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McLaughlin K, Tan KS, Dycoco J, Chen MF, Chaft JE, Mankuzhy NP, Rimner A, Aly RG, Fanaroff RE, Travis WD, Bilsky M, Bains M, Downey R, Huang J, Isbell JM, Molena D, Park BJ, Jones DR, Rusch VW. Superior sulcus non-small cell lung cancers (Pancoast tumors): Current outcomes after multidisciplinary management. J Thorac Cardiovasc Surg 2023; 166:1477-1487.e8. [PMID: 37611845 PMCID: PMC11229055 DOI: 10.1016/j.jtcvs.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/25/2023] [Accepted: 08/07/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Despite neoadjuvant chemoradiotherapy, Pancoast tumors still present surgical and oncologic challenges. To optimize outcomes, we used a multidisciplinary care paradigm with medical and radiation oncology, and involvement of spine neurosurgery for most T3 and all T4 tumors. Spine neurosurgery permitted resection of transverse process for T3 and vertebral body resection for T4 tumors. METHODS Retrospective analysis of single institution, prospective database of patients undergoing resection for cT3 4M0 Pancoast tumors. Patients were grouped as cT3 with combined resection with spine neurosurgery (T3 Neuro), cT3 without spine neurosurgery (T3 NoNeuro), and cT4. Overall survival, progression-free survival were analyzed by Kaplan-Meier and compared between groups using log-rank test. Cumulative incidence of local-regional and distant recurrence were compared using Gray test. P value <.05 was considered significant. RESULTS From 2000 to 2021, 155 patients underwent surgery: median age was 58 years, and 81 were (52%) men. Most patients received neoadjuvant platinum-based neoadjuvant chemoradiotherapy (n = 127 [82%]). Operations were 48 cT3 Neuro, 41 cT3 NoNeuro, 66 cT4. R0 resection was achieved in 49 (94%) cT3 NoNeuro, 35 (85%) cT3 Neuro, and 57 (86%) cT4 patients (P = .4). Complete or major pathologic response occurred in 71 (55%) patients. Lower local-regional cumulative incidence was seen in cT3 Neuro versus cT3 NoNeuro (P = .05) and after major pathologic response. Overall survival and progression-free survival were associated with complete response, pathologic stage, and nodal status but not cT category. CONCLUSIONS This treatment paradigm was associated with a high frequency of R0 resection, complete response, and major pathologic response. cT3 and cT4 tumors had similar outcomes. Novel therapies are needed to improve complete response.
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Affiliation(s)
- Kaitlin McLaughlin
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kay See Tan
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joe Dycoco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Monica F Chen
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jamie E Chaft
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nikhil P Mankuzhy
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rania G Aly
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rachel E Fanaroff
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark Bilsky
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manjit Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James M Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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2
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Hireche K, Moqaddam M, Lonjon N, Marty-Ané C, Solovei L, Ozdemir BA, Canaud L, Alric P. Combined video-assisted thoracoscopy surgery and posterior midline incision for en bloc resection of non-small-cell lung cancer invading the spine. Interact Cardiovasc Thorac Surg 2022; 34:74-80. [PMID: 34999810 PMCID: PMC8932506 DOI: 10.1093/icvts/ivab215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This article aims to evaluate the feasibility and safety of a hybrid video-assisted thoracic surgery (VATS) approach to achieve en bloc lobectomy and spinal resection for non-small-cell lung cancer (NSCLC). METHODS Between October 2015 and November 2020, 10 patients underwent VATS anatomical lobectomy and en bloc chest wall and spinal resection through a limited posterior midline incision as a single operation for T4 (vertebral involvement) lung cancer. Nine patients had Pancoast syndrome without vascular involvement and 1 patient had NSCLC of the right lower lobe with invasion of T9 and T10. RESULTS There were 5 men and 5 women. The mean age was 61 years (range: 47-74 years). Induction treatment was administered to 9 patients (90%). The average operative time was 315.5 min (range: 250-375 min). The average blood loss was 665 ml (range: 100-2500 ml). Spinal resection was hemivertebrectomy in 6 patients and wedge corpectomy in 4 patients. Complete resection (R0) was achieved in all patients. The average hospitalization stay was 14 days (range: 6-50 days). There was no in-hospital mortality. The mean follow-up was 32.3 months (range: 6-66 months). Six patients (60%) are alive without recurrence. CONCLUSIONS VATS is feasible and safe to achieve en bloc resection of NSCLC inviding the spine without compromising oncological efficacy. Further experience and longer follow-up are needed to determine if this approach provides any advantages over thoracotomy.
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Affiliation(s)
- Kheira Hireche
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Mathieu Moqaddam
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Nicolas Lonjon
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Charles Marty-Ané
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Laurence Solovei
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Baris Ata Ozdemir
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
- University of Bristol, Bristol, UK
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
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3
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Coster JN, Groth SS. Surgery for Locally Advanced and Oligometastatic Non-Small Cell Lung Cancer. Surg Oncol Clin N Am 2021; 29:543-554. [PMID: 32883457 DOI: 10.1016/j.soc.2020.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Locally advanced non-small cell lung cancer is a heterogeneous group of tumors that require multidisciplinary treatment. Although there is much debate with regard to their management, a multimodal treatment strategy for carefully selected patients that includes surgery can extend survival compared with nonoperative definitive therapy. As the role of targeted therapies and immune checkpoint inhibitors for these tumors becomes better defined, practices will continue to evolve.
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Affiliation(s)
- Jenalee N Coster
- Division of Thoracic Surgery, Micheal E. DeBakey Department of Surgery, Baylor College of Medicine, 7200 Cambridge St, Ste 6A. Houston, TX 77030, USA
| | - Shawn S Groth
- Division of Thoracic Surgery, Micheal E. DeBakey Department of Surgery, Baylor College of Medicine, 7200 Cambridge St, Ste 6A. Houston, TX 77030, USA.
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4
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Hao X, Wang Z, Cheng D, Zhou J, Chen N, Pu Q, Liu L. The Favorable Prognostic Factors for Superior Sulcus Tumor: A Systematic Review and Meta-Analysis. Front Oncol 2020; 10:561935. [PMID: 33194629 PMCID: PMC7606951 DOI: 10.3389/fonc.2020.561935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Superior sulcus tumor is a rare non-small cell lung cancer with poor prognosis. Exploring the potential prognostic factors of patients with superior sulcus tumor and adopting individualized treatment for patients with different prognostic factors are of great significance for the prolongation of patients' lives. To figure out the prognostic factors of upper sulcus tumors, a meta-analysis was conducted. Method: We searched all the articles published until January 2020 in PubMed, Embase, and Web of Science databases, and the search strategy included the following terms, combining superior sulcus tumor and prognosis. Hazard ratio (HR) with associated confidential interval (CI) was evaluated for the purpose of investigating prognostic factors for superior sulcus tumor. STATA 16.0 was used for analysis of extracted data and assessment of publication bias. Result: Fifteen eligible studies, which had 1,009 patients with superior sulcus tumor, were included in this meta-analysis. The studies were published between 1994 and 2018, and the patient recruitment periods ranged from 1974 to 2016. The median follow-up time ranged from 18 to 95 months. The meta-analysis indicated that lower T stage (HR, 1.63; 95% CI, 1.35–1.97), lower N stage (HR, 3.08; 95% CI: 2.37–3.99), negative surgical margin (HR, 0.25; 95% CI, 0.17–0.38), and pathologic complete response (HR, 0.55; 95% CI, 0.39–0.77) were favorable prognostic factors. Conclusion: We found that T stage, N stage, surgical margin, and pathologic complete response are prognostic factors for superior sulcus tumor. To reach a better long-term survival, patients with these negative prognostic factors may need a more aggressive treatment, while more studies should be conducted to further validate these results and explore a more effective treatment.
