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P3.16-047 Salvage Surgery for Locoregional Recurrence or Persistent Residual Tumor After Definitive Chemoradiation Therapy
S2360
P3.16-045 Evaluation of the Safety and Efficacy of VATS Pneumonectomy in the Treatment of Locally Advanced Lung Cancer J. Goldblatt,1 N. Alam,2 R. Davies,1 J. Lovell,1 G. Wright1 1 Cardiothoracic Surgery, St Vincent’s Hospital, Melbourne/AU, 2 Department of Surgery, University of Melbourne, Melbourne, VIC/AU Background: VATS technique has been increasingly used worldwide for the management of lung cancer1. VATS lobectomy has been shown to be superior to traditional open lobectomy with shorter length of stay, fewer perioperative complications and improved quality of life1. There remain concerns regarding the use of VATS for larger oncological resections including pneumonectomy and sleeve resections. We add more confirmatory data to several retrospective cohort studies demonstrating the safety of VATS pneumonectomy in selected patients.1,2 Method: With ethics approval, a retrospective cohort study was performed at a single-centre in Melbourne, Australia. It included all patients who had undergone a pneumonectomy between 1999 and 2017. The primary outcome was overall survival. Secondary outcomes included: 30-day and 90-day mortality, disease free survival and length of stay. Result: 79 patients underwent pneumonectomy between 1999 and 2017. 27 patients underwent pneumonectomy via VATS approach. There were 76 patients with NSCLC, two with carcinoid and one with melanoma. There was no difference in the tumour size between the two cohorts (VATS median 47mm versus open median 50mm, p¼0.12). There was no significance difference in node positive disease between the two cohorts (p¼0.14). The 30-day and 90-day mortality rate was 3.8% and 5.1% respectively, with all events occurring in the open cohort. Median overall survival for all patients was 22 months, with a median disease-free survival of 14 months. There was no statistically significant difference in overall survival depending on operative access (median survival VATS 86 months versus open 26.2 months, p¼0.12). There was no difference in disease-free survival from NSCLC between the two groups (VATS median 86 months versus open median DFS 15.9 months, p¼0.21). The length of stay was shorter in the VATS cohort (7 days versus 8 days, p¼0.008). The number of lung cancer cases performed as VATS at our institution has increased from 41% between 2002 and 2011 to 84% since 2014. The rate of VATS pneumonectomy has increased from 18% between 2002 and 2011 to 58.6% since 2014, however this increase lagged three years behind less major resections (i.e. lobectomy). Conclusion: In concordance with other recent retrospective cohort studies, our study demonstrates both the safety of VATS pneumonectomy and the oncological efficacy in appropriately selected patients. References: 1. Sahai RK, Nwogu CE, Yendamuri S et al. Is thorascopic pneumonectomy safe? Ann Thorac Surg. 2009;88:10861092. 2. Nagai S, Imanishi N, Matsuoka et al. Video-assisted thorascopic pneumonectomy: retrospective outcome analysis of 47 consecutive patients. Ann Thorac Surg. 2014;97(6):1908-1913. Keywords: VATS, pneumonectomy
P3.16-046 Pneumonectomy After Induction/Neoadjuvant Treatment for NSCLC: Morbidity, Mortality and LongTerm Survival C. Gebitekin,1 A. Toker,2 W. Weder,3 H. Melek,1 B. Özkan,2 I. Opitz,4 G. Cetinkaya,1 S. Collaud,4 A. Bayram1 1Thoracic Surgery, Uludag University, Bursa/TR, 2Thoracic Surgery, Istanbul University, Istanbul/ TR, 3Thoracic Surgery, University Hospital Zurich, Zurich/CH, 4Thoracic Surgery, Zurich University Hospital, Zurich/CH
Journal of Thoracic Oncology
Vol. 12 No. 11S2
