Search

Background Computed tomography (CT) is essential for pulmonary nodule detection in diagnosing lung cancer. As deep learning algorithms have recently been regarded as a promising technique in medical fields, we attempt to integrate a well-trained deep learning algorithm to detect and classify pulmonary nodules derived from clinical CT images. Materials and Methods Open-source data sets and multicenter data sets have been used in this study. A three-dimensional convolutional neural network (CNN) was designed to detect pulmonary nodules and classify them into malignant or benign diseases based on pathologically and laboratory proven results. Results The sensitivity and specificity of this well-trained model were found to be 84.4% (95% confidence interval [CI], 80.5%–88.3%) and 83.0% (95% CI, 79.5%–86.5%), respectively. Subgroup analysis of smaller nodules ( Conclusion Under the companion diagnostics, the three-dimensional CNN with a deep learning algorithm may assist radiologists in the future by providing accurate and timely information for diagnosing pulmonary nodules in regular clinical practices. Implications for Practice The three-dimensional convolutional neural network described in this article demonstrated both high sensitivity and high specificity in classifying pulmonary nodules regardless of diameters as well as superiority compared with manual assessment. Although it still warrants further improvement and validation in larger screening cohorts, its clinical application could definitely facilitate and assist doctors in clinical practice.

e15032 Background: EGFR is a major oncogene in non-small cell lung cancer (NSCLC) patients. Although EGFR tyrosine kinase inhibitors (TKIs) have effectively improved the survival of NSCLC patients, acquired drug resistance is a critical clinical challenge. Minimal residual disease (MRD) is the direct cause of tumor recurrence, and the abundance of circulating tumor DNA (ctDNA) can be used to reflect the status of MRD. We sought to identify the evaluation of effect of ctDNA on tumor therapeutic efficacy. Methods: Blood samples from 32 advanced NSCLC patients were dynamically collected at different timepoints (0, 4, 8, 12, months) with 1 sampling in 6 patients, 2 samplings in 15 patients, 3 samplings in 7 patients, 4 samplings in 3 patients, and 5 samplings in 1 patient. Targeted sequencing of 450 cancer-related genes were performed for genomic alteration identification at OrigiMed, a College of American Pathologists (CAP) accredited and Clinical Laboratory Improvement Amendments (CLIA) certified laboratory in Shanghai, China. The average variant allele frequency of each sample was used to represent ctDNA abundance. Results: A total of 32 advanced NSCLC patients harboring EGFR sensitive mutations were enrolled in the study. Patients consisted of 12 (37.5%) males and 20 (62.5%) females, with a median age of 60 years old, ranged from 38 to 82 years old. These patients were randomly divided into TKI monotherapy group (N = 11) or TKI treatment combined with pemetrexed group (N = 21). The percentage of stable disease (SD) was more pronounced in patients receiving TKI combined with chemotherapy when compared to patients treated with TKI monotherapy (47.6% [10/21] vs. 36.4% [4/11], respectively). Less patients experienced the progression of disease (PD) when they were treated with TKI combined with chemotherapy than those receiving TKI monotherapy (52.4% [11/21] vs. 63.6% [7/11], respectively). For patients with PD, ctDNA abundance was progressively increased in 55.6% (10/18) during dynamic monitoring; whereas ctDNA abundance kept stable in 44.4% (8/18) patients, while 6/8 patients did not continue to perform ctDNA detection for more than half a year. In patients experienced SD, ctDNA abundance was declined in 78.6% (11/14) during dynamic monitoring, while 21.4% (3/14) patients displayed elevated ctDNA abundance. These 3 patients did not continue to perform ctDNA detection for more than 10 months. In majority of NSCLC patients (65.6% [21/32]), variation of ctDNA abundance was correlated to the treatment-induced clinical response. Conclusions: In conclusion, our results suggested that the variation of ctDNA abundance could promptly reflect the clinical response of treatment. The dynamic variation of ctDNA/MRD can possibly be considered as a biomarker of clinical efficacy following treatment in NSCLC patients.