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Affiliation(s)
- Xiaohu Hao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Zihuai Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Diou Cheng
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
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Ziu M, Traylor JI, Paxman J, Gorrebeeck A, Fortes DL. Utilizing Stereotactic Spine Navigation for Posterior Partial Vertebrectomy in an En Bloc Resection of a Superior Pulmonary Sulcus Tumor Invading the Thoracic Vertebrae: A Technical Note. Cureus 2018; 10:e3303. [PMID: 30456002 PMCID: PMC6239614 DOI: 10.7759/cureus.3303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Prior to the development of en bloc techniques, vertebral invasion by non-small cell lung cancer (NSCLC) had been considered a relative contraindication to surgical intervention. However, reports in the literature have demonstrated increased progression-free survival with the use of neoadjuvant chemotherapy followed by anterior en bloc resection of the residual tumor. Stereotactic spine navigation has been shown to improve accuracy during complex vertebral osteotomies, improving patient outcomes. We report a 53-year-old woman with an NSCLC in the left upper lobe, a periosteum attachment of the second and third thoracic vertebrae (T2 and T3, respectively), and an infiltration of the corresponding nerve roots. We describe a surgical approach for the resection of NSCLC with vertebral infiltration utilizing stereotactic spine navigation and intraoperative computed tomography (CT) (O-Arm, Medtronic, Minneapolis, Minnesota, US) for a posterior approach laminectomy, osteotomy, and partial vertebrectomy, followed by trans-thoracic en bloc resection of a superior pulmonary sulcus tumor with nerve root infiltration. Posterior approach vertebral osteotomy and en bloc resection for superior sulcus NSCLC infiltrating the vertebrae utilizing stereotactic spine navigation and intraoperative CT (O-Arm) is a viable alternative to the traditional anterior approach.
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Affiliation(s)
- Mateo Ziu
- Department of Surgery & Perioperative Care, The University of Texas at Austin, Dell Medical School, Austin, USA
| | - Jeffrey I Traylor
- Medical Student, The University of Texas at Austin, Dell Medical School, Austin, USA
| | - Jason Paxman
- Medical Student, The University of Texas at Austin, Dell Medical School, Austin, USA
| | - Allison Gorrebeeck
- Department of Internal Medicine, Dell Seton Medical Center at The University of Texas, Austin, USA
| | - Daniel L Fortes
- Department of Surgery and Perioperative Care, The University of Texas at Austin, Austin, USA
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Pan X, Gu C, Wang R, Zhao H, Yang J, Shi J. Transmanubrial osteomuscular sparing approach for resection of cervico-thoracic lesions. J Thorac Dis 2017; 9:3062-3068. [PMID: 29221280 DOI: 10.21037/jtd.2017.08.99] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To review our experience of transmanubrial osteomuscular sparing approach (TMA) for resection of various lesions involving the thoracic inlet and to prove the feasibility and safety of the approach. Methods Retrospective review of 58 consecutive cases, from April 2007 to January 2016, with surgical resection of cervico-thoracic lesions via TMA. Results There were 22 neurogenic tumors, 21 bronchogenic tumors, and 15 other cases in the study. There was no intraoperative or postoperative mortality. Mean postoperative stay was 10.5 days (3-33 days). Mean operation time was 179.0 mins (57-328 mins) and the mean volume of blood loss for bronchogenic tumors was 900 mL, which was similar to non-bronchogenic tumors (474 mL, P=0.103). Moreover, patients with malignant tumors had more intraoperative blood loss than patients with benign diseases did (847 versus 194 mL, P=0.001). R0 resection was achieved in 28 of 33 (84.8%) malignant cases. Tumor size was related to incomplete resection (8.19 vs. 5.72 cm, P=0.023) in malignancy. Five (8.6%) cases were complicated with chylothorax and all occurred in patients with left incision. All of 21 cases (100%) with brachial plexus compression symptom were relieved after surgery and 3 of 4 (75%) cases with Horner's syndrome were ameliorated postoperatively. Conclusions TMA can be carried out safely in treating various cervico-thoracic lesions with good resection rate. Left side procedure should be cautious of thoracic duct injury.
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Affiliation(s)
- Xufeng Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Chang Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Rui Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jun Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jianxin Shi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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7
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Abstract
Superior sulcus tumors have posed a formidable therapeutic challenge since their original description by Pancoast and Tobias in the early twentieth century. Initial therapeutic efforts with radiotherapy were associated with high rates of relapse and mortality. Bimodality therapy with complete surgical resection in the 1960s paved the way for trimodality therapy as the current standard of care in the treatment of superior sulcus tumors. The evolution of treatment approaches over time has provided outcomes that come increasingly closer to rivaling those of similarly staged nonapical lung cancer.
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Affiliation(s)
- Johannes R Kratz
- Department of Thoracic Surgery, University of California, San Francisco, Box 0118, San Francisco, CA 94143-0118, USA.
| | - Gavitt Woodard
- Department of Surgery, University of California, San Francisco, Box 0470, 513 Parnassus Avenue, 321, San Francisco, CA 94122, USA
| | - David M Jablons
- Department of Thoracic Surgery, University of California, San Francisco, 1600 Divisadero Street, Room A-743, San Francisco, CA 94143-1724, USA
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8
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Abstract
The prevalence of chest wall invasion by non-small cell lung cancer is < 10% in published surgical series. The role of radiation or chemotherapy around the complete resection of lung cancer invading the chest wall, excluding the superior sulcus of the chest, is poorly defined. Survival of patients with lung cancer invading the chest wall is dependent on lymph node involvement and completeness of en-bloc resection. In some patients harboring T3N0 disease, 5-year survival in excess of 50% can be achieved. Offering en-bloc resection of lung cancer invading chest wall to patients with T3N1 or T3N2 disease is controversial.
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Affiliation(s)
- Michael Lanuti
- Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders 7, Boston, MA 02114, USA.
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9
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Solli P, Casiraghi M, Brambilla D, Maisonneuve P, Spaggiari L. Surgical Treatment of Superior Sulcus Tumors: A 15-Year Single-center Experience. Semin Thorac Cardiovasc Surg 2017; 29:79-88. [PMID: 28684003 DOI: 10.1053/j.semtcvs.2017.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/11/2022]
Abstract
This paper reports on the characteristics, treatment modalities, and outcomes of patients with superior sulcus tumors who underwent surgery over a period of 15 years in 1 institution. Clinical records of 94 consecutive patients operated on by the same surgical team for non-small cell lung cancer between July 1998 and December 2013 were retrospectively reviewed. All patients received lung and chest wall en bloc resection. Forty-eight (51%) received induction treatments. Surgery was an anterior approach in 46 patients (48.9%), Paulson incision in 35 (37.2%), and a combined approach in 13 (13.8%). Lung resections were 78 lobectomies (83%), 3 were pneumonectomies (3.2%), 6 were bronchoplastic reconstructions (6.4%), and 7 were wedge resections (7.4%). Nodal dissection was systematic in 96% of patients. The median number of resected ribs was 2 (1-5), chest wall residual defect was reconstructed in 42 patients (44.7%), and 21 patients had an associated vascular resection (22.3%). Resection was radical in 85 patients (90.4%). Overall 90-day mortality was 9.6%. After a median follow-up of 1.9 years, 5-year and 10-year overall survival rates were 35% and 23%, respectively. A lower 5-year survival was observed in patients with nodal disease (48% in N0 vs 18% in N+; P < 0.0001), incomplete resection (21% for incomplete vs 37% for complete resection; P = 0.15), and anteriorly located tumor (anterior vs posterior: 26% vs 50%; P = 0.05). Pancoast tumor is a severe condition, but long-term survival may be achieved in selected cases. Nodal involvement, completeness of resection, and vascular invasion are the most important prognostic factors, and induction treatment may play a role.
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Affiliation(s)
- Piergiorgio Solli
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
| | - Monica Casiraghi
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Daniela Brambilla
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology & Biostatistics, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy; Department of Oncology and Hematology, DIPO, University of Milan, Italy
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10
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Le syndrome de Pancoast et Tobias malin : à propos de 47 cas. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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Bourgeois DJ, Yendamuri S, Hennon M, Gomez J, Malhotra H, Kumaraswamy L, Wang I, Demmy T. Minimally invasive rib-sparing video-assisted thoracoscopic surgery resections with high-dose-rate intraoperative brachytherapy for selected chest wall tumors. Pract Radiat Oncol 2016; 6:e329-e335. [DOI: 10.1016/j.prro.2016.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 11/26/2022]
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Zarogoulidis K, Porpodis K, Domvri K, Eleftheriadou E, Ioannidou D, Zarogoulidis P. Diagnosing and treating pancoast tumors. Expert Rev Respir Med 2016; 10:1255-1258. [PMID: 27786592 DOI: 10.1080/17476348.2017.1246964] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION According to the American College of Chest Physician definition, a Pancoast tumor is a tumor which invades any of the structures of the apex of the chest including the first thoracic ribs or periosteum, the lower nerve roots of the bronchial plexus, the sympathetic chain and stellate gaglion near the apex of the chest or the subclavian vessels. Pancoast tumors account for less than 3-5 % of lung tumors. Areas covered: We searched the libraries scopus and pub med and found 124 related manuscripts. From those we chose 18 to include in our short commentary based on the most up-date information included. Expert commentary: The present status of the recommended treatment of Pancoast tumors for patients medically fit for surgical resection is trimodality (chemoradiation followed by radical surgery excersion) as state of the art. Patients with unresectable Pancoast tumors and poor PS 4 or distant metastasis are candidate for radiation therapy for palliation of symptoms and best supportive care. In this mini review we will present up to date information regarding diagnosis and treatment management.
