Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
loco-regional recurrences, 248 (82.9%) had distant metastases, and 25 (8.4%)
had both. The most frequent sites of distant metastases were lung (n=102,
41%), brain (n=63, 25%), and bone (n=63, 25%). The hazard rate function
for the overall recurrence revealed the peak at approximately 8 months
after surgery then the down-slope pattern before 38 months. A similar risk
pattern was found in distant metastasis but low and steady risk pattern was
detected in loco-regional recurrence. In distant metastases, similar patterns
were found in individual organs, however, earlier peak at approximately 5
months presented in brain metastasis. A comparison of histology showed
that adenocarcinoma exhibited higher recurrence hazard rate of distant
metastasis than squamous cell carcinoma with similar pattern of recurrence
(p=0.03). The status of nodal clearance after induction therapy exhibited
that ypN2 patients (n= 229, 39.9%) had highest hazard rate (p=0.03). The
recurrence hazard rate of ypN0 was the least, but the extent was not smaller,
they showed approximately one of third of ypN2 at peak. Conclusion: The
hazard rate of loco-regional failure after trimodality therapy was low. But the
hazard rate of distant metastasis was considerably high yet and shifted to left
with the peak within 12 moths after surgery. This study guides the intensive
surveillance immediate after completion of trimodality therapy to identify
risk groups of early recurrence and to develop therapeutic strategy.
Keywords: N2, NSCLC, recurrence dynamics, pattern of recurrence
MA06: LOCALLY ADVANCED NSCLC: RISK GROUPS, BIOLOGICAL FACTORS AND
TREATMENT CHOICES
MONDAY, DECEMBER 5, 2016 - 16:00-17:30
MA06.05 SCREENING FOR BRAIN METASTASES IN PATIENTS WITH
STAGE III NSCLC, MRI OR CT? A PROSPECTIVE STUDY
Janna Schoenmaekers 1 , Lizza Hendriks 2 , Paul Hofman 2 , Gerben Bootsma 3 ,
Marcel Westenend 4 , Machiel De Booij 3 , Wendy Schreurs 3 , Ruud Houben 5 , Dirk
De Ruysscher 6 , Anne-Marie Dingemans 2
1 Pulmonary Medicine, Mumc, Maastricht/Netherlands, 2 Pulmonology, Mumc,
Maastricht/Netherlands, 3 Pulmonary Medicine, Zuyderland Ziekenhuis, Heerlen/
Netherlands, 4 Pulmonary Medicine, Viecuri Ziekenhuis Venlo, Venlo/Netherlands,
5 Radiation Oncology, Maastro Clinic, Maastricht/Netherlands, 6 Radiation Oncology
(Maastro Clinic), Maastricht University Medical Center, Maastricht/Netherlands
Background: In all current non-small cell lung cancer (NSCLC) guidelines it
is advised to screen all stage III patients for brain metastases, preferably
by magnetic resonance imaging (MRI), or otherwise a contrast-enhanced
computed tomography (CE-CT). Access to MRI can be problematic and a
dedicated brain CE-CT can be incorporated in the staging 18 Fluodeoxoglucosepositron-emission-tomography
( 18 FDG-PET)-CT scan. The additive value of
a brain MRI after a dedicated brain CE-CT scan is unknown. Methods: In this
observational prospective multicentre study all consecutive stage III NSCLC
patients scheduled for treatment with curative intent from three Dutch
hospitals who underwent a dedicated brain CE-CT incorporated in the staging
18 FDG-PET and an additional brain MRI were included. Patients with another
primary tumour within 2 years of NSCLC diagnosis were excluded. Data
regarding patient characteristics and imaging results were collected. Primary
endpoint was the percentage of patients diagnosed with brain metastases
on MRI without suspect lesions on CE-CT. 118 patients were needed to show a
clinically relevant considered difference of 2%. Results: Between December
14 th 2012 and July 15 th 2016, 264 consecutive patients had an extracranial
stage III NSCLC based on 18 FDG-PET. 111 out of these 264 patients (42.0%) were
excluded because of no dedicated brain CE-CT 57 (51.4%) had only a low dose
CT for attenuation correction, 54 (48.6%) had a CE-CT but without dedicated
brain imaging protocol). Fourty (26.1%) of the remaining 153 patients were
excluded because of asymptomatic brain metastases on dedicated CE-CT
brain (N=8), second primary (N=6) or no brain MRI (N=26). 113 stage III patients
were included (updated results of 118 patients will be presented). 57.5% of the
included patients were male; mean age was 67.0 years, 84.1% had WHO PS 0-1,
60.2% had stage IIIA (before MRI brain) and 42.5% had an adenocarcinoma.
Median time (range) between 18 FDG-PET-CE-CT and MRI was 2.0 (0.0 -8.1)
weeks. 5/113 (4.4%) patients had a solitary brain metastasis on MRI despite
no suspect brain lesions on CE-CT. In retrospect, in one of these five patients
a solitary brain metastasis could be identified on the 18 FDG-PET–CE-CT.
