Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
alternatives to surgical resection, but PDT has not been a modality. Recently,
we have developed a new minimally invasive laser device using a 1.0 mm in
diameter composite-type optical fiberscope (COF), which could transmit
laser energy and images for observation in parallel. In this study, we aimed to
develop a new endobronchial treatment for peripheral cancer using PDT and a
1.0 mm in diameter composite-type optical fiberscope (COF), and we evaluated
the feasibility of PDT using COF for peripheral lung cancer. Methods: This
phase I study enrolled patients with peripheral lung cancers (primary tumor<
20 mm, stage IA), which were definitively diagnosed by bronchoscopic
modalities using radial-probe endobronchial ultrasound (EBUS) and guide
sheaths. We conducted irradiation using a diode laser (664 nm) and optical
fiberscope (COF), four hours after the administration of NPe6 40 mg/m2.
Before performing PDT, we evaluated the tumor lesions using EBUS through
the guide sheaths for peripheral small lesions. Then, we introduced the COF
into the peripheral lung cancer, observed the lesions and irradiated of red
light 664 nm (120 mW, 50 J/cm2). Results: Three patients met our criteria,
and 2cases were adenocarcinoma and 1 case squamous cell carcinoma. We
were able to observe the cancer lesions at the peripheral lung by the COF,
and feasibly irradiated. Two weeks and 3 months after NPe6-PDT, there was
no morbidity including pneumothorax, pneumonia, skin photosensitivity.
Conclusion: The 1.0 mm COF was a very useful device of NPe6-PDT for
peripheral lung cancers, and PDT using the COF was a feasible and noninvasive
treatment. Now, we have started phase II study of PDT using the COF
for peripheral lung cancers. In the future, for non-invasive adenocarcinoma
such as AIS, NPe6-PDT using COF will play an important role.
SESSION MA06: LOCALLY ADVANCED NSCLC: RISK
GROUPS, BIOLOGICAL FACTORS AND TREATMENT CHOICES
MONDAY, DECEMBER 5, 2016 - 16:00-17:30
MA06.01 OVERALL SURVIVAL CHARACTERIZATION OF INCIDENTAL
N2 NON-SMALL CELL LUNG CANCER OVER 14 YEARS AT A SINGLE
CANADIAN INSTITUTION
Cara Van Der Merwe 1 , Adrijana D’Silva 1 , Shannon Otsuka 2 , Gary Gelfand 3 ,
Andrew Graham 3 , Sean Grondin 3 , Sean Mcfadden 3 , Gwyn Bebb 2
1 University of Calgary, Calgary/AB/Canada, 2 Medicine, University of Calgary and
Alberta Health Services, Calgary/Canada, 3 Alberta Health Services, Calgary/AB/
Canada
Background: Incidental stage IIIA non-small cell lung cancer (NSCLC) cases
have positive N2 mediastinal lymph node involvement discovered at the time
of surgery, resulting in stage reclassification. These patients represent a small
group within the stage III patient spectrum with limited data regarding their
outcome. This study’s aim is to characterize the survival of incidental stage
IIIA disease and compare these outcomes to patients diagnosed with stage
II and IIIA disease. Methods: Using the Glans-Look Lung Cancer database
and electronic patient charts, a retrospective review identified patients
consulted at the Tom Baker Cancer Center from 1999 to 2012 who were defined
as incidental stage III NSCLC. Their outcome was compared with stage II
patients who underwent resection and stage IIIA patients treated with
concurrent chemotherapy and radiation (CCR). These groups were selected for
comparison because they represent patients who received the recommended
standard of care for their respective diagnosis. A Kaplan-Meier analysis
was conducted to compare overall survival (OS) among the groups. Results:
Fifty-eight incidental stage III NSCLC patients were identified: median age
was 63 years (SE ±10.3), 46.6% male, and 63.8% received adjuvant therapy.
There were 225 individuals treated with CCR; median age 64 years (SE ±9.0),
56.0% male. The stage II group contained 248 individuals, the median age was
64 years (SE ±10.2), 53.6% were males, and 30.6% received adjuvant therapy.
