Dünya Akciğer Kanseri Konferansı nın ardından. Akciğer Kanserinde 2015 te Yenilik Var Mı?

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2 Dünya Akciğer Kanseri Konferansı nın ardından Akciğer Kanserinde 2015 te Yenilik Var Mı? Dr. Serhan Tanju Koç Üniversitesi Tıp Fakültesi Göğüs Cerrahisi Anabilim Dalı 2

3 Trimodality Therapy in the Treatment of Stage IIIA Non- Small Cell Lung Cancer (NSCLC): A National Cancer Database Analysis Madhusmita Behera1, Conor Steuer2, Felix Fernandez3, Yuan Liu4, Chao Fu4, Theresa W. Gillespie4, Kristin A. Higgins5, Nabil Saba2, RathiN. Pillai6, Seth Force3, Suchita Pakkala2, Dong Shin2, Taofeek K. Owonikoko2, Chandra P. Belani7, Walter J. Curran5, Fadlo Khuri8, Suresh S. Ramalingam8 1Hematology/Medical Oncology, Winship Cancer Institute of Emory University, Atlanta/United States of America, 2Emory, Atlanta/United States of America, 3Thoracic Surgery, Emory University Winship Cancer Institute, Atlanta/United States of America, 4Biostatistics and Bioinformatics, Emory University Winship Cancer Institute, Atlanta/United States of America, 5Radiation Oncology, Emory University Winship Cancer

4 Method National Cancer Database American College of Surgeons American Cancer Society KHDAK Evre IIIA-N2 KT/RT KT/RT + lobektomi KT/RT+ pnömonektomi Madhusmita Behera et al, IASLC, 2015

5 Madhusmita Behera et al, IASLC, 2015

6 Madhusmita Behera et al, IASLC, 2015

7 Sağkalım E vs K HR 1.19 ( ), p<0.001 Akademik merkez vs diğer HR 1.14 ( ), p=0.002 HR 1.13 ( ), p<0.001 Sağ vs Sol pnömonektomi HR 0.84 ( ), p=0.4 Madhusmita Behera et al, IASLC, 2015

8 Madhusmita Behera et al, IASLC, 2015

9 Madhusmita Behera et al, IASLC, 2015

10 Akılda kalan sorular Cerrahi uygulanan seçilmiş hastalar, Multidisipliner konsey KT/RT (tedavi şeması?) Komplet rezeksiyon oranı?

11 Mediastinal Lymphadenectomy Fulfilling NCCN Criteria May Improve the Outcome of Clinical N0-1 and Pathological N2 Non- Small Cell Lung Cancer Nan Wu1, Xing Wang1, Shi Yan1, Kevin Phan2, Tristan D Yan3, Lijian Zhang1, Yue Yang1 1Department of Thoracic Surgery Ii, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing/China, 2Collaborative Research (Core) Group, Sydney University Surgical Society, Sydney/NSW/Australia, 3The Collaborative Research (Core) Group, The Annals of Cardiothoracic Surgery, Sydney/NSW/Australia

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13 (retrospektif analiz) 712-cN0/1 olgu CT de <10mm veya PET/CT de SUV(max) <2 Grup A (%61.7) Mediastinal değerlendirme-nccn Grup B Diğer

14 712 olgu pn0: 450 (%63.2) pn1:110 (%15.4) pn2:152 (%21.3) Median takip 49.5 ay ( ) Sağkalım (5 yıl) pn0: %80±2 pn1: %60±5 pn2: %45±4

15 Sağkalım Grup A vs Grup B

16 Mediastinal değerlendirme 3 istasyon vs >3 istasyon

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18 Quality of Resection in Pathological N2 NSCLC in the Phase 3 Lung Adjuvant Radiotherapy Trial (Lung ART): An Important Factor Pascal-Alexandre, Thomas1, John Edwards2, Paul Van Schil3, Ramon Rami-Porta4, Gisele Goma5, Ariane Dunant6, Cecile Le Pechoux7 1 Thoracic Surgery, North University Hospital, Aix-Marseille University & Hospitals, Marseille/France, 2Thoracic Surgery, Northern General Hospital, Sheffield/United Kingdom, 3Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp/Belgium, 4Thoracic Surgery, Hospital Universitari Mutua Terrassa, and Ciberes Lung Cancer Group, Terrassa/Spain, 5Biostatistics, Gustave Roussy, Villejuif/France, 6Biostatistics, Gustave-Roussy, Paris Sud University, Villejuif/France, 7Radiation Oncology, Gustave-Roussy, Paris Sud University, Villejuif/France 18

19 Lung (ART) Nisan 2015: 298 olgu 4 cerrah: 116 olgu- (QSR) açısından değerlendirme Komplet R0 rezeksiyon + uygun lenf nodu değerlendirilmesi İnkomplet R1-2 Kararsız Yetersiz mediastinal değerlendirme 19

20 «Most adjuvant trials have included completely resected patients, without monitoring of the quality of nodal exploration and resection. This analysis outlines the importance of an external committee evaluating the quality of resection in stage IIIA-N2 NSCLC, and the findings of this audit will be useful in the interpretation of the results of the trial.» Pascal-Alexandre, Thomas,

21 STAS «Spread Through Air Spaces» 21