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Affiliation(s)
- Konstantinos Zarogoulidis
- a Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Konstantinos Porpodis
- a Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Kelly Domvri
- a Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Ellada Eleftheriadou
- a Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Despoina Ioannidou
- a Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Paul Zarogoulidis
- a Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital , Aristotle University of Thessaloniki , Thessaloniki , Greece
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Marulli G, Battistella L, Mammana M, Calabrese F, Rea F. Superior sulcus tumors (Pancoast tumors). ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:239. [PMID: 27429965 DOI: 10.21037/atm.2016.06.16] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Superior Sulcus Tumors, frequently termed as Pancoast tumors, are a wide range of tumors invading the apical chest wall. Due to its localization in the apex of the lung, with the potential invasion of the lower part of the brachial plexus, first ribs, vertebrae, subclavian vessels or stellate ganglion, the superior sulcus tumors cause characteristic symptoms, like arm or shoulder pain or Horner's syndrome. The management of superior sulcus tumors has dramatically evolved over the past 50 years. Originally deemed universally fatal, in 1956, Shaw and Paulson introduced a new treatment paradigm with combined radiotherapy and surgery ensuring 5-year survival of approximately 30%. During the 1990s, following the need to improve systemic as well as local control, a trimodality approach including induction concurrent chemoradiotherapy followed by surgical resection was introduced, reaching 5-year survival rates up to 44% and becoming the standard of care. Many efforts have been persecuted, also, to obtain higher complete resection rates using appropriate surgical approaches and involving multidisciplinary team including spine surgeon or vascular surgeon. Other potential treatment options are under consideration like prophylactic cranial irradiation or the addition of other chemotherapy agents or biologic agents to the trimodality approach.
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Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Lucia Battistella
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Francesca Calabrese
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
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14
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Utility of a Computed Tomography-Based Navigation System (O-Arm) for En Bloc Partial Vertebrectomy for Lung Cancer Adjacent to the Thoracic Spine: Technical Case Report. Asian Spine J 2016; 10:360-5. [PMID: 27114780 PMCID: PMC4843076 DOI: 10.4184/asj.2016.10.2.360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 10/08/2015] [Accepted: 10/08/2015] [Indexed: 11/30/2022] Open
Abstract
We describe successful vertebrectomy from a posterior approach using a computed tomography (CT)-based navigation system (O-arm) in a 53-year-old man with adenocarcinoma of the posterior apex of the right lung with invasion of the adjacent rib, thoracic wall, and T2 and T3 vertebral bodies. En bloc partial vertebrectomy for lung cancer adjacent to the thoracic spine was planned using O-arm. First, laminectomy was performed from right T2 to T3, and pedicles and transverse processes of T2 to T3 were resected. O-arm was used to confirm the location of the cutting edge in the T2 to 3 right vertebral internal body, and osteotomy to the anterior cortex was performed with a chisel. Next, the patient was placed in a left decubitus position. The surgical specimen was extracted en bloc. This case shows that O-arm can be used reliably and easily in vertebrectomy from a posterior approach and can facilitate en bloc resection.
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Early results of a trimodality treatment for superior sulcus tumors. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 11:268-72. [PMID: 26336433 PMCID: PMC4283879 DOI: 10.5114/kitp.2014.45675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 04/10/2014] [Accepted: 07/22/2014] [Indexed: 11/24/2022]
Abstract
Introduction Superior sulcus tumors are a unique form of lung cancer. Preoperative concurrent radio- and chemotherapy improves the results of treating these lung tumors. Aim The study aimed to assess the early results of a trimodality treatment for superior sulcus tumors. Material and methods Fifty-six superior sulcus tumors patients were operated on between 2006 and 2013. Data from 25 patients undergoing preoperative chemoradiotherapy were analyzed. Fifteen men and 10 women were treated (mean age: 59 years). All patients experienced pain in the pectoral girdle of the chest. Results Nineteen patients received preoperative chemoradiotherapy consisting of 2 chemotherapy cycles with cisplatin (a different number of cycles was administered in 6 cases) and irradiation at a mean dose of 51.2 Gy (30-60 Gy) in 25 fractions (25-30 fractions). All patients underwent upper lobectomy. Twenty-two patients underwent chest wall resection, whereas 3 patients underwent extrapleural excision of the infiltrate without rib resection. Stages IIB and IIIB were diagnosed in 15 and 10 patients, respectively. In 9 samples, no neoplastic features were found, 9 showed individual neoplastic lesions, and in 7 most tumor cells were necrotized. The R1 resection was noted in 2 patients. Mean hospitalization time was 13 days. No perioperative deaths were noted. Conclusions The trimodality treatment for superior sulcus tumors is a safe method. Perioperative mortality and the number of complications observed among patients treated with this method are similar to those observed in one-phase surgery. In over half of the patients, chemoradiotherapy resulted in complete or nearly complete remission of the neoplasm.
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Nun AB, Simansky D, Rokah M, Zeitlin N, Avi RB, Soudack M, Golan N, Apel S, Bar J, Yelin A. Hybrid video-assisted and limited open (VALO) resection of superior sulcus tumors. Surg Today 2015. [DOI: 10.1007/s00595-015-1225-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Marulli G, Battistella L, Perissinotto E, Breda C, Favaretto AG, Pasello G, Zuin A, Loreggian L, Schiavon M, Rea F. Results of surgical resection after induction chemoradiation for Pancoast tumours †. Interact Cardiovasc Thorac Surg 2015; 20:805-11; discussion 811-2. [PMID: 25757477 DOI: 10.1093/icvts/ivv032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/23/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pancoast tumour is a rare neoplasia in which the optimal therapeutic management is still controversial. The traditional treatment of Pancoast tumour (surgery, radiotherapy or a combination of both) have led to an unsatisfactory outcome due to the high rate of incomplete resection and the lack of local and systemic control. The aim of the study was to determine the efficacy of the trimodality approach. METHODS Fifty-six patients (male/female ratio: 47/9, median age: 64 years) in stage IIB to IIIB were treated during a period between 1994 and 2013. Induction therapy consisted of 2-3 cycles of a platinum-based chemotherapy associated with radiotherapy (30-44 Gy). After restaging, eligible patients underwent surgery 2 to 4-week post-radiation. RESULTS Thirty-two (57.1%) patients were cT3 and 24 (42.9%) cT4, 47 (83.9%) were N0 and 9 (16.1%) N+. Forty-eight (85.7%) patients underwent R0 resection and 10 (17.9%) had a complete pathological response (CPR). Thirty-day mortality rate was 5.4%, major surgical complications occurred in 6 (10.7%) patients. At the end of the follow-up, 17 (30.4%) patients were alive and 39 (69.6%) died (29 for cancer-related causes), with an overall 5-year survival of 38%. At statistical analysis, stage IIB (P = 0.003), R0 resection (P = 0.03), T3 tumour (P = 0.002) and CPR (P = 0.01) were significant independent predictors of better prognosis. CONCLUSIONS This combined approach is feasible, and allows for a good rate of complete resection. Long-term survival rates are acceptable, especially for early stage tumours radically resected. Systemic control of disease still remains poor, with distant recurrence being the most common cause of death.
