Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Surgery, Mannheim/Germany
Background: National Lung Screening Trial using low-dose CT may result in
a relative reduction in mortality from lung cancer. Screening programs to
be implemented will result in more patients being diagnosed with unclear
pulmonary lesions and indicate excisional biopsy. Minimal invasive resection
of small, deep intrapulmonary lesions can be challenging as the lesions are
difficult to localize during VATS surgery. We introduced an intraoperative
cone-beam computed tomography (CBCT) system in a hybrid operating
theatre to place a marking wire immediately prior to VATS removal of the
suspected lesions. Methods: Fifteen patients (5 m, 10 f, median age 63yrs)
with solitary, deep intrapulmonary nodules of unknown histological status
were identified for intraoperative wire marking. While being under general
anaesthesia for VATS, patients were placed on the operating table. and a
marking wire was placed within the lesion under 3D laser and fluoroscopic
guidance using the CBCT system (Artis zeego, Siemens Healthcare GmbH,
Germany). Then wedge resection by VATS was performed in the same
setting without any repositioning the patient. Results: Complete resection
with adequate safety margins was confirmed for all lesions. Marking wire
placement facilitated resection in 15 out of 16 lesions. Histologically, mean
lesion size was 7.5mm. The mean distance of the lesion to the pleural surface
was 15.9mm (mean lesion depth/lesion diameter ratio = 2.3). Eleven lesions
proved to be malignant, either primary lung cancer or metastases from prior
malignancies. Five lesions turned out to be benign. Mean procedural time for
marking wire placement was 35min; mean VATS duration was 36min. There is
a learning curve fo the whole team involving anesthesiology, radiology, and
thoracic surgery. Conclusion: CATS is a new, safe, and effective procedure for
minimally invasive resection of small, deeply localized intrapulmonary lesions.
The benefits of CATS are: (1) ‘one-stop shopping’ procedure to locate and
remove small lung lesions (2) lower risk for the patient (no patient relocation
intraoperatively, no marking wire loss), and (3) no necessity to coordinate
scheduling between CT and operating theatre.
Keywords: screen-detected lung cancer, Video-assisted thoracic surgery, conebeam
CT, guide-wire placement
POSTER SESSION 3 – P3.04: SURGERY
MISCELLANEOUS I –
WEDNESDAY, DECEMBER 7, 2016
access to the airway and peripheral lung parenchyma.
Keywords: bronchoscopy, photodynamic, laser
POSTER SESSION 3 – P3.04: SURGERY
MISCELLANEOUS I –
WEDNESDAY, DECEMBER 7, 2016
P3.04-010 CHANGES OF RIGHT LUNG VOLUME AFTER RIGHT UPPER
LOBECTOMY FOR LUNG CANCER
Hyeong Ryul Kim 1 , Yong-Hee Kim 2 , Dong Kwan Kim 2 , Seung-Il Park 2
1 Department of Thoracic and Cardiovascular Surgery, Asan Medical Center,
University of Ulsan College of Medicine, Seoul/Korea, Republic of, 2 Seoul Asan
Medical Center, Seoul/Korea, Republic of
Background: Many surgeons routinely perform the division of the inferior
pulmonary ligament (IPL) during the right upper lobectomy for lung cancer. It
is believed that the division of the IPL can facilitate mobilizing and expanding
residual lobes, and decreasing dead space. We aimed to evaluate the volume
changes of the right middle lobe (RML) and the right lower lobe (RLL) after
right upper lobectomy according to IPL division. Methods: We performed
a retrospective analysis of the medical records and images of 181 patients
with lung cancer who had underwent right upper lobectomy via a videoassisted
thoracic surgery (VATS) in Seoul Asan Medical Center from May
2009 to December 2013. The IPL was preserved in 76 patients (Group A) and
was divided in 105 patients (Group B). Using in-house software with chest
computed tomography (CT), we compared the difference volume changes
of pre- and post-operative RML and RLL between the two groups. Results:
There were no significant differences between the two groups in terms of
age, sex, height, tumor size, chronic obstructive pulmonary disease and
smoking status. In group A, the adjusted mean volume change of difference
RML (dRML) and difference RLL (dRLL) were -0.45 mL/kg and 6.03 mL/kg,
respectively. In group B, the adjusted mean volume change of dRML and
dRLL were -0.55 mL/kg and 5.28 mL/kg, respectively. The difference was not
significant. Conclusion: Division of the IPL during the right upper lobectomy is
not beneficial technique regarding remnant lung volume.
