WCIM 2014 SEOUL KOREA 405
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
P-40 Hepato-Biliary-Pancreatic Cancer Improvement in Locoregional Control with Radiation Dose Escalation for R1 Resected Extrahepatic Bile Duct Cancer
Byoung Hyuck Kim1, Eui Kyu Chie1, Kyubo Kim1, Jin-Young Jang2, Sun Whe Kim2, Sae- Won Han3, Do-Youn Oh3, Seock-Ah Im3, Tae-You Kim3, Yung-Jue Bang3, Sung W. Ha1 Departments of Radiation Oncology, Seoul National University Hospital, Korea1, Departments of Surgery, Seoul National University Hospital, Korea2, Departments of Internal Medicine, Seoul National University Hospital, Korea3
Background: To date, there is a paucity of information regarding optimal radiation dose after microscopic positive (R1) resection in patients with extrahepatic bile duct cancer. This study was conducted to evaluate the impact of radiation dose escalation for R1 resection margin (RM).
Methods: A retrospective review was performed on 251 patients who underwent curative resection followed by adjuvant chemoradiotherapy between 1995 and 2009.
Eighty-six patients had R1 RM which included invasive carcinoma (n=63) and carci- noma in situ/high-grade dysplasia (n=23). Among them, 54 patients received radiation dose < 54 Gy (range, 40-50.4 Gy) and 32 patients received = 54 Gy (range, 54-56 Gy).
Concomitant fl uoropyrimidine-based chemotherapy was administered. Acute and late gastrointestinal (GI) toxicity were evaluated using Radiation Therapy Oncology Group criteria. The median follow-up duration was 27 months for all patients and 92 months for survivors.
Results: Radiation dose = 54 Gy was associated with improved locoregional control (LRC) (5yr rate, 73.8% vs. 47.1%, p = 0.038), but not disease-free survival (5yr rate, 43.4% vs. 32.6%, p = 0.427) and overall survival (5yr rate, 40.6% vs. 29.6%, p = 0.393).
In multivariate analysis for LRC, R1 with invasive carcinoma (HR 3.31, 95% CI 1.11-9.85, p = 0.032) and radiation dose < 54 Gy (HR 3.09, 95% CI 1.14-8.39, p=0.027) were independent adverse prognostic factors. Between the two dose groups, there was no signifi cant difference in acute GI toxicity =grade 2 and in late GI toxicity =grade 3.
Conclusions: The current study demonstrated that radiation dose = 54 Gy was asso- ciated with improved LRC in patients with R1 RM and also well tolerated. Therefore, dose escalation could be considered for R1 RM. Prospective study is needed to verify these results.
P-42 Hepato-Biliary-Pancreatic Cancer Multicenter Phase II Study of Docetaxel and Oxaliplatin Combination in Patients with Locally Advanced or Metastatic Biliary Tract Cancer
Eun-Kee Song1, Hye-Suk Han2, Ki-Hyeong Lee2, Kyu Taek Lee3, Sang Byung Bae3, Han Jo Kim3, Samyong Kim4, Hwan Jung Yun4, Sang Hee Cho5, Hyun-Jeong Shim5, Ho- Young Yhim1, Na-Ri Lee1, So Yeon Jeon1, Chang-Yeol Yim1
Department of Internal Medicine, Chonbuk National University Medical School, Korea1, Department of Internal Medicine, Chungbuk National Unviersity College of Medicine, Korea2, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Korea3, Department of Internal Medicine, Chungnam National University College of Medicine, Korea4, Department of Internal Medicine, Chonnam National University Medical School, Korea5
Background: Patients with biliary tract cancer have a poor prognosis and the palliative chemotherapy has shown limited effi cacy. This phase II study aimed to evaluate the effi cacy and safety of a combination of docetaxel and oxaliplatin as fi rst-line therapy in patients with advanced biliary tract cancer.
Methods: Patients with biliary tract cancer have a poor prognosis and the palliative chemotherapy has shown limited effi cacy. This phase II study aimed to evaluate the effi cacy and safety of a combination of docetaxel and oxaliplatin as fi rst-line therapy in patients with advanced biliary tract cancer.
Results: 20 patients (2 patients had locally advanced disease and 18 had metastatic disease) with median age of 57 years (range 45-74) were enrolled. Response was as- sessable in 18 patients (early death in two). ORR was 4/18 (22.2%; 95% CI, 4.0-40.4%) and disease control rate (PR + SD) was 12/18 (66.7%; 95% CI, 46.0-87.4%). At a median follow-up time of 23.2 months (range 2.3-37.8), median PFS for all patients was 2.8 months (95% CI, 1.7-3.9 months) and median OS was 10.0 months (95% CI, 2.4-17.7 months). The most common grade 3 or 4 hematologic and nonhematologic toxicities were neutropenia (40.0%) and peripheral neuropathy (10.0%), respectively.
