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P1.13-010 Is MRI Brain Mandatory in All Patients with Early Stage NSCLC?
November 2017 was developed as a new method for identifying sentinel nodes (SNs) in patient with non-small cell lung cancer (NSCLC). SNs were identified in 87.8% of patients, and the accuracy rate of SN identification was 97.5%. CT lymphography images sometimes show enlargement of lymphatic vessel (Fig), and we noticed this finding is related to lymph node metastasis. Lymphatic vessel enlargement was seen in 80% of lymph node metastasis positive cases whereas only 24.2% of lymph node metastasis negative cases showed lymphatic vessel enlargement (p¼0.027). The aim of this study was to investigate the relationship between the finding of lymphatic vessel enlargement seen in CT lymphography and tumor lymphangiogenesis including lymphatic vessel density or vascular endothelial growth factor (VEGF)-C. Method: Lymphatic vessel enlargement was defined as a finding of an enhanced lymphatic vessel 3mm on CT lymphography. We examined formalin fixed paraffin embedded tumor samples of 36 patients who received CT lymphography preoperatively. Lymphatic vessel density was determined based on the number of peritumoral vessels immunoreactive to anti-D2-40 antibody. The percentage of tumor cells exhibiting cytoplasmic staining for VEGF-C was evaluated and 30% was defined as VEGF-C positive. Result: Twelve out of 36 (33.3%) cases showed finding of the lymphatic vessel enlargement on CT lymphography. Peritumoral lymphatic vessel density of VEGF-C positive patients was significantly higher than that of VEGF-C negative patients (28.4 ± 11.6 vs 17.0 ± 10.5, p¼0.005). Lymphatic vessel enlargement was more frequently seen in VEGF-C positive patients than in VEGF-C negative patients (53.8% vs 21.8% ± 10.5, p¼0.056). Conclusion: Our study suggests VEGF-C secreted by tumor cells play a key role in the lymphatic remodeling and lymphatic vessel enlargement seen in CT lymphography may be a risk factor for lymph node metastasis of NSCLC. Keywords: CT lymphography, lymph node metastasis, nonsmall cell lung cancer
P1.13-010 Is MRI Brain Mandatory in All Patients with Early Stage NSCLC? G. Karimundackal,1 B. Gangadharan2 1Department of Surgical Oncology, Tata Memorial Hospital, Mumbai/IN, 2Surgical Oncology, Tata Memorial Hospital, Mumbai/IN Background: Non - small cell lung cancer (NSCLC) is known to have a high propensity for metastasis to brain. Conventional wisdom and guidelines recommend MRI brain as routine staging investigation for patients planned for radical treatment. However there is little data about the detection rate of brain metastasis using MRI brain in asymptomatic patients with operable/early stage NSCLC. Method: We conducted a prospective observational study to assess the incidence of MRI detected brain metastasis in early operable lung cancer. Consecutive patients presenting to the outpatient department with biopsy proven NSCLC were screened. All patients planned for radical treatment underwent PET CECT and MRI brain as per institutional protocol. Patients with early stage disease ( Stage I to IIIA) on PET CECT with no symptoms suggestive of brain metastasis were included in the study. Data regarding histopathology, T stage, N stage, SUV uptake of primary, clinicoradiological stage, neurological symptoms and MRI brain findings was collected. Result: 1944 consecutive biopsy proven patients of NSCLC presenting in the outpatient department from Jan 1st
Abstracts
S2035
