Annual Meeting Proceedings Part 1 - American Society of Clinical ...

Lung Cancer—Non-small Cell Local-Regional/Small Cell/Other Thoracic Cancers
7048 General Poster Session (Board #35G), Sat, 1:15 PM-5:15 PM
Breath analysis for early detection of lung cancer. Presenting Author:
Geetha D. Vallabhaneni, Winship Cancer Institute, Emory University,
Atlanta, GA
Background: Lung cancer (LC) is the leading cause of cancer death
worldwide. Early detection is critical to reduce LC related mortality. Breath
analysis can be used as a non invasive diagnostic tool in conjunction with
CT screening. We assessed the diagnostic value of breath volatile organic
compounds (BVOCs) in the alveolar breath of female non-small cell lung
cancer (NSCLC) patients. Methods: This is a prospective case-control study
that enrolled newly diagnosed NSCLC and cancer-free female controls. The
study aims: 1) To compare the BVOC signature in female NSCLC patients to
a control group without LC 2) To compare the BVOC signature between
NSCLC and breast cancer (BC) patients. The study was restricted to women
because the pilot data was generated from female subjects with BC.
Consenting eligible patients provided a total of five deep breath samples
into a proprietary breath sampler developed at the Georgia Tech Research
Institute (GTRI) for collecting alveolar breath. Breath samples were
collected five minutes apart from each subject. The collected samples were
analyzed for BVOCs using thermal desorption/gas chromatographic/mass
spectrometric (TD/GC/MS) technique. Statistical differences in BVOCs in
breath samples from cases and controls were assessed using this technique.
Support vector machine classification method was employed to
compare the BVOCs pattern between LC and BC patients. Results: We
enrolled 25 NSCLC and 25 cancer-free subjects. TD/GC/MS analysis
identified a total of 422 BVOCs among the controls and NSCLC subjects.
75 unique BVOCs that were significantly different between cases and
controls were employed for statistical modeling. This 75 BVOCs signature
has a sensitivity of 0.75, a specificity of 0.75 and a classification accuracy
of 75% for NSCLC and controls. Statistical analysis on the full BVOCs data
set from NSCLC and previously collected BVOCs data from BC patients
achieved a classification accuracy of 88%. Conclusions: Unique BVOCs
pattern can identify patients with established NSCLC. Future studies in
at-risk patients will assess the utility of this approach as a less invasive and
minimal risk screening tool for early detection of NSCLC. Supported by the
Kennedy Seed Grant awarded by the Winship Cancer Institute of Emory
University.
7050 General Poster Session (Board #36A), Sat, 1:15 PM-5:15 PM
Case-control study of prophylactic cranial irradiation in nonmetastatic
non-small cell lung cancer. Presenting Author: Simon Cheng, Department
of Radiation Oncology, Columbia University Medical Center, New York, NY
Background: Prophylactic cranial irradiation (PCI) reduces the incidence of
brain metastases in NSCLC patients after primary therapy, but its impact
on survival is uncertain. We report on the largest study of survival in
patients treated with and without PCI for non-small cell lung cancer
(NSCLC). Methods: We reviewed 17 Surveillance, Epidemiology and End
Results (SEER) registries for a retrospective study on patients who had PCI
as part of their primary treatment for NSCLC from 1988 - 97. Cases were
limited to those with non-metastatic (Stage I-III) NSCLC. To balance the
cohorts, we matched each PCI patient with four non-PCI patients on stage,
histology, race and sex. Associations between treatment type, clinical
factors, and demographics were assessed using the Chi-squared test.
Survival time was calculated as the number of months from diagnosis to the
date of death. Survival was censored as of the last month when patients
were known to be alive. Overall (OS) and cancer cause-specific survival
(CSS) were investigated using the Kaplan-Meier, competing risks, Cox
proportional hazards, and log-rank tests. Results: We found 472 PCI
matched to 1,888 non-PCI patients. Characteristics were balanced across
groups: race (p � 1.00), sex (p � 0.95), histology (p � 1.00), stage (p �
1.00), and surgery (p � 0.81). PCI group was younger, median age 64 vs
68 (p � 0.01). PCI vs no PCI median OS was 8 vs 10 months (p � 0.01).
OS was 14% vs 28% at 2 years and 5% vs 12% at 5 years, PCI vs no PCI
respectively (p � 0.01). Stage III OS was also different; 10% vs 21% at 2
years, PCI vs no PCI respectively (p � 0.01). Median CSS was the same at 9
months in both groups. Median follow-up was 14 years. Conclusions: PCI
was not associated with improved OS or CSS in these NSCLC patients, and
PCI may have a detrimental effect on OS. In limited-stage small cell lung
cancer, a retrospective SEER analysis during the 1988 – 97 period showed
a survival benefit in treated patients with PCI, which has been confirmed
with prospective studies. To date, 4 prospective trials examining PCI for
NSCLC have shown a reduced incidence of brain metastases, but the effect
on survival is unclear. Further investigation is needed to determine whether
PCI for NSCLC increases the risk of other causes of death.