Keywords: lung volume, inferior pulmonary ligament, Right upper lobectomy
P3.04-009 PHOTODYNAMIC THERAPY (PDT) TURNS 21:
INDICATIONS, APPLICATIONS AND OUTCOMES FOR NSCLC
Patrick Ross 1 , Patsy Skabla 2 , Susan Moffatt-Bruce 3
1 Surgery, Main Line Health System, Bryn Mawr/PA/United States of America,
2 Surgery, Main Line Health System, Bryn Mawr/United States of America, 3 Thoracic
Surgery, Ohio State University, Columbus/United States of America
Background: Photodynamic therapy (PDT) remains a novel ablative modality
for managing NSCLC as it enters its 21st year since FDA approval. Initially
proposed for definitive management of early NSCLC and palliative control
for advanced NSCLC, PDT has grown beyond these limited indications to find
broad applicability across the spectrum of NSCLC disease. This report details
indications, applications, and outcomes from 2 centers with active PDT
programs. Methods: Patients treated with PDT between 1998 and 2016 were
entered retrospectively (prior to 2012) or prospectively (after 2013) into an IRB
approved registry. All patients received a single photosensitizer, Photofrin,
at a dose of 2 mg/kg IV. PDT was accomplished with lasers delivering light at
630 nm. Dosimetry ranged from 100 J- 200 J We defined a course of therapy as
all light applications administered after a single injection of photosensitizer
(range 1 - 3). Demographics, procedural details, clinical indications, clinical
course and outcomes data were entered into the registry. These records were
evaluated for this review. Results: Our programs treated 812 patients with
PDT; there were 210 females and 602 males. The age at treatment ranged
from 21 to 91. We treated 458 patients with bronchogenic carcinoma. The
stages included: stage 0 (5), stage 1 (48), stage 2 (38), stage 3a (82), stage 3b
(97) stage 4 (116). 393 (85%) patients were managed with a single course of
PDT; 65 patients were treated with multiple courses of PDT ranging from
2 - 6 times. Symptom management and palliation accounted for 63% of the
indications.The majority of patients were treated with curative intent as
part of a multimodality regimen. Photosensitivity was < 1%. There were no
airway perforations. There was 1 bronchial stricture which occurred after
a single course of PDT in a previously resected but not radiated patient.
Conclusion: PDT for NSCLC is applied most often for advanced stage (3b/4)
disease for management of airway symptoms. PDT can be used as a single
definitive therapy for early stage disease and can be incorporated safely
into a multimodality regimen which may include surgery, radiation and
chemotherapy. Photosensitivity and airway injury are rare. Twenty one years
after achieving FDA approval, PDT continues to have a place in managing
patients with NSCLC. The favorable safety profile, compatibility with other
therapies, and repeatability of courses of therapy suggest that we evaluate
additional ways to apply PDT as endoscopic technology provides enhanced
POSTER SESSION 3 – P3.04: SURGERY
MISCELLANEOUS I –
WEDNESDAY, DECEMBER 7, 2016
P3.04-011 SALVAGE SURGERY FOR ISOLATED LOCAL RECURRENCE
AFTER STEREOTACTIC BODY RADIOTHERAPY FOR CLINICAL STAGE I
NON-SMALL CELL LUNG CANCER
Hiroshi Date 1 , Masatsugu Hamaji 1 , Yukinori Matsuo 2 , Akihiko Yoshizawa 3 ,
Toshi Menju 1 , Toyofumi Chen-Yoshikawa 1
1 Thoracic Surgery, Kyoto University Graduate School of Medicine of Medicine,
Kyoto/Japan, 2 Radiology, Kyoto University Graduate School of Medicine of
Medicine, Kyoto/Japan, 3 Pathology, Kyoto University Graduate School of Medicine
of Medicine, Kyoto/Japan
Background: Non-small cell lung cancer (NSCLC) recurs locally in about 10%
of the patients treated with stereotactic body radiotherapy (SBRT). The
purpose of this study was to investigate the safety and outcome of salvage
lung resection in these cases. Methods: We retrospectively analyzed the
clinical data on 13 patients who underwent salvage lung resection for isolated
local recurrence after SBRT between 2007 and 2014. These 13 patients were
diagnosed with clinical stage I NSCLC and received SBRT (48-60 Gy) between
1999 and 2013. Results: All were male and the average age was 76 years (64-86)
at the time of surgery. The average duration between SBRT and the surgery
was 20 months (10-105). Pathological diagnosis was adenocarcinoma in 7,
squamous cell carcinoma in 4, and others in 2. Lobectomy was performed in 10
patients, segmentectomy in 2 and wedge resection in 1. Because the irradiated
area was mainly confined to the peripheral lungs, central pulmonary structures
were intact after irradiation. There was almost no pleural adhesion related
to the irradiation.There was no perioperative mortality and 4 patients had
morbidities. One patient had a conversion from VATS to thoracotomy due to
bleeding and 3 patients had prolonged air leak postoperatively. The resected
tumor diameter ranged from 12 to 50 mm with a median of 33 mm. Viable tumor
cells were found in the specimens of all patients. Two patients were positive on
mediastinal lymph nodes and were offered adjuvant chemotherapy. At a mean
follow-up of 52 months (range, 13 to 103 months), the 3 and 5 year survival rates
were 72% and 41%, respectively. Conclusion: Salvage surgery after SBRT was
feasible and provided encouraging outcome.
Keywords: salvage surgery, stereotactic body radiotherapy, local recurrence,
non-small cell lung cancer
S730 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017