TPS12133 Background: Chemotherapy-induced nausea and vomiting (CINV) is a common side effect of cancer treatments, and dexamethasone offers an advantage over placebo for protection against chemotherapy-induced emesis in both acute and delayed phases. However, its side effects are diverse including moderate to severe insomnia, hyperglycemia, dyspepsia and so on, which are gathering increasing concerns. What’s more, dexamethasone is not applicable to all cancer patients. The incidence of diabetes mellitus varies in different cancer which can reach up to 55.3%, and dexamethasone might not be a proper anti-emesis choice for them. Besides, dexamethasone delivery is always on debating when patients are receiving immunotherapy. However, all anti-emesis regimen recommended in guidelines are dexamethasone based. Alternative anti-emesis regimen are required. Studies have shown that olanzapine plays an important role in treating delayed, refractory, breakthrough nausea and vomiting. Thus, we initiated this prospective, multi-center, phase III study to validate the dexamethasone-free protocol: the non-inferiority role of applying olanzapine to prevent CINV instead of dexamethasone. Methods: This clinical trial started on February 3, 2020 is being conducted in 23 centres. All patients eligible are chemotherapy naïve and plan to receive cisplatin-containing regimen. Based on a 70% complete remission rate of previous study, to demonstrate a non-inferiority margin of 10%, 548 patients are required for two arms with the consideration of 5% of drop out and lost to follow-up (80% power,α = 0.05). Study design: Enrolled patients are randomized 1:1 into 2 arms to receive olanzapine or dexamethasone combined with 5-HT3 receptor antagonist (palonosetron, granisetron or ondansetron) and NK-1 receptor antagonist (aprepitant or fosaprepitant) from the first day of chemotherapy. Olanzapine (5mg) is delivered orally per night from day 1 to day 4. Dexamethasone (12 mg) is given orally or intravenously within 30 minutes before cisplatin administrated on day 1; on day 2-4, the orally or intravenously given dose of dexamethasone is 8 mg. The primary endpoint is complete remission rate of vomiting during the whole observation period (0-120 hours from the starting of first course chemotherapy delivery). The secondary endpoints are complete remission rate of vomiting during 25-120 hours from the starting of first course chemotherapy delivery and no nausea rate during the whole observation period. Besides, side effects will be recorded according protocol. Clinical trial information: NCT04437017.

Background and Purpose: Cisplatin is the most common chemotherapeutic agent for loco-regionally advanced nasopharyngeal carcinoma (NPC); however, toxicity is a limiting factor for some patients. We retrospectively compared the efficacy and toxicity of weekly docetaxel-based and cisplatin-based concurrent chemoradiotherapy in loco-regionally advanced NPC. Methods and Materials: Eighty-four patients with Stage III and IVA-B NPCs, treated between 2007 and 2008, were retrospectively analyzed. Thirty received weekly docetaxel-based concurrent chemotherapy, and 43 were given weekly cisplatin-based concurrent chemotherapy. Radiotherapy was administered using a conventional technique (seven weeks, 2.0 Gy per fraction, total dose 70-74 Gy) with 6-8 Gy boosts for some patients with locally advanced disease. Results: Median follow-up time was 42.3 months (range, 8.6-50.8 months). There were no significant differences in the 3-year loco-regional failure-free survival (85.6% vs. 92.3%; p=0.264), distant failure-free survival (87.0% vs. 92.5%; p=0.171), progression-free survival (85.7% vs. 88.4%; p=0.411) or overall survival (86.5% vs. 92.5%, p=0.298) of patients treated concurrently with docetaxel or cisplatin. Severe toxicity was not common in either group. Conclusions: Weekly docetaxel-based concurrent chemoradiotherapy is potentially effective and has a tolerable toxicity; however, further investigations are required to determine if docetaxel is superior to cisplatin for advanced stage NPC.