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Affiliation(s)
- Giuseppe Marulli
- Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Unit, University of Padova, Padova, Italy
| | - Lucia Battistella
- Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Unit, University of Padova, Padova, Italy
| | - Egle Perissinotto
- Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Unit, University of Padova, Padova, Italy
| | - Cristiano Breda
- Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Unit, University of Padova, Padova, Italy
| | | | - Giulia Pasello
- Department of Oncology, Istituto Oncologico Veneto, Veneto, Italy
| | - Andrea Zuin
- Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Unit, University of Padova, Padova, Italy
| | - Lucio Loreggian
- Department of Radiotherapy, Istituto Oncologico Veneto, Veneto, Italy
| | - Marco Schiavon
- Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Unit, University of Padova, Padova, Italy
| | - Federico Rea
- Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Unit, University of Padova, Padova, Italy
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Setzer M, Robinson LA, Vrionis FD. Management of locally advanced pancoast (superior sulcus) tumors with spine involvement. Cancer Control 2015; 21:158-67. [PMID: 24667403 DOI: 10.1177/107327481402100209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The preferred treatment for locally aggressive lung cancers is triple modality therapy with concurrent and induction chemotherapy with radiation therapy followed by surgery. Patients with locally advanced T4 Pancoast tumors with spine involvement, without mediastinal N2 lymph node involvement and without distant metastases, are appropriate candidates for complete resection with subsequent spine reconstruction. This review addresses the questions of whether triple modality therapy with complete en bloc resection of locally advanced Pancoast tumors offers an advantage in terms of overall survival and complication rates compared with other therapeutic modalities or therapies with incomplete resection. METHODS A comprehensive literature search was conducted using common medical databases. Inclusion and exclusion criteria for the articles were prospectively defined. The articles were independently reviewed and a consensus decision was made about each article. Selected papers were graded by level of evidence. RESULTS A total of 1,001 abstracts and 93 articles fulfilled the criteria; from these studies, 14 were included in this systematic review. No level 1 study was found in this search. Four level 2 studies and 10 level 3 retrospective case series were found. The overall 5-year survival rate reported in these studies ranged from 37% to 59% and the mortality rate ranged from 0% to 6.9%. CONCLUSIONS Evidence suggests that triple modality therapy with complete resection of locally advanced Pancoast tumors with involvement of the spine offers an advantage over other therapeutic modalities or therapies with incomplete resections.
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Affiliation(s)
- Matthias Setzer
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany.
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Collaud S, Machuca T, Mercier O, Waddell TK, Yasufuku K, Pierre AF, Darling GE, Cypel M, Rampersaud YR, Lewis SJ, Shepherd FA, Leighl NB, Cho JBC, Bezjak A, Keshavjee S, de Perrot M. Long-term outcome after resection of non-small cell lung cancer invading the thoracic inlet. Ann Thorac Surg 2014; 98:962-7. [PMID: 25069687 DOI: 10.1016/j.athoracsur.2014.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 04/23/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to update our previous experience and describe long-term results after resection of non-small-cell lung cancer (NSCLC) invading the thoracic inlet. METHODS Patients from a single center undergoing resection of NSCLC invading the thoracic inlet were reviewed with data retrieved retrospectively from their charts. RESULTS Sixty-five consecutive patients with a median age of 61 (32-76) years underwent resection of NSCLC invading the thoracic inlet from 1991 to 2011. Tumor location was divided into 5 anatomic zones from anterior to posterior. Fifty-two (80%) patients had induction therapy, mostly with 2 cycles of cisplatin-etoposide and 45 Gy of concurrent irradiation. All patients underwent at least first rib resection. Lobectomy was performed in 60 patients (92%). Twenty-four patients (37%) had vertebral resection. Arterial resections were performed in 7 patients (11%). Postoperative morbidity and mortality were 46% and 6%, respectively. Pathologic response to induction was complete (pCR) (n = 19) or nearly complete (pNR) (n = 12) in 31 patients (48%). Adjuvant treatment was administered in 14 (25%) patients. After a median follow-up of 20 (0-193) months, 34 patients are alive without recurrence. The overall 5-year survival reached 69%. Univariate analysis identified site of tumor within the thoracic inlet (p = 0.050), response to induction (p = 0.004), and presence of adjuvant treatment (p = 0.028) as survival predictors. CONCLUSIONS Survival after resection of NSCLC invading the thoracic inlet in highly selected patients reached 69% at 5 years. Tumor location within the thoracic inlet, pathologic response to induction therapy, and adjuvant treatments were significant survival predictors.
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Affiliation(s)
- Stéphane Collaud
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Tiago Machuca
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Olaf Mercier
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas K Waddell
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrew F Pierre
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gail E Darling
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Yoga R Rampersaud
- Division of Orthopedic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Stephen J Lewis
- Division of Orthopedic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Frances A Shepherd
- Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Natasha B Leighl
- Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - John B C Cho
- Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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20
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Nikolaos P, Vasilios L, Efstratios K, Panagiotis A, Christos P, Nikolaos B, Antonios H, Tsakiridis K, Zarogoulidis P, Zarogoulidis K, Katsikogiannis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Machairiotis N, Madesis A, Vretzakis G, Kolettas A, Dimitrios D. Therapeutic modalities for Pancoast tumors. J Thorac Dis 2014; 6 Suppl 1:S180-93. [PMID: 24672693 DOI: 10.3978/j.issn.2072-1439.2013.12.31] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 12/16/2013] [Indexed: 01/21/2023]
Abstract
A Pancoast tumor, also called a pulmonary sulcus tumor or superior sulcus tumor, is a tumor of the pulmonary apex. It is a type of lung cancer defined primarily by its location situated at the top end of either the right or left lung. It typically spreads to nearby tissues such as the ribs and vertebrae. Most Pancoast tumors are non-small cell cancers. The growing tumor can cause compression of a brachiocephalic vein, subclavian artery, phrenic nerve, recurrent laryngeal nerve, vagus nerve, or, characteristically, compression of a sympathetic ganglion resulting in a range of symptoms known as Horner's syndrome. Pancoast tumors are named for Henry Pancoast, a US radiologist, who described them in 1924 and 1932.The treatment of a Pancoast lung cancer may differ from that of other types of non-small cell lung cancer (NSCLC). Its position and close proximity to vital structures may make surgery difficult. As a result, and depending on the stage of the cancer, treatment may involve radiation and chemotherapy given prior to surgery. Surgery may consist of the removal of the upper lobe of a lung together with its associated structures as well as mediastinal lymphadenectomy. Surgical access may be via thoracotomy from the back or the front of the chest and modification. Careful patient selection, improvements in imaging such as the role of PET-CT in restaging of tumors, radiotherapy and surgical advances, the management of previously inoperable lesions by a combined experienced thoracic-neurosurgical team and prompt recognition and therapy of postoperative complications has greatly increased local control and overall survival for patients with these tumors.
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Affiliation(s)
- Panagopoulos Nikolaos
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Livaditis Vasilios
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Koletsis Efstratios
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Alexopoulos Panagiotis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Prokakis Christos
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Baltayiannis Nikolaos
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Hatzimichalis Antonios
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Kosmas Tsakiridis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Paul Zarogoulidis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Konstantinos Zarogoulidis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Nikolaos Katsikogiannis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Ioanna Kougioumtzi
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Nikolaos Machairiotis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Theodora Tsiouda
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Nikolaos Machairiotis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Athanasios Madesis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Georgios Vretzakis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Alexandros Kolettas
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
| | - Dougenis Dimitrios
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, Patra, Greece ; 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Anesthesiology Department, University of Larisa, Larisa, Greece ; 9 Anesthesiology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece
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21
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Foroulis CN, Zarogoulidis P, Darwiche K, Katsikogiannis N, Machairiotis N, Karapantzos I, Tsakiridis K, Huang H, Zarogoulidis K. Superior sulcus (Pancoast) tumors: current evidence on diagnosis and radical treatment. J Thorac Dis 2014; 5 Suppl 4:S342-58. [PMID: 24102007 DOI: 10.3978/j.issn.2072-1439.2013.04.08] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 04/09/2013] [Indexed: 11/14/2022]
Abstract
Pancoast tumors account for less than 5% of all bronchogenic carcinomas. These tumors are located in the apex of the lung and involve through tissue contiguity the apical chest wall and/or the structures of the thoracic inlet. The tumors become clinically evident with the characteristic symptoms of the "Pancoast-Tobias syndrome" which includes Claude-Bernard-Horner syndrome, severe pain in the shoulder radiating toward the axilla and/or scapula and along the ulnar distribution of the upper arm, atrophy of hand and arm muscles and obstruction of the subclavian vein resulting in edema of the upper arm. The diagnosis will be made by the combination of the characteristic clinical symptoms with the radiographic findings of a mass or opacity in the apex of the lung infiltrating the 1(st) and/or 2(nd) ribs. A tissue diagnosis of the tumor via CT-guided FNA/B should always be available before the initiation of treatment. Bronchoscopy, thoracoscopy and biopsy of palpable supraclavicular nodes are alternative ways to obtain a tissue diagnosis. Adenocarcinomas account for 2/3 of all Pancoast tumors, while the rest of the tumors are squamous cell and large cell carcinomas. Magnetic resonance imaging of the thoracic inlet is always recommended to define the exact extent of tumor invasion within the thoracic inlet before surgical intervention. Pancoast tumors are by definition T3 or T4 tumors. Induction chemo-radiotherapy is the standard of care for any potentially resectable Pancoast tumor followed by an attempt to achieve a complete tumor resection. Resection can be made through a variety of anterior and posterior approaches to the thoracic inlet. The choice of the approach depends on the location of the tumor (posterior - middle - anterior compartment of the thoracic inlet) and the depth/extent of invasion. Prognosis depends mainly on T stage of tumor, response to preoperative chemo-radiotherapy and completeness of resection. Resection of the invaded strictures of the thoracic inlet should me made en bloc with pulmonary parenchyma resection, preferably an upper lobectomy. Invasion of the vertebral column is not a contraindication for surgery which, however, should be performed in oncologic centers with experience in spinal surgery. Surgery for Pancoast tumors is associated with 5% mortality rate and the complication rate varies from 7-38%. The overall 2-year survival rate after induction chemo-radiotherapy and resection varies from 55% to 70%, while the 5-year survival for R0 resections is quite good (54-77%). The main pattern of recurrence is that of distant metastases, especially in the brain.
