- Email: [email protected]
P1.17: Improved Survival for Stage-2 (N1) Pulmonary Adenocarcinoma and Squamous Cell Carcinoma After Pulmonary Lobectomy
October 2016
not statistical difference (18/208 vs. 4/43; p¼0.70). However, the mean duration of R-VATS segmentectomy was longer than R-VATS lobectomy (258min vs. 207.5min: p<0.01). Total post-operative complications in the segmentectomy group were not significantly different than in the lobectomy group (24/43 vs. 84/208; p¼0.071). Cardiovascular complications did not differ between the two groups. Notably, there was no significant difference in terms of postoperative respiratory failure, pneumonia, hemothorax, prolonged air leak, length of stay, and in-hospital mortality. Individual complications that were significant were the rates of pneumothorax after chest tube removal (p¼0.032) and effusion/empyema (p¼0.011) requiring intervention. Conclusion: R-VATS segmentectomy on average take longer than R-VATS lobectomy and have more postoperative complications, and has 2 significant individual complications, pneumothorax after chest tube removal and effusion/empyema. Therefore, R-VATS segmentectomy may be considered as an alternative procedure to R-VATS lobectomy in order to conserve lung function. Keyword: robotic lung surgery outcomes
Abstracts
S191
histologic subtype between 1988-2003 versus 20042013. Results: Of 2,937 pts, there were 1790 (60.9%) AD pts, 978 (33.3%) SQ pts, 53 (1.8%) NE pts, and 113 (3.8%) AS pts. From 1988-2013, 5-yr survival did not differ between AD (41.6%), SQ (45.9%), NE (55.2%), and AS (46.4%) (p¼0.63). For AD pts, 5-yr survival improved significantly from 35.6% to 45.4% (p<0.0001) between 1988-2003 versus 2004-2013, respectively, while median survival time (MST) improved from 37.0±2.3 mon in 1988-2003 to 52.0 mon in 2004-2013 (p<0.0001). For SQ pts, 5-yr survival also improved significantly from 39.5% to 51.0% (p¼0.004) between eras, while MST improved from 37.0±3.8 mon in 1988-2003 to 60 mon in 2004-2013 (p¼0.005). Neither 5-yr survival for AS pts nor for NE pts changed significantly between 1988-2003 and 2004-2013 (35.5% vs. 48.4%, p¼0.21, for AS; 50.5% vs, 50.8%, p¼0.55, for NE). The T1N1:T2N1 ratio in AD pts was higher than in SQ pts in both eras as well as over the entire study period (all p<0.01), while that for NE pts was higher than in SQ pts only in 2004-2013 and over 1988-2013 (both p<0.01).
P1.17 Improved Survival for Stage-2 (N1) Pulmonary Adenocarcinoma and Squamous Cell Carcinoma After Pulmonary Lobectomy Track: Early Stage NSCLC (Stage I - III) Danny T. Nguyen,1 Jacques-Pierre Fontaine,2 Lary A. Robinson,2 Robert J. Keenan,2 Eric M. Toloza2 1 University of South Florida, Morsani College of Medicine, Tampa/FL/UNITED STATES OF AMERICA, 2Thoracic Oncology, Moffitt Cancer Center, Tampa/FL/UNITED STATES OF AMERICA Background: Non-small cell lung cancer (NSCLC) is comprised of various histologies, including adenocarcinoma (AD), squamous cell (SQ), neuroendocrine (NE), and adenosquamous (AS). We evaluated postoperative survival of stage-2 (N1) NSCLC patients (pts), who underwent lobectomy from 1988 to 2013, and compared survival between 1988-2003 and 2004-2013. Method: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified stage-II (T1N1M0 or T2N1M0) NSCLC pts who underwent lobectomy during 1988-2013, but excluded those who had radiation therapy or multiple primary NSCLC tumors. We grouped the pts by histology and performed KaplanMeier survival analyses, with log-rank test used to compare 5-yr cancer-specific survival of each major
Conclusion: Using SEER data, we found significantly improved postoperative 5-yr cancer-specific survival for stage-2 (N1) AD and SQ, but not for AS pts or for NE pts, between 1988-2003 and 2004-2013. A higher
S192
proportion of T2N1 did not worsen survival for SQ pts. These results likely reflect more minimally invasive surgery and improved perioperative care and/or adjuvant chemotherapy for stage-2 (N1) NSCLC pts. Keywords: Stage-2 (N1) NSCLC, Lobectomy, Adenocarcinoma, Squamous Cell Carcinoma
