The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 369
Poster Session
PS 1443 Hemato-Oncology (Oncology) Concurrent Chemo-Radiation Therapy with Docetaxel of Primary Cardiac Angiosarcoma
Youngwoo Jang1, Heekyung Ahn1, Eunyoung Kim1, Jungkeun Moon1, Yangbin Jeon1, Kyuchan Lee1, Yeonho Park1, Eunyoung Cho1
Gachon University Gil Hospital, Korea1
Primary cardiac cancer is a very rare disease, as the prevalence is 0.001 to 0.03%.
Primary cardiac angiosarcoma is one of the most frequent types of primary cardiac cancers, however, is characterized by extremely poor prognosis, as the mean survival is reported to be only three to four months, and optimal treatment is unknown. Here we report a patient of primary cardiac angiosarcoma with hemorrhagic pericardial effusion who achieved a durable response with tumor excision followed by concurrent chemoradiotherapy with docetaxel. A sixty year old male with underlying history of diabetes mellitus presented with rapidly progressing shortness of breath. Cardiac tam- ponade was diagnosed, and 420 cc of bloody fl uid was drained with pericardiocente- sis. The patient’s blood pressure was restored to within normal limit after pericardial effusion drainage. Subsequent chest computed tomography scan, echocardiography and cardiac Magnetic Resonance Image revealed a 4.5x3.5cm sized infi ltrative mass in the right atrium. Tumor excision was performed, of which pathologic fi ndings revealed cardiac angiosarcoma with tumor involvement of resection margin. The patient under- went adjuvant radiotherapy (5000cGys/30fractions) with concurrent chemotherapy with docetaxel. There was no evidence of recurrence until ten months later, when multiple liver metastases were found on CT scan. Hepatic metastasectomy with peri- op chemotherapy with weekly paclitaxel was followed. As of Jul 2014, the patient is receiving chemotherapy with overall survival of 16 months and counting. Currently there are only three published case reports of cardiac angiosarcoma which showed response to radiation and taxane, and this is the fourth case report of successful treatment. Further investigation on this regimen is warranted.
PS 1444 Hemato-Oncology (Oncology) Comparison of Recist 1.0 and Recist 1.1 in Patients with Metastatic Cancer: A Meta-Analysis
Jin Ju Park1, Jung Han Kim1, Hyeong Su Kim1
Departments of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Korea1
Background: We conducted this meta-analysis to investigate the impact of RECIST 1.1 on the selection of target lesions and classifi cation of tumor response, in comparison with RECIST 1.0.
Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE for articles with terms of ‘RECIST 1.0 or RECIST 1.1. We looked into all abstracts and virtual meeting presentations from the conferences of the American Society of Clinical Oncology and European Society for Medical Oncology held between 2009 and 2013.
Results: There were six articles in the literature comparing the clinical impacts of RECIST 1.0 and RECIST 1.1 in patients with metastatic cancer. A total of 359 patients were recruited from the six trials; 217 with non-small cell lung cancer, 61 with gastric cancer, 58 with colorectal cancer, and 23 with thyroid cancer. The number of target lesions by RECIST 1.1 was significantly lower than that by RECIST 1.0 (p<0.0001).
Because of the new lymph node (LN) criteria, fourteen patients (3.1%) had no target lesions when adopting RECIST 1.1. RECIST 1.1 showed high concordance with RECIST 1.0 in the assessment of tumor responses (k = 0.903). Sixteen patients (4.8%) showed disagreement between the two criteria. The most common cause of discordance was the new LN criteria (9 patients), followed by the maximum of target lesions in RECIST 1.1 (6 patients).
Conclusions: RECIST 1.1 provided a highly concordant response assessment with RE- CIST 1.0 in patients with metastatic cancer. Because of the more stringent LN criteria, however, RECIST 1.1 may adversely affect the patients’ eligibility for clinical trials.
PS 1445 Hemato-Oncology (Oncology) Tumor Response Assessment by the Single-Lesion Measurement per Organ
Hyun chang Choi1, Jung Han Kim1, Hyeong Su Kim1
Departments of Internal Medicine, Kangnam Sacred-Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Korea1
Background: The criterion of two target lesions per organ in RECIST version 1.1 is an arbitrary one, not being supported by any objective evidence. We compared tumor responses respectively using RECIST 1.1 and modifi ed RECIST 1.1 in patients with ad- vanced or metastatic gastric cancer (GC), colorectal cancer (CRC), and non-small cell lung cancer (NSCLC)
Methods: We reviewed medical records of patients with advanced or metastatic GC, CRC, and NSCLC who received a fi rst-line chemotherapy between January, 2004 and December, 2013 and compared the best tumor responses according to two criteria using computed tomography.
Results: A total of 153 patients who had at least two target lesions in any organ according to RECIST 1.1 were included in this pooled study: 64 with NSCLC, 51 with GC, and 38 with CRC. Regardless of the primary sites, the number of target lesions according to mRECIST 1.1 was signifi cantly lower than that according to RECIST 1.1 (p<0.001). The assessment of the best tumor responses showed high concordance be- tween the two criteria, with a kappa value of 0.907 (95% CI, 0.844-0.970). Only eight patients (5.2%) showed disagreement in the best response assessment between the two criteria. Six patients showed disagreement between PR and SD, and two showed disagreement between SD and PD. The overall response rates of chemotherapy, which were calculated regardless of the primary sites and anti-cancer treatment, were not signifi cantly different between the two criteria (33.3% versus 33.3%, p=1.0).
Conclusion: The modifi ed RECIST 1.1 was comparable to the original RECIST 1.1 in the tumor response assessment of patients with metastatic NSCLC, GC, and CRC. Our results suggest that it may be suffi cient to measure the single largest target lesion per organ for evaluating the best tumor response