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Affiliation(s)
- Christophoros N Foroulis
- Department of Cardiothoracic Surgery, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece
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22
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Panagopoulos N, Leivaditis V, Koletsis E, Prokakis C, Alexopoulos P, Baltayiannis N, Hatzimichalis A, Tsakiridis K, Zarogoulidis P, Zarogoulidis K, Katsikogiannis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Kesisis G, Siminelakis S, Madesis A, Dougenis D. Pancoast tumors: characteristics and preoperative assessment. J Thorac Dis 2014; 6 Suppl 1:S108-15. [PMID: 24672686 DOI: 10.3978/j.issn.2072-1439.2013.12.29] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 12/16/2013] [Indexed: 11/14/2022]
Abstract
Superior sulcus tumors (SSTs), or as otherwise known Pancoast tumors, make up a clinically unique and challenging subset of non-small cell carcinoma of the lung (NSCLC). Although the outcome of patients with this disease has traditionally been poor, recent developments have contributed to a significant improvement in prognosis of SST patients. The combination of severe and unrelenting shoulder and arm pain along the distribution of the eighth cervical and first and second thoracic nerve trunks, Horner's syndrome (ptosis, miosis, and anhidrosis) and atrophy of the intrinsic hand muscles comprises a clinical entity named as "Pancoast-Tobias syndrome". Apart NSCLC, other lesions may, although less frequently, result in Pancoast syndrome. In the current review we will present the main characteristics of the disease and focus on the preoperative assessment.
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Affiliation(s)
- Nikolaos Panagopoulos
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Leivaditis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstratios Koletsis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Prokakis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Alexopoulos
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Baltayiannis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Hatzimichalis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kosmas Tsakiridis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Kougioumtzi
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Machairiotis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora Tsiouda
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Kesisis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Siminelakis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Madesis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Dougenis
- 1 Department of Cardiothoracic Surgery, Patras University School of Medicine, 2 Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece ; 7 Oncology Department, "Saint Luke" Private Clinic of Health Excellence, Thessaloniki, Panorama, Greece ; 8 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece ; 9 Cardiothoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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23
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Spaggiari L, D'Aiuto M, Veronesi G, Leo F, Solli P, Elena Leon M, Gasparri R, Galetta D, Petrella F, Borri A, Scanagatta P. Anterior approach for Pancoast tumor resection. Multimed Man Cardiothorac Surg 2014; 2007:mmcts.2005.001776. [PMID: 24415052 DOI: 10.1510/mmcts.2005.001776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tumors arising anteriorly in the apex of the chest were long considered unresectable because of early invasion of vascular structures limiting radical resection through the conventional Paulson approach. These tumors became operable in 1993 when Dartevelle popularized the cervico-thoracic transclavicular technique for resecting these neoplasms. Since then several different surgical approaches to anterior Pancoast tumors have been proposed, drastically improving the rate of radical resections of these tumors. However, there is no consensus on which anterior surgical approach provides the best access to all of the apical non-small cell lung cancers of the thoracic inlet. Moreover, it is still unclear if integrated neoadjuvant and adjuvant treatments can improve the rates of complete resection, local recurrence and long-term survival.
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Affiliation(s)
- Lorenzo Spaggiari
- University of Milan, School of Medicine, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
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24
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Kozower BD, Larner JM, Detterbeck FC, Jones DR. Special treatment issues in non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e369S-e399S. [PMID: 23649447 DOI: 10.1378/chest.12-2362] [Citation(s) in RCA: 244] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This guideline updates the second edition and addresses patients with particular forms of non-small cell lung cancer that require special considerations, including Pancoast tumors, T4 N0,1 M0 tumors, additional nodules in the same lobe (T3), ipsilateral different lobe (T4) or contralateral lung (M1a), synchronous and metachronous second primary lung cancers, solitary brain and adrenal metastases, and chest wall involvement. METHODS The nature of these special clinical cases is such that in most cases, meta-analyses or large prospective studies of patients are not available. To ensure that these guidelines were supported by the most current data available, publications appropriate to the topics covered in this article were obtained by performing a literature search of the MEDLINE computerized database. Where possible, we also reference other consensus opinion statements. Recommendations were developed by the writing committee, graded by a standardized method, and reviewed by all members of the Lung Cancer Guidelines panel prior to approval by the Thoracic Oncology NetWork, Guidelines Oversight Committee, and the Board of Regents of the American College of Chest Physicians. RESULTS In patients with a Pancoast tumor, a multimodality approach appears to be optimal, involving chemoradiotherapy and surgical resection, provided that appropriate staging has been carried out. Carefully selected patients with central T4 tumors that do not have mediastinal node involvement are uncommon, but surgical resection appears to be beneficial as part of their treatment rather than definitive chemoradiotherapy alone. Patients with lung cancer and an additional malignant nodule are difficult to categorize, and the current stage classification rules are ambiguous. Such patients should be evaluated by an experienced multidisciplinary team to determine whether the additional lesion represents a second primary lung cancer or an additional tumor nodule corresponding to the dominant cancer. Highly selected patients with a solitary focus of metastatic disease in the brain or adrenal gland appear to benefit from resection or stereotactic radiosurgery. This is particularly true in patients with a long disease-free interval. Finally, in patients with chest wall involvement, provided that the tumor can be completely resected and N2 nodal disease is absent, primary surgical resection should be considered. CONCLUSIONS Carefully selected patients with more uncommon presentations of lung cancer may benefit from an aggressive surgical approach.
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Affiliation(s)
- Benjamin D Kozower
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA
| | - James M Larner
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - Frank C Detterbeck
- Division of Thoracic Surgery, Yale University School of Medicine, New Haven, CT
| | - David R Jones
- Department of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA.
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Deslauriers J, Tronc F, Fortin D. Management of tumors involving the chest wall including pancoast tumors and tumors invading the spine. Thorac Surg Clin 2013; 23:313-25. [PMID: 23931015 DOI: 10.1016/j.thorsurg.2013.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Bronchogenic carcinomas involving the chest wall include tumors invading the ribs and spine, as well as Pancoast tumors. In the past, such neoplasms were considered to be incurable, but with new multimodality regimens, including induction chemoradiation followed by surgery, they can now be completely resected and patients can benefit from prolonged survival. The most important prognostic factors are the completeness of resection and the pathologic nodal status.
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Affiliation(s)
- Jean Deslauriers
- Division of Thoracic Surgery, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Laval University, 2725 chemin Sainte-Foy, L-3540, Quebec City, Quebec G1V 4G5, Canada.
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26
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Ripley RT, Rusch VW. Role of induction therapy: surgical resection of non-small cell lung cancer after induction therapy. Thorac Surg Clin 2013; 23:273-85. [PMID: 23931012 DOI: 10.1016/j.thorsurg.2013.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Patients with Stage III non-small cell lung cancer are best managed by multimodality therapy. Patients with N2 disease can be treated with induction therapy (usually chemotherapy) followed by surgical resection. Patients whose medical comorbidities preclude surgery should be treated with definitive chemoradiotherapy. T3 or T4 tumors involving the superior sulcus or spine are best managed with induction chemoradiotherapy and surgical resection.
