Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
nivolumab was well tolerated and it brings the benefit for some patients
after 1-3 lines of previous anticancer therapy. Although serious ADRs are
relatively rare, management of side effects requires good cooperation with
the patients as well as cooperation with highly specialized departments
(gastroenterologists, endocrinologists, dermatologists).
POSTER SESSION 1 - P1.04: PULMONOLOGY –
MONDAY, DECEMBER 5, 2016
P1.04-013 DIAGNOSTICS AND TREATMENT OF ALK-POSITIVE NSCLC
PATIENTS - A SINGLE CENTER EXPERIENCE
Milos Pesek 1 , Petr Grossmann 2 , Petr Mukensnabl 3 , Gabriela Krakorova 4
1 Dept. of Pneumology and Phthiseology, Charles University in Prague, Plzeň/Czech
Republic, 2 Molecular Pathology Laborartory, Bioptic Laboratory, Ltd, Plzeň/Czech
Republic, 3 Dept. of Pathology, Faculty Hospital, Plzeň/Czech Republic, 4 Dept. of
Pneumology and Phthiseology, Faculty Hospital, Plzeň/Czech Republic
Background: ALK positive advanced NSCLC patients could get significant
benefit of targeted therapy. In Czech Republic, targeted therapy is payed
just as second-and more line treatment, required positive FISH result of
ALK-positive NSCLC tumour. Methods: We investigate ALK-rearrangement in
selected group of NSCLC patients starting from January 2011 via fluorescence
in situ hybridization (FISH) with the Vysis ALK Break Apart FISH Probe Kit
(Abbott Molecular). We evaluate frequence of positive and inconclusive
results. In the group of ALK positive patients we evaluate clinical behaviour
of tumours and effectivity and side effects of ALK inhibitors. Results:
From January 2011 till June 2016, 798 nonsquamous NSCLC tumour samples
were evaluated by FISH method. 20 (3.2 %) of evaluable 660 samples were
positive, 138 tumour samples were clasified as ALK break inconclusive (17.3
%). ALK break positive group of patients consist of 13 men and 7 women,
median age 68.5 years. 17 of them were adenocarcinomas, in two there were
adenosquamous histology and in one NSCLC-NOS was found. The limit of ALK
positivity was 10 % positive cells, the range of our positive results were 10 – 72
%. 6/20 patients were treated by crizotinib. Two of them received second ALK
inhibitor ceritinib after failure of crizotinib, those patients are alive and well
5 and 8 years from diagnosis of adenocarcinoma st. IV. Three patients died
before they could get an access to targeted therapy, seven others with low
PS died before start of targeted therapy, in three others there is not actual
need for targeted treatment. One patient on crizotinib died after 11 months
of targeted treatment, two other died after one month of treatment, in one
patient targeted therapy was refused due to intolerance. Conclusion: Patients
suffering from advanced ALK rearranged NSCLC should have perspectives
of long lasting tumour response on ALK inhibitors. ALK rearrangement
investigations should be done in nonsquamous NSCLC routinely. In our
departments, we have relatively high frequency of inconclusive ALK testing
results. However, it is not easy to get adequate tissue sample from routine
investigations. Positive results are found most frequently in adenocarcinoma
patients. We consider due to rapid progression of ALK positive tumours on
chemotherapy that targeted therapy should be realised as a first line option.
Keywords: NSCLC; ALK translocation; crizotinib; ceritinib
POSTER SESSION 1 - P1.04: PULMONOLOGY –
MONDAY, DECEMBER 5, 2016
P1.04-014 DIAGNOSTIC YIELD IN PATIENTS UNDERGOING
ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSBRONCHIAL
NEEDLE ASPIRATION FOR DIAGNOSIS OF LUNG CANCER
Sunkaru Touray 1 , Rahul Sood 1 , Carlos Martinez-Balzano 1 , Jonathan Holdorf 1 ,
Anne Lim 2 , Andres Sosa 1 , Paulo Oliveira 1 , Scott Kopec 1
1 Pulmonary Allergy & Critical Care Medicine, University of Massachusetts Medical
School, Worcester/United States of America, 2 Internal Medicine, Saint Vincent
Medical Center, Worcester/MA/United States of America
Background: Endobronchial Ultrasound-Guided Transbronchial Needle
Aspiration (EBUS-TBNA) is an established diagnostic tool in the evaluation
of lung cancer with a variable diagnostic yield, ranging from 62 % - 93 % 1–4 .
Although the procedure can be performed under moderate sedation (MS) or
general anesthesia (GA) 5 , the impact of sedation type on the diagnostic yield
has yielded variable results with some authors reporting a higher yield with
deep sedation 6 , whereas others note no difference between MS and GA 5 .
We present findings of a retrospective study that looked at the diagnostic
yield using an artificial airway under GA compared to conscious sedation
through a natural airway in patients undergoing EBUS-TBNA . Methods:
Demographic information on age, sex, race and co-morbidities were used to
compute an age adjusted Charlson Co-morbidity index for each of 88 patients.