P1.18 Long-Term Clinical Outcomes and Safety Profile for Central Lung SBRT for NSCLC Track: Early Stage NSCLC (Stage I - III) Kenneth W. Merrell,1 Benjamin Mou,1 Christopher L. Hallemeier,1 Dawn A. Owen,2 Katy Nelson,1 Yolanda I. Garces,1 Kenneth R. Olivier1 1 Radiation Oncology, Mayo Clinic, Rochester/MN/UNITED STATES OF AMERICA, 2Radiation Oncology, Veterans Affairs Ann Arbor Health System, Ann Arbor/MI/UNITED STATES OF AMERICA Background: Previous studies suggest central lung SBRT is associated with an increased risk of severe toxicity relative to peripherally located tumors when using high SBRT dose levels. Initial results from RTOG 0813 suggest a safe toxicity profile for central lung SBRT with moderate SBRT dosing. We reviewed our institutional data to further evaluate the safety and efficacy of central lung SBRT. Method: We reviewed our prospectively collected SBRT database for patients with centrally located NSCLC who received SBRT between April 2008 and November 2014. A central tumor was defined as within or touching the proximal bronchial tree zone or mediastinal structures. The most frequent dose and fractionation was 50 Gy in 5 fractions (59%) and 48 Gy in 4 fractions (31%). Local, regional, and distant control (LC, RC, DC) and overall survival (OS) were calculated using Kaplan-Meier estimates. Radiation Therapy Oncology Group Common Toxicity Criteria was used for toxicity grading. Univariate and multivariate (MVA) were performed using Cox proportional hazards regression models. Results: A total of 110 central lung tumors in 103 patients were included for analysis. The median age of the group was 73.8 (range, 40-95). The median follow-up time of living patients was 50 months. The mean tumor size was 20 mm (range, 5-70). The most common histology was squamous cell carcinoma (43.8%). A total of 33% of patients had prior lung surgery and 7% had prior radiotherapy. The 5-year rates of LC, RC, and DC were
Journal of Thoracic Oncology
Vol. 11 No. 10S
89%, 77%, and 82%, respectively. The median and 5-year OS were 3.5 years and 34.5%, respectively. We did not identify any univariates that predicted for tumor control or other clinical outcomes. Two patients (1.8%) experienced acute cardiopulmonary toxicity grade 3 including a grade 3 and 5 radiation pneumonitis. The rate of late toxicity grade 3 was 16% (grade 3¼14%, grade 4¼1%, grade 5¼1%). This included radiation pneumonitis (10%), upper airway necrosis and distal lung collapse (3%), myocardial dysfunction (2%), and worsening pulmonary function (1%). One patient experienced a late grade 5 toxicity after upper airway necrosis resulting in atelectasis and pulmonary compromise. Conclusion: SBRT for central NSCLC using moderate SBRT dose and fractionation provides high rates of LC. We observed acceptably low rates of grade 4 or 5 toxicity potentially attributable to SBRT. Our data contributes to the growing body of data supporting efficacy SBRT for central lung NSCLC. Keywords: NSCLC, SBRT, Central Lung Cancer, Early Stage NSCLC
P1.19 Barriers to Deliver Personalized Medicine to Young Patients With Non-Small Cell Lung Cancer in Latin America Track: Early Stage NSCLC (Stage I - III) Liliana Fernandez, Juan F. Henao, Luz F. Sua, Valeria Zuñiga, Leidys Gutiérrez Biomedical Research Group In Thorax., Fundación Valle del Lili, Universidad Icesi, Cali/COLOMBIA Background: Young patients with NSCLC are a particular subset of patients. Within this group, the disease is strongly related with driver mutations rather than smoking history, therefore, these patients would benefit from targeted therapy (TT) which has evidenced to be superior over standard chemotherapy. We aimed to estimate the prevalence of EGFR mutations and EML4-ALK fusions and describe treatment patterns and clinical outcomes in young patients with NSCLC of a reference hospital from Cali-Colombia. Method: Our clinic data base queried for NSCLC cases from June-2013 to February-2016. Young patients were defined as those aged 50 years or less. Eleven patients were included. Patient’s demographics, clinicopathological characteristics and presence of EGFR or EML4-ALK mutations were analyzed. The primary outcomes were overall follow up and survival.