2015 to Dec 31st 2015, were screened. 168 patients in stage I to IIIA as per PET CECT, without obvious evidence of brain metastasis were included in the study, 81(48.2%) were in stage I&II and 87(51.7%) were in stage IIIA. Among the remaining 1776 patients, 213 patients had brain metastasis at presentation. Two patients with early stage disease and symptomatic solitary brain metastasis were treated with radical intent and excluded from the study. The incidence of MRI detected asymptomatic brain metastasis in the study population (Stage I to IIIA) was 6/168 (3.5%) and all were in stage IIIA. MRI brain did not pick up any brain metastasis in asymptomatic Stage I&II NSCLC patients. No co-relation could be found between grades of tumor, SUV of primary, T stage or N stage with the incidence of brain metastasis. Three patients in the study population developed brain metastasis while on treatment. Conclusion: Although this study is limited by the small sample size, the role of MRI brain in staging of early stage NSCLC (Stage I & II) needs to be reevaluated in light of the low yield seen in asymptomatic patients. Rigorous evaluation of the patient’s history and clinical symptoms may obviate the need of MRI brain in this subset. This may become increasingly relevant with the implementation of lung cancer screening programs. Keywords: early stage NSCLC, MRI Brain, Brain metastasis
P1.13-011 Prospective Cohort Study of Patterns of Staging and Treatment Selection with or Without Multidisciplinary (MD) Care F. Rugless,1 M. Ray,2 M. Smeltzer,3 B. Jackson,1 C. Foust,1 A. Patel,1 N. Boateng,1 N. Faris,1 C. Houston-Harris,1 C. Fehnel,1 M. Meadows,2 K. Roark,1 L. Mchugh,1 R. Signore,1 E. Robbins,1 R. Fox,1 R. Osarogiagbon1 1Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN/US, 2Epidemology and Biostatistics, University of Memphis School of Public Health, Memphis, TN/US, 3Epidemiology and Biostatistics, University of Memphis School of Public Health, Memphis, TN/US Background: Lung cancer survival depends on accurate staging and treatment selection. Because staging and treatment are increasingly multi-modal, we examined staging and treatment selection practices with or without MD care in a single healthcare system. Method: Eligible patients had untreated lung cancer, ECOG performance status of 0-2, and gave informed consent. Comparisons were made between patients seen in a co-located MD clinic (MDC) and those receiving standard care (SC). Some SC patients were discussed at a multidisciplinary tumor conference (MDTC), thus allowing comparison of MD care to pure SC and MDTC. Diagnostic, staging, treatment procedures and patient outcomes were prospectively recorded. Staging thoroughness was defined as biopsy of stagedefining lesion; bimodality staging (PET+CT or CT+invasive staging biopsy); trimodality staging (PET+CT+invasive staging biopsy). Stage migration was determined comparing baseline stage (from first radiologic scan) to final clinical stage prior to treatment. Stageappropriate treatment was defined by NCCN guidelines using final, pre-treatment stage. Chi-squared test and multivariable logistic regressions adjusted for age, sex, and histology were used to examine differences between patient cohorts. Result: Of 527 patients, 178 were MDC, 77 MDTC, 272 SC. Race and gender were similar but median age (67 v 66 v 69 (p¼0.0032) and insurance distribution (p¼0.0021) differed across groups. MDC tended to have more thorough staging than MDTC and SC. Significant differences were observed in staging migration and appropriate treatment, favoring MDC and MDTC patients (Table 1). After adjusting for age, sex, and
P1.13-010 Is MRI Brain Mandatory in All Patients with Early Stage NSCLC? G. Karimundackal,1 B. Gangadharan2 1Department of Surgical Oncology, Tata Memorial Hospital, Mumbai/IN, 2Surgical Oncology, Tata Memorial Hospital, Mumbai/IN Background: Non - small cell lung cancer (NSCLC) is known to have a high propensity for metastasis to brain. Conventional wisdom and guidelines recommend MRI brain as routine staging investigation for patients planned for radical treatment. However there is little data about the detection rate of brain metastasis using MRI brain in asymptomatic patients with operable/early stage NSCLC. Method: We conducted a prospective observational study to assess the incidence of MRI detected brain metastasis in early operable lung cancer. Consecutive patients presenting to the outpatient department with biopsy proven NSCLC were screened. All patients planned for radical treatment underwent PET CECT and MRI brain as per institutional protocol. Patients with early stage disease ( Stage I to IIIA) on PET CECT with no symptoms suggestive of brain metastasis were included in the study. Data regarding histopathology, T stage, N stage, SUV uptake of primary, clinicoradiological stage, neurological symptoms and MRI brain findings was collected. Result: 1944 consecutive biopsy proven patients of NSCLC presenting in the outpatient department from Jan 1st