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Affiliation(s)
- R Taylor Ripley
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Shamji FM. Absolute and relative contraindications to pulmonary resection: effect of lung cancer surgery guidelines on medical practice. Thorac Surg Clin 2013; 23:247-55. [PMID: 23566976 DOI: 10.1016/j.thorsurg.2013.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patients with primary lung cancer that has not spread beyond a lung should be considered for an operation provided their general health is good, their functional capacity is adequate, and survival benefits outweigh the operative risk. Not all patients are suitable for pulmonary resection. Alternative forms of treatment should be considered for patients who have disseminated cancer, limited cardiopulmonary reserve, advanced chronologic and physiologic age, and those who decline treatment.
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Affiliation(s)
- Farid M Shamji
- Division of Thoracic Surgery, General Campus, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
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Stoker GE, Buchowski JM, Kelly MP, Meyers BF, Patterson GA. Video-assisted thoracoscopic surgery with posterior spinal reconstruction for the resection of upper lobe lung tumors involving the spine. Spine J 2013; 13:68-76. [PMID: 23295033 DOI: 10.1016/j.spinee.2012.11.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 08/11/2012] [Accepted: 11/16/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Video-assisted thoracoscopic surgery (VATS) is associated with less morbidity and recovery time compared with traditional open thoracotomy (OT) for the resection of early stage non-small cell lung cancer (NSCLC). Local invasion of NSCLC into adjacent vertebrae confers a TNM T status of T4. Anatomical lobectomy by VATS with simultaneous posterior spinal reconstruction (PSR), as a single procedure, offers advantages to selected patients judged as suitable candidates for resection. PURPOSE To report the preliminary results of a novel, multidisciplinary surgical technique for the treatment of upper lobe lung cancers with direct extension to the spine. STUDY DESIGN Consecutive case series. PATIENT SAMPLE Eight adults who underwent PSR with either VATS or OT for the treatment of a T4 (vertebral body invasion) NSCLC. OUTCOME MEASURES Total operative time, estimated blood loss, length of hospital stay, postoperative tumor recurrence and metastasis, survival, reoperations, and any other intraoperative or postoperative complication. METHODS Eight consecutive patients who underwent instrumented PSR with corpectomy for the treatment of an upper lobe NSCLC at a single institution were identified. Either VATS (n=4) or OT (n=4) was performed at the time of the reconstruction in each patient. All tumors were stage III NSCLC without metastasis. RESULTS Patients who underwent VATS and OT were aged 54±11 and 54±2.9 years, respectively. Mean operative time and blood loss were similar between the groups: VATS: 367±117 minutes versus OT: 518±264 minutes; VATS: 813±463 mL versus OT: 1,250±1,500 mL. Mean follow-up was 16±13 months after surgery. Complications occurred in all eight patients. One OT patient had wound dehiscence requiring a tissue flap, and another suffered from a septic shock. No wound complications developed after VATS. Death secondary to tumor recurrence occurred once in each group. For the six surviving patients, 23±15 months (range, 4.5-43 months) have elapsed since surgery. CONCLUSIONS Video-assisted thoracoscopic surgery with PSR is a novel and viable method for the complete resection of T4 NSCLC.
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Affiliation(s)
- Geoffrey E Stoker
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S. Euclid Ave., West Pavilion Suite 11300, Campus Box 8233, St. Louis, MO 63110, USA
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Ichiki Y, Nagashima A, Yasuda M, Takenoyama M. Analysis of the surgical treatment for superior sulcus tumors. Surg Today 2012; 43:1419-24. [PMID: 23212702 DOI: 10.1007/s00595-012-0431-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 10/01/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE This study was undertaken to assess the mortality, complication, and major morbidity rates of surgical treatment for superior sulcus tumors (SSTs), and to estimate the significance of prognostic factors. METHODS We retrospectively reviewed the hospital records of 50 consecutive patients undergoing surgical treatment for SSTs between 1992 and 2007. The significance of risk factors for an adverse outcome was investigated. RESULTS Both the thirty-day and in-hospital mortality rates were 0 %. Complications developed in 18.0 % (9/50) of the patients. The overall 5-year survival was 32.7 %. Pathological T4 and N1 or more were the risk factors predicting an adverse outcome. Survival was not significantly influenced by the preoperative symptoms, the histological type, the invaded organ or the curability. CONCLUSION Surgical treatment for SSTs is associated with acceptable overall morbidity and mortality rates. However, special care must be taken for the patients with pathological T4 and N1 or higher tumors. Preoperative chemoradiotherapy followed by surgical treatment has become a logical strategy for SSTs. Preoperative chemoradiotherapy for SSTs may yield better results than surgery alone.
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Affiliation(s)
- Yoshinobu Ichiki
- Department of Chest Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan,
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[Single French centre retrospective analysis of local control after high dose radiotherapy with or without chemotherapy and local control for Pancoast tumours]. Cancer Radiother 2012; 16:107-14. [PMID: 22341507 DOI: 10.1016/j.canrad.2011.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 09/23/2011] [Accepted: 10/11/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE Superior sulcus non-small cell lung cancer represents less than 5% of all lung cancers and is a challenge for the physicians because of clinical presentation, treatments related toxicities and poor prognosis. The aim of this preliminary retrospective report is to present outcomes of patients affected by a superior sulcus non-small cell lung cancer, treated by high dose radiotherapy (>60 Gy) with or with our chemotherapy. PATIENTS AND METHODS All adult inoperable or unresectable patients (≥18 years) with a clinical and radiological diagnosis of superior sulcus non-small cell lung cancer treated in our department by radiotherapy with or without chemotherapy were retrospectively analysed. Primary endpoint was the local control. Overall survival, metastasis free survival and toxicity rates were also analysed and reported. RESULTS From January 1999 to June 2009, 12 patients were treated by exclusive high-dose radiochemotherapy. Median age was 53 years (range: 33-64 years); mean follow-up time was 20 months (range: 2-75 months). Mean local control, overall survival and metastasis free survival were 20.2, 22 and 20 months, respectively. At the time of this analysis, seven patients died of cancer and three of them presented only a metastatic disease progression. One patient died of acute cardiac failure 36 months after the end of radiochemotherapy and was disease free. Treatment was well tolerated and any acute and/or late G3-4 toxicity was recorded (NCI-CTC v 3.0 score). CONCLUSION This analysis confirms the interest of exclusive high-dose radiochemotherapy in treating inoperable superior sulcus non-small cell lung cancer patients, in achieving good local control and overall survival rates.
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D'Andrilli A, Venuta F, Menna C, Rendina EA. Extensive resections: pancoast tumors, chest wall resections, en bloc vascular resections. Surg Oncol Clin N Am 2012; 20:733-56. [PMID: 21986269 DOI: 10.1016/j.soc.2011.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Infiltration by lung tumor of adjacent anatomic structures including major vessels, main bronchi, and chest wall not only influences the oncologic severity of the disease but also increases the technical complexity of surgery, requiring extended resections and demanding reconstructive procedures. Completeness of resection represents in every case one of the main factors influencing the long-term outcome of patients. Technical and oncologic aspects of extended operations, including resection of Pancoast tumors and chest wall, bronchovascular sleeve resections, and en bloc resections of major thoracic vessels, are reported in this article.
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Affiliation(s)
- Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, University LaSapienza, Via di Grottarossa 1035, 00189 Rome, Italy.
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Fadel E, Missenard G, Court C, Mercier O, Mussot S, Fabre D, Dartevelle P. Long-Term Outcomes of En Bloc Resection of Non-Small Cell Lung Cancer Invading the Thoracic Inlet and Spine. Ann Thorac Surg 2011; 92:1024-30; discussion 1030. [DOI: 10.1016/j.athoracsur.2011.04.100] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 04/12/2011] [Accepted: 04/15/2011] [Indexed: 10/17/2022]
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Campo-Cañaveral de la Cruz JL, Herrero Collantes J, Sánchez Lorente D, Torres Lanzas J. [Chest wall surgery]. Arch Bronconeumol 2011; 47 Suppl 3:15-24. [PMID: 21640288 DOI: 10.1016/s0300-2896(11)70024-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite the numerous differences among the distinct diseases of the chest wall, the surgery of this area shows certain common features. Treatment has progressively changed in the last few years due to advances in diagnostic techniques, minimally invasive procedures and reconstruction materials, and especially due to the multidisciplinary management of many diseases. Nuss' minimally invasive correction of pectus excavatum has gained devotees, although open approaches are performed with increasingly small incisions, almost comparable to the lateral incisions in Nuss' technique. Surgeons supporting the open approach also cite the evident disadvantages of the need for a steel implant for 2 or 3 years and for a second intervention to remove this implant. En-bloc resections with reconstruction using materials, which are increasingly better and covered by myocutaneous grafts in collaboration with plastic surgery departments, constitute a major advance in the treatment of chest wall tumors. Trimodal therapy for Pancoast tumors, consisting of induction chemotherapy and radiotherapy and subsequent surgical treatment of the tumor, currently provides the best results in terms of resectability and survival.