Background: To compare the effects of neoadjuvant/induction chemotherapy or chemoradiation on morbidity, mortality, and longterm survival in patients with locally advanced NSCLC undergoing pneumonectomy. Method: All pneumonectomies following neoadjuvant treatment performed for NSCLC between 2000 and 2016 were retrospectively reviewed. The study included 162 patients (28 females; median patient age, 55.4 years [range, 31e73]). Neoadjuvant treatment consisted of chemotherapy in 115 patients (71%, group I) and chemoradiation in 47 patients (29%, group II). Chemotherapy was cisplatin-based, and 2e6 cycles of treatment were completed. Radiotherapy was administered sequentially (dose, 45e60 Gy). Surgery was performed 3e6 weeks after neoadjuvant treatment. Both groups were assessed for 90-day mortality, morbidity, and long-term survival. Result: Right pneumonectomy was performed in 60 (37%) patients, and the procedure was completed in a standard manner in 64.2% of the patients. Morbidity was observed in 27.7% of the patients (27,8% in group I; 27.6% in group II,p¼0.98). The incidence of bronchopleural fistula was 4.3% (4.2% in group I; 4.3% group II). The 90-days mortality rate was 3.1% (5 patients in group I, 0 in group II,p¼0.17). The mortality rates for right and left pneumonectomy were 3.3 (2/60 patients) and 3% (3/102 patients), respectively (p¼0.61). The 5-year survival rates were 46.2% in group I and 54.2% in group II, (P ¼ 0.16). Conclusion: Pneumonectomy after neoadjuvant chemotherapy or chemoradiation appears to be safe with an acceptable morbidity, mortality, and long-term survival. Chemoradiation did not improve long-term survival compared to chemotherapy despite comparable 90-day mortality and postoperative morbidity. Keywords: pneumonectomy, mortality, Neoadjuvant treatment
P3.16-047 Salvage Surgery for Locoregional Recurrence or Persistent Residual Tumor After Definitive Chemoradiation Therapy J. Osawa,1 H. Ito,2 M. Nito,1 K. Inafuku,1 J. Samejima,1 T. Nagashima,1 H. Nakayama,1 K. Yamada,2 T. Yokose3 1Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama/JP, 2 Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama/JP, 3Pathology, Kanagawa Cancer Center, Yokohama/JP Background: There are few treatment options with curative intent for locoregional recurrence or residual tumor of locally advanced lung cancer after definitive chemoradiation therapy. Lung resection; salvage surgery is likely to be one of the options for local control in this situation. However, perioperative complications and survival benefit of salvage surgery are not well-reported. Method: Patients who underwent lung resection after definitive chemoradiation therapy for the treatment of non-small cell lung cancer were selected. Frequency and content of perioperative complications, 5-y overall survival rate and disease free survival rate were retrospectively analyzed. Result: A total of 13 patients treated between January 2001 and December 2016 were eligible for evaluation. (12 men and 1 women, mean age 54 years, Median follow-up was 39.7 months.) The indication for surgery was primary tumor regrowth (69%) or tumor persistence (31%). The prior median radiation therapy dose was 60Gy (range 60-77Gy). The indication of for surgery were primary tumor regrowth (8 patients)or tumor persistence(5 patients). All patients underwent an anatomical resection, surgical procedure included lobectomy in 10 patients, pneumonectomy in 2 patients, bilobectomy in 1 patients. 2 patients underwent a bronchoplasty. Median estimated blood loss was 247ml, and median operative duration was 278 min. Compared with anatomical resection we usually perform, salvage surgery needs longer
November 2017 operative duration. Postoperative complications occurred in 4 patients(31%) without perioperative death within 90 days: arrhythmia, delayed pulmonary fistula, acute exacerbation of interstitial pneumonia and empyema. the 5-y overall survival and 5-y recurrence free survival rate were 73.3% and 55.0%,respectively. Conclusion: Salvage surgery for locoregional recurrence or residual tumor after definitive chemoradiotherapy was acceptable in safety. It should be considered as a treatment option for selected patients. However, the technique of salvage surgery is complicated, it needs an adequate experience. Keywords: lung cancer, salvage surgery, chemoradiation