Abstracts
S2035
2015 to Dec 31st 2015, were screened. 168 patients in stage I to IIIA as per PET CECT, without obvious evidence of brain metastasis were included in the study, 81(48.2%) were in stage I&II and 87(51.7%) were in stage IIIA. Among the remaining 1776 patients, 213 patients had brain metastasis at presentation. Two patients with early stage disease and symptomatic solitary brain metastasis were treated with radical intent and excluded from the study. The incidence of MRI detected asymptomatic brain metastasis in the study population (Stage I to IIIA) was 6/168 (3.5%) and all were in stage IIIA. MRI brain did not pick up any brain metastasis in asymptomatic Stage I&II NSCLC patients. No co-relation could be found between grades of tumor, SUV of primary, T stage or N stage with the incidence of brain metastasis. Three patients in the study population developed brain metastasis while on treatment. Conclusion: Although this study is limited by the small sample size, the role of MRI brain in staging of early stage NSCLC (Stage I & II) needs to be reevaluated in light of the low yield seen in asymptomatic patients. Rigorous evaluation of the patient’s history and clinical symptoms may obviate the need of MRI brain in this subset. This may become increasingly relevant with the implementation of lung cancer screening programs. Keywords: early stage NSCLC, MRI Brain, Brain metastasis
P1.13-011 Prospective Cohort Study of Patterns of Staging and Treatment Selection with or Without Multidisciplinary (MD) Care F. Rugless,1 M. Ray,2 M. Smeltzer,3 B. Jackson,1 C. Foust,1 A. Patel,1 N. Boateng,1 N. Faris,1 C. Houston-Harris,1 C. Fehnel,1 M. Meadows,2 K. Roark,1 L. Mchugh,1 R. Signore,1 E. Robbins,1 R. Fox,1 R. Osarogiagbon1 1Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN/US, 2Epidemology and Biostatistics, University of Memphis School of Public Health, Memphis, TN/US, 3Epidemiology and Biostatistics, University of Memphis School of Public Health, Memphis, TN/US Background: Lung cancer survival depends on accurate staging and treatment selection. Because staging and treatment are increasingly multi-modal, we examined staging and treatment selection practices with or without MD care in a single healthcare system. Method: Eligible patients had untreated lung cancer, ECOG performance status of 0-2, and gave informed consent. Comparisons were made between patients seen in a co-located MD clinic (MDC) and those receiving standard care (SC). Some SC patients were discussed at a multidisciplinary tumor conference (MDTC), thus allowing comparison of MD care to pure SC and MDTC. Diagnostic, staging, treatment procedures and patient outcomes were prospectively recorded. Staging thoroughness was defined as biopsy of stagedefining lesion; bimodality staging (PET+CT or CT+invasive staging biopsy); trimodality staging (PET+CT+invasive staging biopsy). Stage migration was determined comparing baseline stage (from first radiologic scan) to final clinical stage prior to treatment. Stageappropriate treatment was defined by NCCN guidelines using final, pre-treatment stage. Chi-squared test and multivariable logistic regressions adjusted for age, sex, and histology were used to examine differences between patient cohorts. Result: Of 527 patients, 178 were MDC, 77 MDTC, 272 SC. Race and gender were similar but median age (67 v 66 v 69 (p¼0.0032) and insurance distribution (p¼0.0021) differed across groups. MDC tended to have more thorough staging than MDTC and SC. Significant differences were observed in staging migration and appropriate treatment, favoring MDC and MDTC patients (Table 1). After adjusting for age, sex, and