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Moon SD, Ohguri T, Imada H, Yahara K, Yamaguchi S, Hanagiri T, Yasumoto K, Yatera K, Mukae H, Terashima H, Korogi Y. Definitive radiotherapy plus regional hyperthermia with or without chemotherapy for superior sulcus tumors: A 20-year, single center experience. Lung Cancer 2011; 71:338-43. [DOI: 10.1016/j.lungcan.2010.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 06/10/2010] [Accepted: 06/10/2010] [Indexed: 10/19/2022]
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Parissis H, Young V. Treatment of pancoast tumors from the surgeons prospective: re-appraisal of the anterior-manubrial sternal approach. J Cardiothorac Surg 2010; 5:102. [PMID: 21050456 PMCID: PMC2992054 DOI: 10.1186/1749-8090-5-102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 11/04/2010] [Indexed: 11/23/2022] Open
Abstract
Pancoast tumours are now amenable to multimodality treatment with an acceptable survival. This is because trimodality treatment improves tumor sterilization and hence outcome. Moreover the development of an anterior approach to access the tumor, further improved the technical challenges for a sound resection.The Anterior-manubrial sternal approach was described more than a decade ago and although this method facilitates better exposure of the extreme apex of the lung, brachial plexus and subclavian vessels, its popularity has not reached high levels. We felt that by re-addressing this topic we would stimulate reconsideration of the anterior approach.
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Affiliation(s)
| | - Vincent Young
- Cardiothoracic Dept, St James Hospital, Dublin 8, Dublin, Ireland
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Abdelrahman AM, Mourad IA, Gaafar RM, Elhossieny HA. Carcinoma of the superior pulmonary sulcus: Results of multidisciplinary treatment. Thorac Cancer 2010; 1:163-168. [PMID: 27755818 DOI: 10.1111/j.1759-7714.2010.00025.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Superior sulcus tumors are a complex subset of tumors accounting for less than 5% of lung tumors. METHODS Twenty-three patients admitted between 2001 and 2007 were included in the study,. Computed tomography scan of the chest was considered the primary diagnostic and staging investigation for all patients. Radiation therapy was given preoperatively to 20 patients, neoadjuvant chemotherapy was given to 13 patients. RESULTS There were 22 men and one woman in the study. The mean age was 53 years. Lobectomy was performed in 20 patients and wedge resection was done for three patients. Three to five ribs were resected in all patients. Extended resections were performed in eight patients. Positive mediastinal lymph nodes were found six patients. The staging was: Stage IIB (11 patients); Stage IIIA (four patients), Stage IIIB (six patients) and Stage IV (two patients). Negative resection margin was achieved in 18 patients. Postoperative complications developed in nine patients, there was one operation related mortality. Tumor recurrence developed in 16 patients. The mean survival time was 2.8 years and the overall 5-years survival was 26%. CONCLUSION Multimodality treatment gives satisfactory results with low morbidity and mortality rates and acceptable survival.
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Affiliation(s)
- Abdelrahman Mohamed Abdelrahman
- Department of Surgery, National Cancer Institute, Cairo University, Cairo, Egypt Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt Department of Radiotherapy, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ismael Abdelmonem Mourad
- Department of Surgery, National Cancer Institute, Cairo University, Cairo, Egypt Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt Department of Radiotherapy, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Rabab Mohamed Gaafar
- Department of Surgery, National Cancer Institute, Cairo University, Cairo, Egypt Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt Department of Radiotherapy, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hisham Abdelkader Elhossieny
- Department of Surgery, National Cancer Institute, Cairo University, Cairo, Egypt Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt Department of Radiotherapy, National Cancer Institute, Cairo University, Cairo, Egypt
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Current treatment concepts of Pancoast tumors. Eur Surg 2010. [DOI: 10.1007/s10353-010-0556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Utzschneider S, Wicherek E, Weber P, Schmidt G, Jansson V, Dürr HR. Surgical treatment of bone metastases in patients with lung cancer. INTERNATIONAL ORTHOPAEDICS 2010; 35:731-6. [PMID: 20559828 DOI: 10.1007/s00264-010-1074-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 06/01/2010] [Accepted: 06/03/2010] [Indexed: 10/19/2022]
Abstract
Lung cancer is the leading cause of cancer mortality. Bone metastases are a common complication in lung cancer. The therapeutic approach and the type of surgical treatment of these lesions have not been clearly defined. Outcome and prognosis of patients with bony metastases and a variety of surgical interventions were analysed retrospectively. In 58 patients we performed 62 surgeries. The most common locations of metastases were the spine (32 patients), the proximal femur (10) and the pelvis (11). Twenty-one patients had a singular and 20 had multiple osseous lesions; 17 showed additional visceral involvement. Nine patients had a local progression of their disease and 49 a systemic progression. Patients with local progression (n = 9) had a better prognosis than the patients with systemic progression (p = 0.0083). Fracture (p = 0.0017) worsened prognosis, whereas the number of bone lesions or the presence of a visceral lesion did not. Patients with small lesions showed a better survival than patients with large lesions (p = 0.02). Ten percent of the patients died within 30 days and 78% within one year after surgery. Fracture of bone due to metastatic lung cancer worsens the prognosis whereas the number of bone lesions, the presence of a visceral lesion and the surgical approach do not.
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Affiliation(s)
- Sandra Utzschneider
- Department of Orthopaedics, Orthopaedic Oncology, Grosshadern Medical Center, Ludwig-Maximilians-University of Munich, Munich, Germany
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Is There a Standard of Care for the Radical Management of Non-small Cell Lung Cancer Involving the Apical Chest Wall (Pancoast Tumours)? Clin Oncol (R Coll Radiol) 2010; 22:334-46. [DOI: 10.1016/j.clon.2010.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 02/14/2010] [Accepted: 03/04/2010] [Indexed: 11/18/2022]
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LI J, DAI CH, SHI SB, BAO QL, YU LC, WU JR. Induction concurrent chemoradiotherapy compared with induction radiotherapy for superior sulcus non-small cell lung cancer: a retrospective study. Asia Pac J Clin Oncol 2010; 6:57-65. [DOI: 10.1111/j.1743-7563.2009.01265.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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West HJ. The role for surgery in stage III non-small-cell lung cancer: can we reliably select the right patients? Clin Lung Cancer 2009; 10:314-6. [PMID: 19808188 DOI: 10.3816/clc.2009.n.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lebreton G, Baste JM, Thumerel M, Delcambre F, Velly JF, Jougon J. The hemiclamshell approach in thoracic surgery: indications and associated morbidity in 50 patients. Interact Cardiovasc Thorac Surg 2009; 9:965-9. [PMID: 19773230 DOI: 10.1510/icvts.2009.211623] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This retrospective study was carried out to evaluate the indications for and outcomes of the hemiclamshell (HCS) approach (longitudinal partial sternotomy with antero-lateral thoracotomy) in patients undergoing mass resection in thoracic surgery. All patients (50) who underwent a HCS procedure in our department, between July 1996 and July 2005, were studied retrospectively, analyzing the indications, morbidity and outcome (pain, neurological or shoulder defects, mortality) at one month and one year. The main indications were apical tumours (38%), tumours of the cervicothoracic junction (46%) and chest wall (10%), and 'bulky' tumours (6%). One-month mortality was 6%. Two patients suffered from a chylothorax and one from phrenic paralysis. The postoperative analgesic requirements were similar to those after other thoracic surgery approaches. Twelve percent of patients suffered pain at one month and 6% at one year. Shoulder dysfunction was observed in 10% of patients at one month and 6% at one year. In conclusion, the HCS surgical approach was associated with an uncomplicated postoperative course. This anterior approach is suitable for apical tumours, tumours of the cervicothoracic junction and 'bulky' lung tumours, providing good access for control of the large vessels and radical mediastinal clearance.
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Affiliation(s)
- Guillaume Lebreton
- Department of Thoracic Surgery, Haut-Lévêque Hospital, University Hospital of Bordeaux, 33604, Pessac, France.