P3.16-048 The Role of Pulmonary Resection in Stage IVa NonSmall Cell Carcinoma Patients T. Igarashi,1 K. Hayashi,1 K. Okamoto,1 R. Kaku,1 Y. Kataoka,1 Y. Kawaguchi,1 M. Hashimoto,1 Y. Ohshio,1 K. Teramoto,2 J. Hanaoka1 1Department of Surgery, Shiga University of Medical Science, Otsu/JP, 2Department of Medical Oncology, Shiga University of Medical Science, Otsu/JP Background: In non-small cell lung cancer (NSCLC), pulmonary resection for stage IV patients was not recommended in standard therapy. However, various new treatments for advanced or recurrence NSCLC patients such as molecular-targeted therapy for driver oncogenes or immune checkpoint therapy have improved the survival of those patients in these days. Therefore, we need to review the role of surgery for advanced NSCLC patients again. Method: Clinical records of 334 patient diagnosed stage IV in Shiga University of Medical Science between 2006 and 2015 were reviewed and clinicopatholocgial features and overall survival were analyzed retrospectively. Result: 32 patients underwent surgery in this period, and the patients included 25 men and 7 women, with median age of 70.0 years (52-82 years). There were 22 adenocarcinomas, 8 squamous cell carcinomas and 2 other histological subtypes. Surgery included 19 pulmonary resections, 3 spinal fixation surgery, 7 intracranial surgery and 3 other surgery. Median overall survival following surgery or non-surgery was 15.8 month and 9.9 months, respectively (P¼0.002). Moreover, in 19 cases of pulmonary resection, there were 7 patients with pleural disseminations (IVa) and 12 patients with distant metastases (IVb). In case with disseminations (IVa), median overall survival was also significantly longer in patients with pulmonary resection than in those of non-operative 31 patients in the same period (42.2 months vs 8.3 months, P¼0.038). Conclusion: Although further study in larger sets of patients would be warranted, surgery should not be excluded from treatment modality for stage IV patients, especially IVa cases if we could selected appropriately. Keywords: Non-small cell carcinoma, dissemination, pulmonary resection
P3.16-049 Surgery with Continued TKI Therapy After Acquiring Resistance to EGFR or ALK TKI S. Ohara,1 Y. Kobayashi,2 T. Fujino,2 Y. Sesumi,3 M. Nishino,2 M. Chiba,4 M. Shimoji,2 K. Tomizawa,2 T. Takemoto,3 T. Mitsudomi2 1 Kindai University, Osaka Sayama City/JP, 2Thoracic Surgery, Kindai University Faculty of Medicine, Osaka-Sayama/JP, 3Thoracic Surgery, Kinki University Faculty of Medicine, Osaka-Sayama/JP, 4 Division of Thoracic Surgery, Kinki University Faculty of Medicine, Osaka-Sayama/JP
Abstracts
S2361
Background: Lung cancer with ALK or EGFR activation inevitably acquires resistance to respective TKIs despite an initial good response. Relapses with only a limited number of regions, so-called oligo-recurrences, occur in a subset of such patients. Here, we present two cases of lung cancer treated with surgery and continued TKI therapy after acquiring resistance to EGFR or ALK TKI. Method: Retrospecive review of patient charts. Result: Case1: A 46-year-old man was diagnosed as having ALK-positive adenocarcinoma with pleural dissemination by exploratory thoracotomy. After 2.5 years’ treatment with alectinib, the primary tumor in the left lower lobe gradually progressed. Left S6 segmentectomy was performed. Genetic analyses of resected specimens revealed ALK G1202R resistant mutation. Alectinib treatment was resumed after surgery and the patient is free of disease 1.5 year after surgery. Case2: A 65-year-old woman presented with lung cancer with ureteral metastasis. Genetic analyses of resected ureteral tumor revealed EGFR L858R point mutation. Gefitinib was initiated and partial response was observed. After 1 year treatment with gefitinib, right middle lobectomy was performed to resect the remaining tumor. Gefitinib treatment was continued and recurrence-free survival of 2 years was achieved. Conclusion: These two patients appear to benefit from surgery and continued TKI therapy after acquiring resistance to EGFR or ALK TKI. It may be one of the treatment strategy in selected patients. Keywords: EGFR, ALK, oligo-recurrence