not statistical difference (18/208 vs. 4/43; p¼0.70). However, the mean duration of R-VATS segmentectomy was longer than R-VATS lobectomy (258min vs. 207.5min: p<0.01). Total post-operative complications in the segmentectomy group were not significantly different than in the lobectomy group (24/43 vs. 84/208; p¼0.071). Cardiovascular complications did not differ between the two groups. Notably, there was no significant difference in terms of postoperative respiratory failure, pneumonia, hemothorax, prolonged air leak, length of stay, and in-hospital mortality. Individual complications that were significant were the rates of pneumothorax after chest tube removal (p¼0.032) and effusion/empyema (p¼0.011) requiring intervention. Conclusion: R-VATS segmentectomy on average take longer than R-VATS lobectomy and have more postoperative complications, and has 2 significant individual complications, pneumothorax after chest tube removal and effusion/empyema. Therefore, R-VATS segmentectomy may be considered as an alternative procedure to R-VATS lobectomy in order to conserve lung function. Keyword: robotic lung surgery outcomes
Abstracts
S191
histologic subtype between 1988-2003 versus 20042013. Results: Of 2,937 pts, there were 1790 (60.9%) AD pts, 978 (33.3%) SQ pts, 53 (1.8%) NE pts, and 113 (3.8%) AS pts. From 1988-2013, 5-yr survival did not differ between AD (41.6%), SQ (45.9%), NE (55.2%), and AS (46.4%) (p¼0.63). For AD pts, 5-yr survival improved significantly from 35.6% to 45.4% (p<0.0001) between 1988-2003 versus 2004-2013, respectively, while median survival time (MST) improved from 37.0±2.3 mon in 1988-2003 to 52.0 mon in 2004-2013 (p<0.0001). For SQ pts, 5-yr survival also improved significantly from 39.5% to 51.0% (p¼0.004) between eras, while MST improved from 37.0±3.8 mon in 1988-2003 to 60 mon in 2004-2013 (p¼0.005). Neither 5-yr survival for AS pts nor for NE pts changed significantly between 1988-2003 and 2004-2013 (35.5% vs. 48.4%, p¼0.21, for AS; 50.5% vs, 50.8%, p¼0.55, for NE). The T1N1:T2N1 ratio in AD pts was higher than in SQ pts in both eras as well as over the entire study period (all p<0.01), while that for NE pts was higher than in SQ pts only in 2004-2013 and over 1988-2013 (both p<0.01).
P1.17 Improved Survival for Stage-2 (N1) Pulmonary Adenocarcinoma and Squamous Cell Carcinoma After Pulmonary Lobectomy Track: Early Stage NSCLC (Stage I - III) Danny T. Nguyen,1 Jacques-Pierre Fontaine,2 Lary A. Robinson,2 Robert J. Keenan,2 Eric M. Toloza2 1 University of South Florida, Morsani College of Medicine, Tampa/FL/UNITED STATES OF AMERICA, 2Thoracic Oncology, Moffitt Cancer Center, Tampa/FL/UNITED STATES OF AMERICA Background: Non-small cell lung cancer (NSCLC) is comprised of various histologies, including adenocarcinoma (AD), squamous cell (SQ), neuroendocrine (NE), and adenosquamous (AS). We evaluated postoperative survival of stage-2 (N1) NSCLC patients (pts), who underwent lobectomy from 1988 to 2013, and compared survival between 1988-2003 and 2004-2013. Method: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified stage-II (T1N1M0 or T2N1M0) NSCLC pts who underwent lobectomy during 1988-2013, but excluded those who had radiation therapy or multiple primary NSCLC tumors. We grouped the pts by histology and performed KaplanMeier survival analyses, with log-rank test used to compare 5-yr cancer-specific survival of each major
Conclusion: Using SEER data, we found significantly improved postoperative 5-yr cancer-specific survival for stage-2 (N1) AD and SQ, but not for AS pts or for NE pts, between 1988-2003 and 2004-2013. A higher
S192
proportion of T2N1 did not worsen survival for SQ pts. These results likely reflect more minimally invasive surgery and improved perioperative care and/or adjuvant chemotherapy for stage-2 (N1) NSCLC pts. Keywords: Stage-2 (N1) NSCLC, Lobectomy, Adenocarcinoma, Squamous Cell Carcinoma