463s
7049 General Poster Session (Board #35H), Sat, 1:15 PM-5:15 PM
Outcomes of combined modality treatment in elderly patients with stage III
non-small cell lung cancer. Presenting Author: Ludimila Cavalcante, Mount
Sinai Medical Center, Miami Beach, FL
Background: The use of combined modality treatment (CMT) has been
demonstrated to improve survival in patients with inoperable, locally
advanced NSCLC. Elderly patients have been traditionally excluded from
prospective clinical trials investigating CMT and thus the optimal treatment
strategy for these patients remains unclear. We retrospectively evaluated
the outcomes of elderly patients who received concurrent and sequential
chemoradiation. Methods: All lung cancer patients age 70 or older who
received chemotherapy and radiation treatment at Mt. Sinai Medical Center
for stage III NSCLC between 1997 and 2010 were analyzed from tumor
registry data. Among 282 lung cancer elderly patients diagnosed with stage
III disease, 64 patients (22.7 %) received CMT as part of their treatment.
Patients who underwent surgery and palliative radiation were excluded.
Statistical analysis was performed by log-rank, Kaplan-Meier methods, and
t-test. Results: Median age at diagnosis for the CMT group was 75 years
(70-87), male/female: 34/30, TNM: T4N0-1: 12, T3N1: 1, TXN2: 41,
TXN3: 10. Concurrent chemoradiation was delivered in 43 cases and
sequential in 21 cases. RT doses ranged from 50 to 63 Gy. The most
common chemotherapy regimens used were carboplatin and taxol (44 %)
and carboplatin and etoposide (15%). The most common treatment-related
toxicities were esophagitis (42%), anemia (39%), and pneumonia (24%).
Median survival (MST) was 19 months and 11 months in the concurrent
and sequential chemoradiation groups (p�0.67). Observed two, three and
five-year overall survival (OS) in the CMT group was 49.1%, 27.5%, and
12.5%, respectively. Conclusions: Although CMT is not commonly used in
elderly patients with lung cancer, the treatment is feasible and beneficial
for selected patients in the community setting. Interestingly, the MST of
elderly patients who received CMT in this cohort was comparable to that of
younger historical controls with CMT. There was also a trend for increased
survival in the concurrent versus sequential chemoradiation group.
7051 General Poster Session (Board #36B), Sat, 1:15 PM-5:15 PM
Correlation of pretreatment surgical staging and PET SUVmax with outcomes
in NSCLC. Presenting Author: Giancarlo Moscol, Albert Einstein
Medical Center, Philadelphia, PA
Background: The AJCC staging does not recognize the number of involved
mediastinal lymph nodes (LN), nodal stations or PET findings as prognostic
factors in non-small cell lung cancer (NSCLC). Most clinical studies report
poorer survival with greater number of involved LN and maximal tumor
standardized uptake value (SUVmax) � 5. We hypothesized that clinical
outcomes can be predicted by (1) number of involved LN, (2) number of
involved nodal stations, (3) SUVmax of primary tumor and (4) SUVmax of
mediastinum. Methods: Records of patients diagnosed with NSCLC stages
I-IIIA from 1/1/99 to 12/31/10 were reviewed. Data collected included age,
type of surgery, AJCC stage, number of LN/stations sampled and SUVmax
of primary tumor/mediastinum. Primary outcomes were tumor recurrence
and death. Descriptive statistics were used to summarize demographics.
Prognostic factors were analyzed by a multivariate analysis using Cox’s
proportional hazard model. Survival was estimated by the Kaplan-Meier
method. Results: There were 369 patients with complete clinical data; 207
underwent surgical staging with mediastinoscopy (62) or VATS/open
thoracotomy (145). The median number of LN sampled was 9 (range 1-35)
and the median number of stations biopsied was 3 (range 1-9). PET was
performed in 89 patients; 59 scans showed tumor SUVmax � 5. A total of
65/207 patients received chemotherapy. With median follow-up time of 29
months (range 1-116), 73 recurrences and 90 deaths were observed. Cox
analysis showed greater recurrence risk for patients with 4 or more involved
LN (HR� 4.66, CI�1.19-18.18, p�0.027) and higher mortality for
patients with tumor SUVmax � 5 (HR�14.83, CI�2.32-94.9, p�0.004).
Outcomes did not correlate with the number of involved nodal stations
(p�0.76 for recurrence, p�0.51 for mortality) or with SUVmax of mediastinum
(p�0.17 for recurrence, p�0.93 for mortality). Conclusions: The
number of involved LN was an independent prognostic factor for recurrence
but not for mortality. A tumor SUVmax �5 was independently associated
with greater mortality. The number of involved stations and the SUVmax of
mediastinum did not correlate with worse outcomes. Our results are limited
due to the small number of cases with PET/CT scans and short follow-up.
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