P3.16-050 Stromal PDGFR-b Expression Influences Postoperative Survival of NSCLC Patients Receiving Preoperative Chemo- or Chemo-Radiotherapy R. Kanzaki,1 H. Naito,2 D. Eino,2 T. Kawamura,1 N. Ose,1 S. Funaki,1 Y. Shintani,1 M. Minami,1 M. Okumura,1 N. Takakura2 1General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka/ JP, 2Research Institute for Microbial Diseases, Osaka University, Suita/JP Background: Platelet-Derived growth factor beta (PDGFR-b) is a functional regulator of mesenchymal cells. It is reported that PDGFR-b is expressed by cancer associated fibroblasts, and PDGFR signaling supports cancer cells. Stromal expression of PDGFR-b is reported to be associated with poor prognosis in prostate, breast, pancreas, and gastric cancers. However, the significance of stromal PDGFR-b expression in non-small cell lung cancer (NSCLC) in patients undergoing preoperative chemo- or chemoradio-therapy had not been undetermined. Method: Seventy-two patients with NSCLC undergoing preoperative chemo- or chemoradio-therapy between 1996 and 2006 were assessed for expression of stromal PDGFR-b by immunohistochemistry using resected specimens. After cancer cells and stromal tissues were identified by HE staining, stromal PDGFR-b expression was defined as positive when it was observed in >5% of the stromal area. Relationships between stromal PDGFR-b expression and disease-free survival (DFS) and disease-specific survival (DSS) were analyzed. Result: The mean age of the 72 patients was 59.7 years. Sixty-one (85%) were male and 11 (15%) female. Forty patients (56%) underwent preoperative chemoradiotherapy and 32 patients (44%) underwent preoperative chemothearapy. Indications for preoperative chemotherapy were N2 disease in 51 (71%), T3 or T4 disease in 20 (28%), and other reasons in the remaining patient (1%). Regimens for preoperative chemotherapy were cisplatin (CDDP)-based in 34 patients (47%) and carboplatin (CBDCA)-based in 37 (52%). Type of resection were pneumonectomy in 7 (10%), bilobectomy in 6 (8%), lobectomy in 57 (79%), and sublobar resection in 2 (3%) patients. Complete resection were achieved in 59 patients (82%). The pathologic stage (7th ed.) was IA in 11 (15%), IB in 12 (17%), IIA in 6 (8%), IIB in14 (19%), IIIA in 19 (27%), IIIB in 5 (7%), and IV in 5 (7%) patients. The histological type
P3.16-045 Evaluation of the Safety and Efficacy of VATS Pneumonectomy in the Treatment of Locally Advanced Lung Cancer J. Goldblatt,1 N. Alam,2 R. Davies,1 J. Lovell,1 G. Wright1 1 Cardiothoracic Surgery, St Vincent’s Hospital, Melbourne/AU, 2 Department of Surgery, University of Melbourne, Melbourne, VIC/AU Background: VATS technique has been increasingly used worldwide for the management of lung cancer1. VATS lobectomy has been shown to be superior to traditional open lobectomy with shorter length of stay, fewer perioperative complications and improved quality of life1. There remain concerns regarding the use of VATS for larger oncological resections including pneumonectomy and sleeve resections. We add more confirmatory data to several retrospective cohort studies demonstrating the safety of VATS pneumonectomy in selected patients.1,2 Method: With ethics approval, a retrospective cohort study was performed at a single-centre in Melbourne, Australia. It included all patients who had undergone a pneumonectomy between 1999 and 2017. The primary outcome was overall survival. Secondary outcomes included: 30-day and 90-day mortality, disease free survival and length of stay. Result: 79 patients underwent pneumonectomy between 1999 and 2017. 27 patients underwent pneumonectomy via VATS approach. There were 76 patients with NSCLC, two with carcinoid and one with melanoma. There was no difference in the tumour size between the two cohorts (VATS median 47mm versus open median 50mm, p¼0.12). There was no significance difference in node positive disease between the two cohorts (p¼0.14). The 30-day and 90-day mortality rate was 3.8% and 5.1% respectively, with all events occurring in the open cohort. Median overall survival for all patients was 22 months, with a median disease-free survival of 14 months. There was no statistically significant difference in overall survival depending on operative access (median survival VATS 86 months versus open 26.2 months, p¼0.12). There