Pathology reports were reviewed and an EBUS-TBNA was determined to be
diagnostic if any of the sampled lymph nodes yielded a diagnosis. Assessment
of the impact of using an artificial airway under GA on diagnostic yield was
determined using multivariate logistic regression. Continuous variables are
presented as means (± SD) and categorical variables are reported as counts
and percentages. For all tests, two-sided P values < 0.05 were considered
statistically significant. Results: Patients in the GA group were older (65
years versus 57.6, p= 0.005), had a higher age-adjusted Charlson comorbidity
index, (3.7 versus 1.9, p < 0.001) and a higher ASA classification (3 versus 2
p=0.004). Average lymph node size was smaller in the artificial airway group
(16.2 mm versus 20.7mm, p = 0.01). Despite these differences, the diagnostic
yield was the same (61.4 % in each group). In multivariate analyses, female
sex and lymph node size were the only predictors of a diagnostic EBUS-TBNA.
OR 3.3, 95 % CI, 1.23 – 9.1 for female gender, (p= 0.02) and 1.1, 95 % CI, 1.00 –
1.18 for lymph node size (p= 0.04). Diagnoses made were: adenocarcinoma of
the lung 42.6 %, Sarcoidosis 16.7 %, Small cell lung cancer 14.8 %, Squamous
cell carcinoma 11.1 %. Conclusion: EBUS-TBNA performed under general
anesthesia through an artificial airway was not associated with an increased
diagnostic yield, and therefore concious sedation should be considered
where appropriate, with general anesthesia reserved for those patients who
are older, and with a higher perioperative risk. More research assessing the
determinants of a positive diagnosis including physician pretest likelihood
and PET/CT avidity are needed to improve diagnostic outcomes.
Keywords: EBUS-TBNA, moderate sedation, Diagnostic yield, lung cancer
POSTER SESSION 1 - P1.04: PULMONOLOGY –
MONDAY, DECEMBER 5, 2016
P1.04-015 CLINICAL APPLICATION OF VIRTUAL NAVIGATED
BRONCHIAL INTERVENTION
Naohiro Kajiwara, Junichi Maeda, Koichi Yoshida, Masaru Hagiwara, Tetsuya
Okano, Masatoshi Kakihana, Tatsuo Ohira, Norihiko Ikeda
Department of Surgery, Tokyo Medical University, Tokyo/Japan
Background: Removal of endobronchial tumor is considered the first
treatment of choice to improve respiratory status to dilate and maintain the
airway. In patients with inoperable tumors we frequently regard endoscopic
treatment as the first treatment of choice, but the indications and decisions
regarding the method require careful consideration. We reported the
indications and efficacy of virtual navigated bronchial intervention for the
treatment of bronchial tumors. To select safer and precisely approach for
patients with bronchial tumors, we evaluate virtual navigated bronchial
intervention using a high-speed 3-dimensional (3D) image analysis system,
Synapse Vincent (Fuji Photo Film Co., Ltd., Tokyo, Japan). Methods: We set
out to clarify, based on retrospective evaluation of routine work-up data
in our charts and patient treatment data, the efficacy of virtual navigated
bronchial intervention for the treatment of different types of bronchial
tumors, yet representative of the spectrum of conditions we encounter, in
order to provide a guide to techniques available in interventional bronchology
for obstructive lesions. All computed tomography (CT) must satisfy several
conditions necessary to analyze images by Synapse Vincent. Synapse Vincent
provides more information not only concerning tumor size and shape, but
also whether the tumor invades surrounding tissue and the extent of airway
and vessel involvement. Constructed images are displayed on a monitor,
which can be utilized for deciding the simulation and interventional strategy
and for navigation during interventional manipulation. Results: In these
cases, Synapse Vincent was used to determine the best planning of virtual
navigated bronchial intervention. The feasibility and safety of Synapse
Vincent in performing useful preoperative simulation and navigation of
interventional procedures lead to the safer, more precise, and less invasive for
the patient, and easy to construct an image, depending on the purpose, in 5-10
minutes using Synapse Vincent. Moreover, if the lesion is in the parenchyma
or sub-bronchial lumen, it helps to perform simulation with virtual skeletal
subtraction to estimate potential lesion movement. By using virtual
navigated system for simulation, bronchial intervention was performed with
no complications safely and precisely. Conclusion: Preoperative simulation
using virtual navigated bronchial intervention reduces the surgeon’s stress
levels, particularly when highly skilled techniques are needed to operate on
lesions. This task, including interventional simulation and navigation both
pre- and during manipulation, could lead to greater safety and precision.
These technological instruments should be helpful for bronchial intervention
procedures, and are also excellent devices for educational training.
Keywords: Interventional bronchology, Virtual navigation system
POSTER SESSION 1 - P1.04: PULMONOLOGY –
MONDAY, DECEMBER 5, 2016
P1.04-016 EBUS PLUS FLUOROSCOPY-GUIDED BIOPSY COMPARED
Copyright © 2016 by the International Association for the Study of Lung Cancer
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