Journal Thoracic Oncology

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Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017 POSTER SESSION 1 - P1.08: SURGERY SURGERY FOR LOCALLY ADVANCED AND ADVANCED NSCLC – MONDAY, DECEMBER 5, 2016 P1.08-073 EXPERIENCE OF THIRD PRIMARY LUNG TUMORS AFTER TREATMENT OF FIRST AND SECOND PRIMARY LUNG CANCER Takehiro Watanabe, Takahisa Koizumi, Tatsuhiko Hirono Thoracic Surgery, Nishi-Niigata Chuo National Hospital, Niigata/Japan Background: Widespread adoption of lung cancer screening and development of high-resolution computed tomography (HRCT) have led to a marked increase in the detection of early lung cancer in Japan. After curative resection for early lung cancer, second primary lung cancers develop in a significant proportion. The majority of these cancers are detected at an early stage because of careful follow-up using HRCT. In our experience, more than 80% of these patients were treated with surgery or radiation therapy, and some of them have acquired with long-term survival. Recently we have experienced with third primary lung tumors in long-term survivors. In this paper, we reviewed the incidence, management, and outcome of third primary lung tumors. Methods: Between April 1996 and March 2016, 1194 patients underwent complete resection for primary lung cancer in our institution. Of these individuals, patients who developed a third primary lung tumor were selected for this study. Results: Of 1194 consecutive patient, 105 patients (8.8%) developed second primary lung cancers, and 11 patients (1%) of them developed third primary lung tumors. The patients included 10 men and one woman. The initial resection for primary lung cancer was lobectomy in 9 patients and segmentectomy in 2. Surgical resection for second primary lung cancer was performed in 8 patients, and radiation therapy was performed in 3. Four of the 11 patients underwent resection for third primary lung tumors. One patient had completion pneumonectomy, 1 had segmentectomy, and 2 had wedge resections. Five patients were treated by radiation therapy. The two remaining patients received best supportive care. Survival after resection of first primary lung cancer ranged from 50 months to 185 months, with a median survival of 138 months and an average survival of 137 months. Currently, 4 patients are alive without evidence of recurrence. Among them, three patients were treated by their third pulmonary resection, and one patient was treated by radiation therapy. Conclusion: During 20 years, third primary lung tumors were diagnosed in only 11 patients (1%). But long-term survivors after resection of lung cancer are increasing. Careful follow-up and early detection of second primary lung cancers using HRCT will induce the increase of experience for treatment of third primary lung tumors. In our little experience, aggressive surgery for third primary lung tumors may improve survival. Keywords: third primary lung tumor, radiation therapy, lung cancer, Surgery POSTER SESSION 1 - P1.08: SURGERY SURGERY FOR LOCALLY ADVANCED AND ADVANCED NSCLC – MONDAY, DECEMBER 5, 2016 P1.08-074 EFFECT OF INTRAPLEURAL PERFUSION HYPERTHERMIC CHEMOTHERAPY IN NON-SMALL CELL LUNG CANCER WITH PLEURAL SEEDING Hyo-Jun Jang 1 , Kyung Wook Shin 1 , Sukki Cho 1 , Sook Whan Sung 2 , Kwhanmien Kim 1 , Sanghoon Jheon 1 1 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam/Korea, Republic of, 2 Seoul St.Mary’s Hospital, Seoul/ Korea, Republic of Background: Pleural seeding is generally associated with poor prognosis in advanced non-small cell lung cancer (NSCLC). Although palliative chemotherapy is the mainstay modality for these patients, intrapleural perfusion hyperthermic chemotherapy (IPHC) may be a good alternative. The aim of this study was to evaluate the efficacy of IPHC and predictive factors for longer survival in NSCLC with pleural seeding. Methods: From 2003 to 2014, 51 patients who underwent IPHC for NSCLC with pleural seeding at the first operation in 36 or after postoperative recurrence in 16 patients were enrolled. IPHC was performed with cisplatin (dose:150mg/m 2 ) for 90 minutes. For patients with pleural seeding at first operation, parenchymal resection was performed and mediastinal LN was evaluated. We included some procedures other than pre-IPHC pleural biopsy, pre-IPHC lavage cytology, post-IPHC lavage cytology, and post-IPHC pleural biopsy. Subjects were divided into two groups: group I is shorter survivor of less than 36 months and group II is longer survivor of more than 36 months of overall survival duration. Results: There were 22 male patients and the mean age was 59.6 years. There were 7 patients in pathologic stage T1, 28 in T2, 13 in T3, and 3 