was no difference in disease-free survival from NSCLC between the two groups (VATS median 86 months versus open median DFS 15.9 months, p¼0.21). The length of stay was shorter in the VATS cohort (7 days versus 8 days, p¼0.008). The number of lung cancer cases performed as VATS at our institution has increased from 41% between 2002 and 2011 to 84% since 2014. The rate of VATS pneumonectomy has increased from 18% between 2002 and 2011 to 58.6% since 2014, however this increase lagged three years behind less major resections (i.e. lobectomy). Conclusion: In concordance with other recent retrospective cohort studies, our study demonstrates both the safety of VATS pneumonectomy and the oncological efficacy in appropriately selected patients. References: 1. Sahai RK, Nwogu CE, Yendamuri S et al. Is thorascopic pneumonectomy safe? Ann Thorac Surg. 2009;88:10861092. 2. Nagai S, Imanishi N, Matsuoka et al. Video-assisted thorascopic pneumonectomy: retrospective outcome analysis of 47 consecutive patients. Ann Thorac Surg. 2014;97(6):1908-1913. Keywords: VATS, pneumonectomy
P3.16-046 Pneumonectomy After Induction/Neoadjuvant Treatment for NSCLC: Morbidity, Mortality and LongTerm Survival C. Gebitekin,1 A. Toker,2 W. Weder,3 H. Melek,1 B. Özkan,2 I. Opitz,4 G. Cetinkaya,1 S. Collaud,4 A. Bayram1 1Thoracic Surgery, Uludag University, Bursa/TR, 2Thoracic Surgery, Istanbul University, Istanbul/ TR, 3Thoracic Surgery, University Hospital Zurich, Zurich/CH, 4Thoracic Surgery, Zurich University Hospital, Zurich/CH
Journal of Thoracic Oncology
Vol. 12 No. 11S2
Background: To compare the effects of neoadjuvant/induction chemotherapy or chemoradiation on morbidity, mortality, and longterm survival in patients with locally advanced NSCLC undergoing pneumonectomy. Method: All pneumonectomies following neoadjuvant treatment performed for NSCLC between 2000 and 2016 were retrospectively reviewed. The study included 162 patients (28 females; median patient age, 55.4 years [range, 31e73]). Neoadjuvant treatment consisted of chemotherapy in 115 patients (71%, group I) and chemoradiation in 47 patients (29%, group II). Chemotherapy was cisplatin-based, and 2e6 cycles of treatment were completed. Radiotherapy was administered sequentially (dose, 45e60 Gy). Surgery was performed 3e6 weeks after neoadjuvant treatment. Both groups were assessed for 90-day mortality, morbidity, and long-term survival. Result: Right pneumonectomy was performed in 60 (37%) patients, and the procedure was completed in a standard manner in 64.2% of the patients. Morbidity was observed in 27.7% of the patients (27,8% in group I; 27.6% in group II,p¼0.98). The incidence of bronchopleural fistula was 4.3% (4.2% in group I; 4.3% group II). The 90-days mortality rate was 3.1% (5 patients in group I, 0 in group II,p¼0.17). The mortality rates for right and left pneumonectomy were 3.3 (2/60 patients) and 3% (3/102 patients), respectively (p¼0.61). The 5-year survival rates were 46.2% in group I and 54.2% in group II, (P ¼ 0.16). Conclusion: Pneumonectomy after neoadjuvant chemotherapy or chemoradiation appears to be safe with an acceptable morbidity, mortality, and long-term survival. Chemoradiation did not improve long-term survival compared to chemotherapy despite comparable 90-day mortality and postoperative morbidity. Keywords: pneumonectomy, mortality, Neoadjuvant treatment
P3.16-047 Salvage Surgery for Locoregional Recurrence or Persistent Residual Tumor After Definitive Chemoradiation Therapy J. Osawa,1 H. Ito,2 M. Nito,1 K. Inafuku,1 J. Samejima,1 T. Nagashima,1 H. Nakayama,1 K. Yamada,2 T. Yokose3 1Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama/JP, 2 Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama/JP, 3Pathology, Kanagawa Cancer Center, Yokohama/JP Background: There are few treatment options with curative intent for locoregional recurrence or residual tumor of locally advanced lung cancer after definitive chemoradiation therapy. Lung resection; salvage surgery is likely to be one of the options for local control in this situation. However, perioperative complications and survival benefit of salvage surgery are not