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Favaretto A, Pasello G, Loreggian L, Breda C, Braccioni F, Marulli G, Stragliotto S, Magro C, Sotti G, Rea F. Preoperative concomitant chemo-radiotherapy in superior sulcus tumour: A mono-institutional experience. Lung Cancer 2009; 68:228-33. [PMID: 19632000 DOI: 10.1016/j.lungcan.2009.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 06/15/2009] [Accepted: 06/29/2009] [Indexed: 11/30/2022]
Abstract
UNLABELLED Superior sulcus tumour (SST) is an uncommon neoplasia whose optimal treatment remains controversial. Usually resected after induction RT or treated with definitive chemo-radiotherapy, it has recently aroused more interest because of preoperative chemo-radiotherapy. Treatment consisted of a platinum-based chemotherapy: carboplatin AUC 5 on days 1 and 22, combined with mitomycin-C 8 mg/m(2) on days 1 and 22, and vinblastine 4 mg/m(2) on days 1, 8, 22 and 29 (MVC) from 1994 to 1999, or combined with navelbine 25mg/m(2) on days 1, 8, 22 and 29 (NC), from 2000 to 2007. Radiotherapy was administered 5 days/week, 30 Gy in 10 fractions on days 22-35 (from 1994 to 1996), or 44 Gy in 22 fractions on days 22-52 (from 1997 to 2007). SURGERY was planned after 2-3 weeks since the completion of radiotherapy. Since 1994, 37 pts were treated with induction chemo-radiotherapy, 1 with induction radiotherapy only. Induction chemotherapy: 16 pts had MVC (43%) and 21 NC (57%); induction radiotherapy: 7 patients treated with MVC had 30 Gy/10F, 9 had 44 Gy/22F; all the patients treated with NC had 44 Gy/22F, but 2 of them did not complete radiotherapy because of early death (after 16 Gy/8F) and toxicity (after 38 Gy/19F). Grade 3-4 haematological toxicity of induction chemo-radiotherapy was found in 13 patients (35%); the most frequent non-haematological toxicities were constipation and oesophagitis. One complete, 18 partial and 8 minimal responses/stable disease were observed. Moreover, 1 progression disease and 1 early death occurred. SURGERY 30 upper lobectomies (17 right, 13 left) and 4 segmentectomies, with chest wall resections, were performed (89% resection rate); 4 pts were not operated. Radical resections were achieved in 74% of the patients, with 5 pathologic complete remissions at resection. Twenty-seven patients (71%) had improvement of shoulder/arm pain. Median progression-free survival was 64 weeks and median survival was 148 weeks. The 5-year overall and progression-free survivals were 40% and 29%, respectively. In the multimodality treatment of SST, concurrent carboplatin-based chemotherapy plus radiotherapy were active and feasible without major toxicities. This resulted in high resectability rate and favourable progression-free and overall survival rates.
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Affiliation(s)
- Adolfo Favaretto
- Medical Oncology Dept. Istituto Oncologico Veneto - IRCCS, Via Gattamelata, 64, I-35128 Padua, Italy.
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Survival after trimodality treatment for superior sulcus and central T4 non-small cell lung cancer. J Thorac Oncol 2009; 4:62-8. [PMID: 19096308 DOI: 10.1097/jto.0b013e3181914d52] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION For sulcus superior tumors and central cT4 tumors, low resectability and poor long-term survival rates are obtained with single-modality treatment. METHODS Analysis of all consecutive patients in our prospective database, who had potentially resectable superior sulcus (cT3-T4) and central cT4 tumors and were treated with induction chemoradiotherapy (two courses of cisplatin-etoposide) and concomitant radiotherapy (45 Gy/1.8 Gy) after multidisciplinary discussion. Surgery with attempted complete resection was performed in patients showing response or stable disease on computed tomography. RESULTS Between April 2002 and February 2008, 32 consecutive patients were enrolled. Two patients did not complete the induction chemoradiotherapy. Thirty patients were reassessed after induction, 28 had response or stable disease by conventional imaging. Twenty-seven patients were surgically explored since one patient became medically inoperable during induction treatment. The overall complete resectability was 78% (25/32). Resection was microscopically incomplete (R1) in two patients. In 11 patients (41%), a pneumonectomy was performed, and in 14 patients (52%), a chest wall resection was necessary. In 74% of the resected patients, there was a complete pathologic response or minimal residual microscopic disease. The mean postoperative hospital stay was 9.2 days with no hospital mortality and no bronchopleural fistula. With a median follow-up of 26.5 months, 5-year survival rates are 74% in the intent-to-treat population (n = 32) and 77% in completely resected patients (n = 25), with no statistically significant difference between sulcus superior tumors and centrally located T4 tumors. CONCLUSION In patients with sulcus superior tumors and in selected patients with centrally located T4 tumors, trimodality treatment is feasible with acceptable morbidity and mortality. The complete resectability is high, and long-term survival is promising.
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Grossesse et cancer du poumon : à propos d’un cas et revue de la littérature. ACTA ACUST UNITED AC 2008; 37:808-10. [DOI: 10.1016/j.jgyn.2008.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 05/26/2008] [Accepted: 05/28/2008] [Indexed: 11/15/2022]
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Chen F, Takahashi A, Omasa M, Neo M, Fujibayashi S, Wada H, Bando T. En bloc total vertebrectomy for lung cancer invading the spine. Lung Cancer 2008; 61:137-9. [DOI: 10.1016/j.lungcan.2007.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Revised: 11/27/2007] [Accepted: 12/02/2007] [Indexed: 10/22/2022]
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Jain S, Sommers E, Setzer M, Vrionis F. Posterior midline approach for single-stage en bloc resection and circumferential spinal stabilization for locally advanced Pancoast tumors. J Neurosurg Spine 2008; 9:71-82. [DOI: 10.3171/spi/2008/9/7/071] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The treatment of Pancoast (superior sulcus) tumors that extensively invade the vertebral column remains controversial. Different surgical approaches involving multistage resection techniques have been previously described for superior sulcus tumors that invade the chest wall and spinal column. Typically a posterior approach to stabilize the spine is followed by a second-stage thoracotomy (posterolateral or trap door) for definitive en bloc resection of stage T4 Pancoast tumors. The authors report and elaborate on a surgical technique successfully used for an en bloc resection as well as spinal stabilization through a single-stage posterior approach without any added morbidity.Two patients with histologically proven Pancoast tumors were treated by single-stage resection and stabilization through a posterior approach at the H. Lee Moffitt Cancer Center. A wedge lung resection or lobectomy was performed by the chest surgeon utilizing the chest wall defect. Placement of an anterior cage (in one case) and posterior cervicothoracic spinal instrumentation (in both cases) was performed during the same operation. Average blood loss was 675 ml and surgical time was 7 hours. The median hospital stay was 9 days (range 7–11 days). Both patients did well postoperatively and were free of recurrence at the 2-year follow-up.Radical resection of Pancoast tumors including lobectomy, chest wall resection, costotransversectomy, and partial or complete vertebrectomy with simultaneous instrumentation for spinal stabilization can be performed through a posterior single-stage approach.
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Affiliation(s)
- Surbhi Jain
- 1NeuroOncology Program,
- 2Department of Neurological Surgery, and
| | - Eric Sommers
- 3Thoracic Oncology Program, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | - Matthias Setzer
- 1NeuroOncology Program,
- 2Department of Neurological Surgery, and
| | - Frank Vrionis
- 1NeuroOncology Program,
- 2Department of Neurological Surgery, and
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The Impact of Residual Tumor Morphology on Prognosis, Recurrence, and Fistula Formation after Lung Cancer Resection. J Thorac Oncol 2008; 3:599-603. [DOI: 10.1097/jto.0b013e3181753b70] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Erasmus JJ, Sabloff BS. CT, positron emission tomography, and MRI in staging lung cancer. Clin Chest Med 2008; 29:39-57, v. [PMID: 18267183 DOI: 10.1016/j.ccm.2007.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lung cancer is a common malignancy and remains the leading cause of cancer-related deaths in both men and women in the United States. Imaging plays an important role in the detection, diagnosis, and staging of the disease as well as in assessing response to therapy and monitoring for tumor recurrence after treatment. This article reviews the staging of the two major histologic categories of lung cancer-non-small-cell lung carcinoma (NSCLC) and small-cell lung carcinoma-and emphasizes the appropriate use of CT, MRI, and positron emission tomography imaging in patient management. Also discussed are proposed revisions of the International Association for the Study of Lung Cancer's terms used to describe the extent of NSCLC in terms of the primary tumor, lymph nodes, and metastases descriptors.
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Affiliation(s)
- Jeremy J Erasmus
- Division of Diagnostic Imaging, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0371, Houston, TX 77030, USA.
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