in T4. With respect to N stage, 18 patients in N0, 9 in N1, 17 in N2, and 8 in Nx. Major post- IPHC complication was acute renal insufficiency (n=4). All patients, except 3, received systemic chemotherapy after IPHC. Pleural seeding aggravation was seen in 28 patients, and the development of pleural effusion was observed in 5 patients after IPHC. EGFR mutation was examined in 38 patients after 2007; of which, 20 patients showed to have EGFR mutation. Targeted agents were used in 32 out of 51 patients. The mean overall survival was 36.4 months (5.9-98.0); 28 patients died during the follow-up period. The 2-year and 5-year survival rates were 75.7 % and 39.8%, respectively. The prognostic factors for patients with overall survival of more than 36 months, seen in 19 patients, were old age, negative post-IPHC pleural biopsy, and presence of EGFR mutation. Conclusion: IPHC appears to be a safe procedure for advanced lung cancer patients with pleural seeding, and IPHC may provide better survival to only a highly selective group of patients. Old age, negative post-IPHC pleural biopsy, and presence of EGFR mutation are the predictive factors for longer survivor. Keywords: pleural seeding, non-small cell lung cancer, intrapleural perfusion hyperthermic chemotherapy POSTER SESSION 1 - P1.08: SURGERY SURGERY FOR LOCALLY ADVANCED AND ADVANCED NSCLC – MONDAY, DECEMBER 5, 2016 P1.08-075 SALVAGE SURGERY FOR STAGE IV NON-SMALL CELL LUNG CANCER Hideaki Kojima 1 , Shoko Hayashi 1 , Kiyomichi Mizuno 1 , Yoshiyuki Yasuura 1 , Reiko Shimizu 1 , Hiroyuki Kayata 1 , Shoji Takahashi 1 , Mitsuhiro Isaka 1 , Toshiaki Takahashi 2 , Yasuhisa Ohde 3 1 Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka/Japan, 2 Thoracic Oncology, Shizuoka Cancer Center, Shizuoka/Japan, 3 Thoracic Surgery, Shizuoka Cancer Center, Shizuoka/Japan Background: There have been few reports regarding salvage surgery in patients with primary lung cancer, and the efficacy of salvage pulmonary resection for primary lung cancer have not been fully elucidated. Furthermore, salvage surgery for stage IV non-small cell lung cancer have been rarely performed. The purpose of this study is to evaluate the efficacy of salvage surgery for stage IV non-small cell lung cancer. Methods: We performed a retrospective analysis of 4 patients who underwent salvage pulmonary resection for stage IV non-small cell lung cancer between September, 2002 and September, 2015 at the Shizuoka Cancer Center Hospital. Results: Of 2606 cases of surgically resected lung cancer in our hospital, 4 cases (0.15%) of salvage surgery for stage IV non-small cell lung cancer patients were performed. There were 2 men and 2 women. The range of age was 38-63 years old (median 57 years old). The histological type was 3 adenocarcinomas and one large cell carcinoma. The reasons diagnosed stage IV non-small cell lung carcinoma were 2 liver metastasis, 1 brain metastasis, and 1 abdominal lymph node metastasis. All cases have administered chemotherapy, and salvage pulmonary resection was performed for persistent or recurrent primary lung tumors. The median period for surgery from chemotherapy was 17.5 months (range 13-55 months). The lobectomy was performed in all cases. There were no complications after surgery and the mean length of hospital stay was 9 days. Postoperative disease free survival of all patients was 2, 2, 5, 52 months (median 3.5 months), respectively. 3 cases had recurred after surgery and all of them were distant recurrence. 2 cases were died of disease (survival time 15, 42 months, respectively), 1 case was alive with recurrent disease, and 1 case was alive with no recurrent disease (survival time 52 months). Conclusion: Although almost all cases had developed distant recurrence after surgery early, one case was long-term survival. Salvage surgery might have been effective for highly selected stage IV non-small cell lung cancer patients. Keywords: salvage pulmonary resection, salvage surgery, stage IV, non-small cell lung cancer POSTER SESSION 1 - P1.08: SURGERY SURGERY FOR LOCALLY ADVANCED AND ADVANCED NSCLC – MONDAY, DECEMBER 5, 2016 P1.08-076 RECURRENCE PATTERNS IN LUNG CANCER PATIENTS TREATED WITH PROTOCOL BASED MULTIMODALITY TREATMENT AT A TERTIARY CARE CANCER CENTER IN INDIA Ashish Jakhetiya 1 , Vinay Kumar 1 , Surayanarayana Deo 1 , Nootan Shukla 1 , Durgatosh Pandey 1 , Prabhat Malik 2 , Deepali Jain 3 , Sunil Kumar 1 1 Surgical Oncology, All India Institute of Medical Sciences, New Delhi/India, 2 Medical Oncology, All India Institute of Medical Sciences, New Delhi/India, 3 Pathology, All India Institute of Medical Sciences, New Delhi/India Background: Wide disparity has been reported in lung cancer survival between high