well-reported. Method: Patients who underwent lung resection after definitive chemoradiation therapy for the treatment of non-small cell lung cancer were selected. Frequency and content of perioperative complications, 5-y overall survival rate and disease free survival rate were retrospectively analyzed. Result: A total of 13 patients treated between January 2001 and December 2016 were eligible for evaluation. (12 men and 1 women, mean age 54 years, Median follow-up was 39.7 months.) The indication for surgery was primary tumor regrowth (69%) or tumor persistence (31%). The prior median radiation therapy dose was 60Gy (range 60-77Gy). The indication of for surgery were primary tumor regrowth (8 patients)or tumor persistence(5 patients). All patients underwent an anatomical resection, surgical procedure included lobectomy in 10 patients, pneumonectomy in 2 patients, bilobectomy in 1 patients. 2 patients underwent a bronchoplasty. Median estimated blood loss was 247ml, and median operative duration was 278 min. Compared with anatomical resection we usually perform, salvage surgery needs longer
November 2017 operative duration. Postoperative complications occurred in 4 patients(31%) without perioperative death within 90 days: arrhythmia, delayed pulmonary fistula, acute exacerbation of interstitial pneumonia and empyema. the 5-y overall survival and 5-y recurrence free survival rate were 73.3% and 55.0%,respectively. Conclusion: Salvage surgery for locoregional recurrence or residual tumor after definitive chemoradiotherapy was acceptable in safety. It should be considered as a treatment option for selected patients. However, the technique of salvage surgery is complicated, it needs an adequate experience. Keywords: lung cancer, salvage surgery, chemoradiation
P3.16-048 The Role of Pulmonary Resection in Stage IVa NonSmall Cell Carcinoma Patients T. Igarashi,1 K. Hayashi,1 K. Okamoto,1 R. Kaku,1 Y. Kataoka,1 Y. Kawaguchi,1 M. Hashimoto,1 Y. Ohshio,1 K. Teramoto,2 J. Hanaoka1 1Department of Surgery, Shiga University of Medical Science, Otsu/JP, 2Department of Medical Oncology, Shiga University of Medical Science, Otsu/JP Background: In non-small cell lung cancer (NSCLC), pulmonary resection for stage IV patients was not recommended in standard therapy. However, various new treatments for advanced or recurrence NSCLC patients such as molecular-targeted therapy for driver oncogenes or immune checkpoint therapy have improved the survival of those patients in these days. Therefore, we need to review the role of surgery for advanced NSCLC patients again. Method: Clinical records of 334 patient diagnosed stage IV in Shiga University of Medical Science between 2006 and 2015 were reviewed and clinicopatholocgial features and overall survival were analyzed retrospectively. Result: 32 patients underwent surgery in this period, and the patients included 25 men and 7 women, with median age of 70.0 years (52-82 years). There were 22 adenocarcinomas, 8 squamous cell carcinomas and 2 other histological subtypes. Surgery included 19 pulmonary resections, 3 spinal fixation surgery, 7 intracranial surgery and 3 other surgery. Median overall survival following surgery or non-surgery was 15.8 month and 9.9 months, respectively (P¼0.002). Moreover, in 19 cases of pulmonary resection, there were 7 patients with pleural disseminations (IVa) and 12 patients with distant metastases (IVb). In case with disseminations (IVa), median overall survival was also significantly longer in patients with pulmonary resection than in those of non-operative 31 patients in the same period (42.2 months vs 8.3 months, P¼0.038). Conclusion: Although further study in larger sets of patients would be warranted, surgery should not be excluded from treatment modality for stage IV patients, especially IVa cases if we could selected appropriately. Keywords: Non-small cell carcinoma, dissemination, pulmonary resection