Conclusions: Docetaxel and oxaliplatin combination was moderately active and fea- sible in patients with locally advanced or metastatic biliary tract cancer. This regimen warrants further investigation as a fi rst- or second-line therapy for the treatment of unresectable biliary tract cancer.
P-43 Hepato-Biliary-Pancreatic Cancer Second-Line Therapy in Advanced Biliary Tract Cancer, Retrospective Analysis
Hyun Jung Kim1, Jina Yun1, Han Jo Kim3, Kyoung Ha Kim2, Se Hyung Kim1, Sang-Cheol Lee3, Sang Byung Bae3, Chan Kyu Kim1, Nam Su Lee2, Kyu Taek Lee3, Seong Kyu Park1, Jong-Ho Won2, Hee Sook Park2, Dae Sik Hong1
Soonchunhyang University Hospital Bucheon, Korea1, Soonchunhyang University Hospital Seoul, Korea2, Soonchunhyang Univeristy Hospital Cheonan, Korea3
Background: We investigated the treatment outcomes of 2nd line palliative chemo- therapy in patients with advanced biliary tract cancer (BTC) and analyzed the affecting factors to response or survivals
Methods: We retrospectively reviewed and analyzed the outcomes in advanced BTC patients who underwent 2nd line chemotherapy, histologic confi rmed as adenocarcino- ma, and treated in Soonchunhyang Universitiy Hospital (Seoul, Bucheon and Cheonan) between Dec 2004 and May 2014. The term of overall survival (OS) from the diagnosed date was designated as OS1 and OS from the date begin the 2nd line therapy as OS2.
Results: In total 65 patients, median age was 56 years (40-76) and the ratio of cholan- giocarcinoma : gall bladder cancer: ampulla of vater cancer was 41(63.1%): 18 (27.7%):
6 (9.25). The half patients (33 patients) were treated with gemcitabine based and 28 patients (43.1%) with 5FU based. The response rate (RR) was 3.0% and disease control rate was 21.5% in ITT analysis. There was no signifi cant affecting factor on RR. The median OS1 and OS2 was 13.3 months (95% CI 7.3-19.3) and 7.2 months (95% CI 3.9- 10.5 months). The progression free survival (PFS) was 3.7 months (95% CI 2.5-4.9). The prognostic factors for OS1 or OS2 were Performance Status (PS) (P=0.001, 0.003) and response to the 1st line therapy (P=0.001, 0.046), and the responder to the 2nd line therapy was good prognostic factor for the OS2 (P=0.004) or PFS (P=0.000) in multivar- iate analysis. The major hematologic toxicity was neutropenia (Gr 3-4 36.9%) and the Gr 3-4 non-hematologic toxicities were rare.
Conclusion: In advanced BTC, the effect of 2nd line chemotherapy was modest, but maybe beneficial in selected patients. The randomized clinical trials for the 2nd line chemotherapy in good PS patients with chemo-sensitive tumor in initial therapy are needed.
P-46 Lung Cancer
EGFR Activating Mutation and Pattern of Brain Metastasis in Non-Small Cell Lung Cancer
Hee Kyung Ahn1, Young Saing Kim1, Inkeun Park1, Junshik Hong1, Sun Jin Sym1, Jinny Park1, Dong Bok Shin1, Jae Hoon Lee1, Eun Kyung Cho1
Gachon University Gil Medical Center, Korea1
Background: The aim of this study is to examine the association of the timing and survival of brain metastasis(BM) according to EGFR mutation status in patients with non-small cell lung cancer(NSCLC).
Methods: We retrospectively reviewed patients with advanced non-small cell lung cancer (NSCLC) who underwent EGFR mutation analysis at a single center from Janu- ary 2010 to August 2013. Among 268 patients identifi ed, 67 patients with BM during the course of the disease were fi nally included in analysis. Survival was estimated with the Kaplan-Meier method and compared using the log-rank test.
Results: Among the 67 patients with BM, 25 patients had EGFR activating mutations (deletion in exon 19 or L858R). Two patients had missense mutations in exon 20 and 40 patients had wild-type EGFR. BM was signifi cantly more prevalent in patients with EGFR mutation (39%) than those with EGFR WT (23%) (p=0.015). BM was the fi rst metastasis site in 30% of patients with EGFR mutation and 14% of patients with EGFR WT. Among patients with metachronous BM development, median time to BM development had a trend toward longer in patients with EGFR mutation (13.6 months) than in patients with EGFR WT (8 months) without signifi cance. Median overall sur- vival from BM(BM OS) was signifi cantly longer in patient with EGFR mutation (25.1 months vs. 6.9 months, p<0.001). In subgroup analysis, BM OS was significantly longer in patients with EGFR mutation among those with synchronous BM(p<0.001), however the difference in BM OS was not signifi cant in patients with metachronous BM development.
Conclusions: NSCLC patients with EGFR mutation were more prevalent with synchro- nous BM. EGFR mutation was associated with signifi cantly longer survival from BM diagnosis, especially in those with synchronous BM development.