income countries (HIC) and low-middle income countries (LMIC). The aim of present study is to analyze treatment outcomes and relapse patterns following protocol based multimodality management including quality control surgery in lung cancer patients from a tertiary care cancer center in S404 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017 India (LMIC). Methods: A retrospective analysis of computerized prospective clinical database of lung cancer patients treated consecutively during January 2006 to June 2015, in the department of Surgical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India was performed. The AJCC/ TNM (2010) staging system was referred for staging purpose. All patients were offered protocol based trimodality therapy (Surgery + Systemic therapy + Radiotherapy). Clinical spectrums, Follow up patterns, compliance to treatment and relapse patterns were analyzed. Results: A total of 136 patients underwent surgery during this period. Mean age at presentation was 53.16 years (SD 13.56) with male predominance (78%). Cough (58%) and Hemoptysis (42%) were most common presenting symptoms. Majority operated upfront (70%) and 126 (92.6%) underwent curative resection. Most common procedure was lobectomy (52%) however 42 patients (30%) underwent pneumonectomy due to advanced stage. Most common histology was squamous cell carcinoma (45%) followed by adenocarcinoma (36%). Most common stage was IIIA (30%) followed by IIB (27%). Median duration of surgery and hospital stay was 180 minutes and 7 days respectively. One patient developed post operative pneumonia and succumbed to it while 15 others developed major postoperative morbidity which was managed conservatively. Total of 30% received adjuvant chemotherapy and 11% received adjuvant radiotherapy. After median follow up of 7.26 months 16 (11.75%) patients had documented recurrences. Out of 16 patients 3 had isolated loco-regional, 4 had loco-regional with systemic and 9 had systemic recurrence. Among systemic recurrences five had multiple visceral, bone and brain in three each followed by contralateral lung in two patients. Conclusion: Majority of lung cancer patients presents in advanced stage. With good protocol based approach including quality-controlled surgery excellent outcomes can be achieved which are comparable to western world even in resource constrained low middle income countries like India. Keywords: low and middle income country, lung cancer, Surgery POSTER SESSION 1 - P1.08: SURGERY SURGERY FOR LOCALLY ADVANCED AND ADVANCED NSCLC – MONDAY, DECEMBER 5, 2016 patients is not widely accepted and chemotherapy is usually administered. The study was aimed to evaluate the long-term results and prognosis after surgical resection of oligometastases in NSCLC patients. Methods: 139 patients with isolated distant metastases of NSCLC (M1a – 38, M1b – 101) operated on in our clinic from 1998 to 2011 were included in the retrospective trial from the prospective database. Solitary brain metastasis was diagnosed in 82, pleural metastases – in 21, contralateral lung – in 17, adrenal metastases – in 11, others – in 8 patients. Synchronous metastases were detected in 61 (43,9%), metachronous – in 78 (56,1%) patients. In patients with pleural dissemination lung resection with pleurectomy followed by PDT was carried out. The primary lung cancer was completely resected in all cases. Surgery included pneumonectomy – in 17, lobectomy/bilobectomy – in 112 and sublobar resection – in 10 patients. Median follow up is 52 month. Results: Postoperative complications were registered in 10 (7,2%) patients, mortality – 2,2%. Median survival after pulmonary resection and removal of brain metastasis was 23,0 months, contralateral lung resection – 12,0, after lung resection with pleurectomy – 11,0 and adrenalectomy – 9,0 months. 5-year survival after lung resection and brain metastasectomy was 20,6%, contralateral lung resection – 12,0%, lung resection and pleurectomy (limited pleural spread) – 10,7%. No one survived more than 2 years after adrenalectomy. Survival of patients in N0-1 cases was significantly better in all groups: after brain metastasectomy - 34,5% vs 0%, contralateral lung resection – 28,0% vs 0%, pleural dissemination – 4,7% vs 0% in N2 positive patients with median survival 19,0 and 8,0; 15,0 and 8,0; 23,0 and 10,0 months respectively. Overall survival was worse in synchronous group if compare with metachronous detection: after brain metastasectomy 10,0% and 19,8%; contralateral lung resection 0% and 32,0% with median survival 18,0 and 25,0; 11,0 and 21,0 months respectively. Multivariate analysis confirmed that positive N2 status (p
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