The OS of the incidental group was 47.4 months (95% CI 20.0-74.7). The OS for
patients treated with CCR only was 24.0 months (95% CI 20.8-27.2) and 55.3
months (95% CI 43.7-66.9) for stage II resected cases. There was a significant
difference in OS between CCR-treated stage IIIA and incidental cases (p = .001)
but not between stage II and incidental (p = .264). The five-year survival rates
were 44.6% (SE ±6.5) for incidental IIIA, 21.0% (SE ±2.7) for CCR-treated IIIA,
and 46.9% (SE ±3.2) for resected stage II. Conclusion: This study demonstrates
that incidental stage IIIA-N2 patients are a distinct group whose median
OS closely resembled stage II patients. The benefit of resection for stage
IIIA patients suggests that the traditional influence of stage in dictating
treatment is changing. Further investigation is needed to identify which stage
IIIA patients benefit the most. Ongoing analysis will include a comparison of
progression-free survival between the three groups, impact assessment of
post-operative treatment on OS, and a description of the diagnostic process
evolution over time leading to an incidental N2 diagnosis.
Keywords: Incidental, outcomes, locally advanced disease
MA06: LOCALLY ADVANCED NSCLC: RISK GROUPS, BIOLOGICAL FACTORS AND
TREATMENT CHOICES
MONDAY, DECEMBER 5, 2016 - 16:00-17:30
MA06.02 DOES PATHOLOGICAL STAGING FOLLOWING
NEOADJUVANT THERAPY (YPTNM) REFLECT THE REALITY?
Huseyin Melek 1 , Hasan Kara 2 , Adalet Demir 3 , Mehmet Erol 1 , Ahmet Sami
Bayram 1 , Akif Turna 2 , Alper Toker 3 , Cengiz Gebitekin 4
1 Thoracic Surgery, Uludag University, Bursa/Turkey, 2 Department of Thoracic
Surgery, Istanbul University Cerrahpasa Medical School, Istanbul/Turkey, 3 Thoracic
Surgery, Istanbul University, Istanbul/Turkey, 4 Thoracic Surgery, Uludag University,
Faculty of Medicine, Bursa/Turkey
Background: Complete histopathological response or downstaging has been
reported as a good prognostic factor for locally advanced non-small cell lung
cancer (NSCLC) patients who received neoadjuvant therapy and underwent
surgical resection. However, it is yet to be known if the prognosis of pStage
I patients is similar to that of ypStage I cases. In this study we aimed to
compare the long-term survival following surgical excision between locally
advanced NSCLC that have been downstaged to stage I after neoadjuvant
therapy versus stage I NSCLC treated by direct surgery. Methods: In this
is multi-centered study we retrospectively analyzed the medical data of
NSCLC patients undergoing surgery (segmentectomy or more) between
January 1998 and December 2014. According to the histopathological results
patients with Stage 1 (T1-2aN0) disease (n=427) were included into the study.
Patients were divided into two groups Group 1: patients who underwent
direct surgical resection without any preoperative therapy (n=291), Group
2: Patients who had locally advanced disease (T3-4N0-1 or T1-3N2) and
received neoadjuvant treatment (chemotherapy or chemoradiation) for
locally advanced NSCLC (n=136). The survival rates and effecting factors
were analyzed. Results: All but 64 patients were male with a mean age of
60y (20-87y). According to tumor type; 192(45%) patients had squamous
cell carcinoma, 158(37%) adenocarcinoma and 77 (18%) patients NSCLC.
Neoadjuvant treatment consisted of chemotherapy in 89 (65,4%) and
chemoradiation in 47(34,5%) patients. Histopathological investigation of the
resected specimen revealed stage Ib (T2aN0) in 205 patients (group 1; n=140,
group 2;n= 65, p=0,95). Overall morbidity rate for all patients was 30,9%
(132/427) with 1.8% mortality. Five year survival rate in all patiens was 71%
(77% in group I and 57% in group 2). The difference was statistically different
between the groups, p