeted agents were changed into another targeted agent in 9 patients after the operation.
Conclusion
The pulmonary resection for advanced NSCLC after targeted therapy was feasible, and the surgical specimen obtained from the operation could be used for further planning of targeted therapy. The long-term benefits of pulmonary resection on survival after targeted therapy have to be studied in further trials.