P1.18 Long-Term Clinical Outcomes and Safety Profile for Central Lung SBRT for NSCLC Track: Early Stage NSCLC (Stage I - III) Kenneth W. Merrell,1 Benjamin Mou,1 Christopher L. Hallemeier,1 Dawn A. Owen,2 Katy Nelson,1 Yolanda I. Garces,1 Kenneth R. Olivier1 1 Radiation Oncology, Mayo Clinic, Rochester/MN/UNITED STATES OF AMERICA, 2Radiation Oncology, Veterans Affairs Ann Arbor Health System, Ann Arbor/MI/UNITED STATES OF AMERICA Background: Previous studies suggest central lung SBRT is associated with an increased risk of severe toxicity relative to peripherally located tumors when using high SBRT dose levels. Initial results from RTOG 0813 suggest a safe toxicity profile for central lung SBRT with moderate SBRT dosing. We reviewed our institutional data to further evaluate the safety and efficacy of central lung SBRT. Method: We reviewed our prospectively collected SBRT database for patients with centrally located NSCLC who received SBRT between April 2008 and November 2014. A central tumor was defined as within or touching the proximal bronchial tree zone or mediastinal structures. The most frequent dose and fractionation was 50 Gy in 5 fractions (59%) and 48 Gy in 4 fractions (31%). Local, regional, and distant control (LC, RC, DC) and overall survival (OS) were calculated using Kaplan-Meier estimates. Radiation Therapy Oncology Group Common Toxicity Criteria was used for toxicity grading. Univariate and multivariate (MVA) were performed using Cox proportional hazards regression models. Results: A total of 110 central lung tumors in 103 patients were included for analysis. The median age of the group was 73.8 (range, 40-95). The median follow-up time of living patients was 50 months. The mean tumor size was 20 mm (range, 5-70). The most common histology was squamous cell carcinoma (43.8%). A total of 33% of patients had prior lung surgery and 7% had prior radiotherapy. The 5-year rates of LC, RC, and DC were
Journal of Thoracic Oncology
Vol. 11 No. 10S
89%, 77%, and 82%, respectively. The median and 5-year OS were 3.5 years and 34.5%, respectively. We did not identify any univariates that predicted for tumor control or other clinical outcomes. Two patients (1.8%) experienced acute cardiopulmonary toxicity grade 3 including a grade 3 and 5 radiation pneumonitis. The rate of late toxicity grade 3 was 16% (grade 3¼14%, grade 4¼1%, grade 5¼1%). This included radiation pneumonitis (10%), upper airway necrosis and distal lung collapse (3%), myocardial dysfunction (2%), and worsening pulmonary function (1%). One patient experienced a late grade 5 toxicity after upper airway necrosis resulting in atelectasis and pulmonary compromise. Conclusion: SBRT for central NSCLC using moderate SBRT dose and fractionation provides high rates of LC. We observed acceptably low rates of grade 4 or 5 toxicity potentially attributable to SBRT. Our data contributes to the growing body of data supporting efficacy SBRT for central lung NSCLC. Keywords: NSCLC, SBRT, Central Lung Cancer, Early Stage NSCLC
P1.19 Barriers to Deliver Personalized Medicine to Young Patients With Non-Small Cell Lung Cancer in Latin America Track: Early Stage NSCLC (Stage I - III) Liliana Fernandez, Juan F. Henao, Luz F. Sua, Valeria Zuñiga, Leidys Gutiérrez Biomedical Research Group In Thorax., Fundación Valle del Lili, Universidad Icesi, Cali/COLOMBIA Background: Young patients with NSCLC are a particular subset of patients. Within this group, the disease is strongly related with driver mutations rather than smoking history, therefore, these patients would benefit from targeted therapy (TT) which has evidenced to be superior over standard chemotherapy. We aimed to estimate the prevalence of EGFR mutations and EML4-ALK fusions and describe treatment patterns and clinical outcomes in young patients with NSCLC of a reference hospital from Cali-Colombia. Method: Our clinic data base queried for NSCLC cases from June-2013 to February-2016. Young patients were defined as those aged 50 years or less. Eleven patients were included. Patient’s demographics, clinicopathological characteristics and presence of EGFR or EML4-ALK mutations were analyzed. The primary outcomes were overall follow up and survival.