P3.16-049 Surgery with Continued TKI Therapy After Acquiring Resistance to EGFR or ALK TKI S. Ohara,1 Y. Kobayashi,2 T. Fujino,2 Y. Sesumi,3 M. Nishino,2 M. Chiba,4 M. Shimoji,2 K. Tomizawa,2 T. Takemoto,3 T. Mitsudomi2 1 Kindai University, Osaka Sayama City/JP, 2Thoracic Surgery, Kindai University Faculty of Medicine, Osaka-Sayama/JP, 3Thoracic Surgery, Kinki University Faculty of Medicine, Osaka-Sayama/JP, 4 Division of Thoracic Surgery, Kinki University Faculty of Medicine, Osaka-Sayama/JP
Abstracts
S2361
Background: Lung cancer with ALK or EGFR activation inevitably acquires resistance to respective TKIs despite an initial good response. Relapses with only a limited number of regions, so-called oligo-recurrences, occur in a subset of such patients. Here, we present two cases of lung cancer treated with surgery and continued TKI therapy after acquiring resistance to EGFR or ALK TKI. Method: Retrospecive review of patient charts. Result: Case1: A 46-year-old man was diagnosed as having ALK-positive adenocarcinoma with pleural dissemination by exploratory thoracotomy. After 2.5 years’ treatment with alectinib, the primary tumor in the left lower lobe gradually progressed. Left S6 segmentectomy was performed. Genetic analyses of resected specimens revealed ALK G1202R resistant mutation. Alectinib treatment was resumed after surgery and the patient is free of disease 1.5 year after surgery. Case2: A 65-year-old woman presented with lung cancer with ureteral metastasis. Genetic analyses of resected ureteral tumor revealed EGFR L858R point mutation. Gefitinib was initiated and partial response was observed. After 1 year treatment with gefitinib, right middle lobectomy was performed to resect the remaining tumor. Gefitinib treatment was continued and recurrence-free survival of 2 years was achieved. Conclusion: These two patients appear to benefit from surgery and continued TKI therapy after acquiring resistance to EGFR or ALK TKI. It may be one of the treatment strategy in selected patients. Keywords: EGFR, ALK, oligo-recurrence
P3.16-050 Stromal PDGFR-b Expression Influences Postoperative Survival of NSCLC Patients Receiving Preoperative Chemo- or Chemo-Radiotherapy R. Kanzaki,1 H. Naito,2 D. Eino,2 T. Kawamura,1 N. Ose,1 S. Funaki,1 Y. Shintani,1 M. Minami,1 M. Okumura,1 N. Takakura2 1General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka/ JP, 2Research Institute for Microbial Diseases, Osaka University, Suita/JP Background: Platelet-Derived growth factor beta (PDGFR-b) is a functional regulator of mesenchymal cells. It is reported that PDGFR-b is expressed by cancer associated fibroblasts, and PDGFR signaling supports cancer cells. Stromal expression of PDGFR-b is reported to be associated with poor prognosis in prostate, breast, pancreas, and gastric cancers. However, the significance of stromal PDGFR-b expression in non-small cell lung cancer (NSCLC) in patients undergoing preoperative chemo- or chemoradio-therapy had not been undetermined. Method: Seventy-two patients with NSCLC undergoing preoperative chemo- or chemoradio-therapy between 1996 and 2006 were assessed for expression of stromal PDGFR-b by immunohistochemistry using resected specimens. After cancer cells and stromal tissues were identified by HE staining, stromal PDGFR-b expression was defined as positive when it was observed in >5% of the stromal area. Relationships between stromal PDGFR-b expression and disease-free survival (DFS) and disease-specific survival (DSS) were analyzed. Result: The mean age of the 72 patients was 59.7 years. Sixty-one (85%) were male and 11 (15%) female. Forty patients (56%) underwent preoperative chemoradiotherapy and 32 patients (44%) underwent preoperative chemothearapy. Indications for preoperative chemotherapy were N2 disease in 51 (71%), T3 or T4 disease in 20 (28%), and other reasons in the remaining patient (1%). Regimens for preoperative chemotherapy were cisplatin (CDDP)-based in 34 patients (47%) and carboplatin (CBDCA)-based in 37 (52%). Type of resection were pneumonectomy in 7 (10%), bilobectomy in 6 (8%), lobectomy in 57 (79%), and sublobar resection in 2 (3%) patients. Complete resection were achieved in 59 patients (82%). The pathologic stage (7th ed.) was IA in 11 (15%), IB in 12 (17%), IIA in 6 (8%), IIB in14 (19%), IIIA in 19 (27%), IIIB in 5 (7%), and IV in 5 (7%) patients. The histological type