Conclusion: Although asymptomatic brain metastasis were detected in
staging CE-CT, MRI brain is in daily practice clinically relevant superior to a
CE-CT in screening for brain metastases in stage III NSCLC
Keywords: MRI versus CT, NSCLC, brain metastases, Screening
MA06: LOCALLY ADVANCED NSCLC: RISK GROUPS, BIOLOGICAL FACTORS AND
TREATMENT CHOICES
MONDAY, DECEMBER 5, 2016 - 16:00-17:30
MA06.06 TUMOR MICROENVIRONMENT AND BRAIN METASTASES
IN COMPLETELY RESECTED STAGE IIIA(N2) NON-SMALL CELL LUNG
CANCER
Qin Zhang, Xiaolong Fu, Xuwei Cai, Wen Feng
Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University,
Shanghai/China
Background: Tumor-infiltrating lymphocytes (TILs) and tumor budding were
all the markers of tumor microenvironment. This study aimed to explore the
potential association of tumor microenvironment with brain metastases (BM)
in patients with completely resected stage IIIA(N2) NSCLC. Methods: 301
consecutive patients with pathological stage IIIA(N2) NSCLC who underwent
complete surgery were reviewed between January 2005 and July 2012.
Full-face hematoxylin and eosin-stained sections from surgical specimens for
each case were evaluated for the density of TILs. Patients were stratified into
TIL- and TIL+ groups based on pathologic evaluation. Tumor budding was
defined as single cancer cells and clusters composed of up to four cancer cells.
According to the number of tumor budding per field, the cases were classified
into two groups: grade 1, up to five budding foci; and grade 2, six or more
budding foci. The relationship between tumor microenvironment and BM at
the initial presentation was analyzed. Results: Brain was the most common
site of distant failure, and 92.5% BM developed in 3 years after the complete
resection. 53 (17.6%) patients had BM as the first failure. Although, univariate
analysis showed that TIL was not significantly associated with an increased
risk of developing BM as the first site of failure in 3 years (P=0.196), a higher
density of TILs was associated with improved postoperative survival time
(P=0.058). Patients with the tumor budding >5 experienced increased BM in 3
years versus patients with the tumor budding ≤5 (P=0.068). Multivariate
analysis showed that adenocarcinomas and multiple N2 stations were
significantly associated with the high risk of BM as the initial site of failure in
3 years.
Conclusion: In patients with completely resected stage IIIA(N2) NSCLC, tumor
budding >5 had a tendency to experience more BM. TIL seems to be a potential
role in predicting survival of patients in completely resected stage IIIA(N2)
NSCLC.
Keywords: Tumor Budding, brain metastases, stage IIIA(N2) NSCLC, tumorinfiltrating
lymphocytes
MA06: LOCALLY ADVANCED NSCLC: RISK GROUPS, BIOLOGICAL FACTORS AND
TREATMENT CHOICES
MONDAY, DECEMBER 5, 2016 - 16:00-17:30
MA06.07 IMPACT OF TYPE 2 DIABETES MELLITUS AND ITS
METABOLIC CONTROL ON PROGNOSIS OF UNRESECTABLE NON-
SMALL CELL LUNG CANCER PATIENTS
Milana Bergamino Sirvén 1 , Aj Rullan 1 , Maria Saigi 1 , Inmaculada Peiró 2 , Eduard
Montanya 3 , Ramon Palmero 1 , Jose Carlos Ruffinelli 1 , Arturo Navarro-Martin 4 ,
Marta Domenech ViÑolas 1 , Ana Ortega Franco 1 , Susana Padrones 5 , Samantha
Aso 5 , Isabel Brao 1 , Ernest Nadal 1 , Felipe Cardenal 1
1 Medical Oncology, Catalan Institut of Oncology -Ico Hospitalet, Hospitalet Del
Llobregat/Spain, 2 Nutritional Unit, Catalan Institut of Oncology -Ico Hospitalet,
Hospitalet Del Llobregat/Spain, 3 Endocrinology Department, Bellvitge Hospital,
Barcelona/Spain, 4 Radiation Oncology Department, Catalan Institute of Oncology
-Ico Hospitalet, Barcelona/Spain, 5 Respiratory Department, Bellvitge Hospital,
Barcelona/Spain
Background: Type 2 Diabetes Mellitus (T2DM) has been associated with an
increased risk of relapse and mortality in several cancer locations, but the
prognostic value of T2DM or its metabolic control (MC) in patients (pts) with
stage III non-small cell lung cancer (NSCLC) have not been studied yet. The
purpose of this study is to evaluate the influence of T2DM and its MC on the
prognosis of pts with NSCLC treated with concurrent chemoradiotherapy
Copyright © 2016 by the International Association for the Study of Lung Cancer
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