Neoadjuvant chemotherapy for stage IIIA non-small cell lung cancer (NSCLC) remains controversial. The role of the expressions of P53, K-ras, HER2, vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR), CD44, and matrix metalloproteinase-9 (MMP-9) in predicting efficacy of neoadjuvant chemotherapy on stage IIIA NSCLC is still unclear although they have been found to be related to prognosis. This study was to determine the predictive effect of multi-gene expression on treatment outcome of neoadjuvant chemotherapy for resectable stage IIIA NSCLC.Expressions of p53, K-ras, HER2, VEGF, EGFR, CD44, MMP-9 in the patients enrolled in the prospective randomized controlled trial were detected by immunohistochemistry. The treatment efficacies of combination (neoadjuvant chemotherapy combined with surgery) group (36 patients) and surgery alone group (32 patients) were compared.The high gene expression rate was 58.3% in combination group, and 40.6% in surgery alone group(P=0.145). In combination group, no significant difference of disease-free survival rate (P=0.903) and survival time (P=0.238) was found between patients with histopathologic regression and patients without histopathologic regression; high gene expression had no correlation with pathologic regression (P= 0.862); the mean disease-free survival time was significantly lower in high gene expression subgroup than in low gene expression subgroup [(14.1+/-9.8) months vs. (27.2+/-13.6) months, P=0.032]; the 2-year disease-free survival rate was 38.1% in high gene expression subgroup, and 46.7% in low gene expression subgroup (P=0.607).Pathologic regression after neoadjuvant chemotherapy has no correlation with disease-free survival rate and survial time. The high gene expression maybe indicate high risk of postoperative metastasis; the necessity of postoperative chemotherapy needs further study.

To study the reasonable dosage for paraplatin according to different dosage calculations.A prospective, randomized, single-blinded study on 54 patients with advanced non-small-cell lung cancer (NSCLC) treated with paraplatin was conducted. Patients were divided to 2 groups. In group A, paraplatin dosage was calculated according to patients' body surface, and in group B, it was calculated according to the area under the curve (AUS). Hematological toxicity, response rate and survival rate in the two groups of patients were compared.Neutropenia in group A and group B was seen in 77.8% and 37.0% (P0.05), and thrombocytopenia in 18.5% and 3.7% (P0.05) of patients, respectively. Hemoglobin decrease was seen in 48.2% of patients in both groups. The average quantity of paraplatin given in one cycle of treatment was 535.93 +/- 106.71 mg and 398.52 +/- 71.72 mg (P0.01) respectively. The average time interval between treatment cycles was 27.04 +/- 5.30 d and 22.85 +/- 2.80 d (P0.05). The response rate and survival rate of patients in group A and B were 22.2% versus 48.2% (P0.05), and 40.7% versus 44.4% (P0.05) respectively, but the median survival time was identical (12 months) in the two groups.NSCLC patients given paraplatin with dosages calculated on the basis of AUC have higher response rate and less severe hematological toxicity than those given paraplatin with dosages on the basis of body surface. However, the median survival time and survival rate have no statistical differences between the two groups of patients.

To study the clinical application of needle video-assisted thoracoscopic biopsy in the pathologic diagnosis and staging for advanced lung cancer.Ninety-four patients were diagnosed as having advanced lung cancer staged IIIa-IV by chest X-ray, computed tomography and magnetic resonance imaging, for which a pathologic diagnosis was not made by sputum and pleural effusion cytology or bronchoscopic examination. Needle video-assisted thoracoscopic biopsy was performed for primary lesions, mediastinal lymph nodes, metastatic lesions in the lungs and the chest wall.Pathologic samples were obtained in 89 of the 94 patients by needle video-assisted thoracoscopic surgery. The successful rate was 95%. After operation, the pathologic diagnosis was confirmed to be lung cancer in all the 89 patients. Adenocarcinoma was found in 47 patients, squamous carcinoma in 23, adenosquamous carcinoma in 12, and small cell lung cancer in 7. Compared to the clinical diagnosis before operation, the pathologic diagnosis post-operation was changed in 15 patients. Pneumothorax and mild haemoptysis occurred in 4 patients and 2 of the cases respectively. All the patients were followed for 8 - 18 months with computed tomography and physical examination. No implantation metastasis was found.Needle video-assisted thoracoscopic biopsy is an effective diagnostic measure for patients with advanced lung cancer for which pathologic diagnosis, typing and staging are not determined by routine examinations.