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Di Tommaso L, Di Tommaso E, Giordano R, Mileo E, Santini M, Pilato E, Iannelli G. Endovascular Surgery of Descending Thoracic Aorta Involved in T4 Lung Tumor. J Endovasc Ther 2023; 30:84-90. [PMID: 35114844 DOI: 10.1177/15266028221075551] [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: 01/25/2023]
Abstract
PURPOSE Surgical treatment of primary lung T4 tumors is controversial especially when the cancer invades the mediastinal structures or the descending thoracic aorta. Conventional surgical treatment is associated with a high perioperative mortality and morbidity rate. Thoracic EndoVascular Aortic Repair has emerged as a valid off-label alternative to conventional surgery. We aimed to assess perioperative and midterm aortic-related outcome of patients who have undergone aortic stent-graft implantation, followed by en bloc surgical treatment of the involved aorta and lung cancer resection. MATERIALS AND METHODS From July 2017 to May 2020, we treated 5 patients diagnosed with a T4 lung cancer by the involvement of the descending thoracic aorta. When only the descending thoracic aorta is involved, a 2-stage procedure was considered, with aortic stent-graft implantation performed before tumor resection. One-stage strategy, with stent-graft implantation carried out before thoracotomy, was preferred for patients with the involvement of cardiac and/or other vascular mediastinal structures. RESULTS The mean age was 58.4 ± 6.2 years. All patients were affected by non-small cell lung cancer. All 5 patients required a single stent-graft to completely cover the involved segment of aorta. Four patients underwent a 2-stage procedure. One patient, with the involvement of the left inferior pulmonary vein, required a 1-stage en bloc resection of the left lower lobe, aortic wall adventitia, left inferior pulmonary vein, and reconstruction of the left atrial wall. Primary procedural success was achieved in all. At follow-up, no patient developed aortic-related complications. One patient died 2 years after surgery, due to local recurrence of the tumor. CONCLUSION T4 lung resection combined with aortic stent-graft implantation can be safely performed. Endovascular surgery, by avoiding the use of cardiopulmonary bypass, aortic cross-clamping, and graft replacement, can reduce significant morbidity and mortality rate. Postoperative and long-term outcome of these patients treated with endovascular surgery is mainly related to pulmonary disease, not to aortic treatment.
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Affiliation(s)
- Luigi Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Ettorino Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Raffaele Giordano
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Emilio Mileo
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Emanuele Pilato
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Gabriele Iannelli
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
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Dell’Amore A, Campisi A, De Franceschi E, Bertolaccini L, Gabryel P, Chen C, Ciarrocchi AP, Russo MD, Cannone G, Fang W, Piwkowski C, Spaggiari L, Rea F. Surgical results of non-small cell lung cancer involving the heart and great vessels advanced lung cancer surgically treated. Eur J Surg Oncol 2022; 48:1929-1936. [DOI: 10.1016/j.ejso.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/22/2022] [Accepted: 02/06/2022] [Indexed: 10/19/2022] Open
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Maurizi G, D'Andrilli A, Vanni C, Ciccone AM, Ibrahim M, Andreetti C, Tierno SM, Venuta F, Rendina EA. Direct Cross-Clamping for Resection of Lung Cancer Invading the Aortic Arch or the Subclavian Artery. Ann Thorac Surg 2020; 112:1841-1846. [PMID: 33352179 DOI: 10.1016/j.athoracsur.2020.12.009] [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: 05/19/2020] [Revised: 10/18/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Resection of lung cancer infiltrating the aortic arch or the subclavian artery can be accomplished in selected patients with the use of cardiopulmonary bypass (CPB). Direct cross-clamping of the aortic arch and the left subclavian artery without CPB for radical resection of the tumor can be an alternative. This study presents one group's experience with this technique. METHODS Between October 2016 and May 2019, 9 patients (5 male, 4 female) underwent radical resection of lung cancer infiltrating the aortic arch (n = 5) or the left subclavian artery (n = 4) by direct cross-clamping technique at Sapienza University of Rome, Italy. Seven left upper lobectomies, 1 left pneumonectomy, and 1 left upper sleeve lobectomy were performed. Reconstruction of the aortic arch was performed by direct suturing or polyethylene terephthalate (Dacron) patch, whereas the subclavian artery was reconstructed with a Dacron conduit. Three patients received neoadjuvant chemotherapy. RESULTS Patients' mean age was 64.7 ± 13.3 years (range, 36 to 78 years). Aortic arch resection was partial in all cases (adventitial in 1 and full thickness in 4); left subclavian artery resection was adventitial in 2 patients and circumferential in 2. All the resections were complete. Prosthetic reconstruction was performed in 4 cases. Mean operative time was 130 ± 25.6 minutes; mean vascular clamping time was 28.2 ± 3.2 minutes. No mortality occurred. The major complication rate was 11.1 %. At a mean follow-up of 17 ± 9 months (range, 5 to 29 months), the recurrence rate was 33.3%. Median survival was 20 months. CONCLUSIONS Direct cross-clamping as an alternative to CPB for resection of lung cancer infiltrating the aortic arch or the subclavian artery is a feasible, safe, and reliable procedure in selected patients.
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Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
| | - Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Camilla Vanni
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Anna Maria Ciccone
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Claudio Andreetti
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Simone M Tierno
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Li Q, Zhang P, Wang Y, Liu D, Luo L, Diasio RB, Yang P, Jiang G. T4 extension alone is more predictive of better survival than a tumour size >7 cm for resected T4N0-1M0 non-small-cell lung cancer†. Eur J Cardiothorac Surg 2020; 55:682-690. [PMID: 30508081 DOI: 10.1093/ejcts/ezy360] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/14/2018] [Accepted: 09/03/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES T4N0-1 non-small-cell lung cancer (NSCLC) was historically considered curable but now includes tumours of size >7 cm according to the 8th edition tumour, node and metastasis (TNM) staging. This study was set out to evaluate the role of surgery and predictors of long-term survival after surgery in this renewed group of patients. METHODS Patients, with clinical T4N0-2M0 NSCLC diagnosed in 2010-2013, in the National Cancer Database were queried. A Cox regression analysis was applied to investigate independent predictors of survival in 1588 N0-1 surgical cases. For previous T3 cases, the efficacy of treatment including and not including surgery was compared after propensity score matching by age, gender, race, facility type, comorbidity, laterality, clinical N stage, histology and tumour grade. RESULTS In newly defined T4N0-1 NSCLC patients undergoing surgery, age, gender, comorbidity, nodal status, resection margin, tumour grade, chemotherapy and extension-size group were shown to be independent predictors of survival. In particular, patients with only T4 extension showed better survival than patients with tumour size >7 cm only [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.62-0.92, P = 0.016]. In the latter group, surgical treatment was associated with better survival than non-surgical treatment after matching (HR 0.45, 95% CI 0.42-0.48, P < 0.001). CONCLUSIONS In the newly defined T4 NSCLC, tumour size >7 cm is a descriptor that is more predictive of worse survival than local extension alone for patients whose treatment included surgery. For T4-extended, N0-1 NSCLC with a tumour size ≤7 cm, surgery might be associated with favourable long-term outcomes and should be further encouraged as a treatment option.
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Affiliation(s)
- Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Yi Wang
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dan Liu
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
- Division of Pulmonary & Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Luo
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Research and Education, Guizhou Province People's Hospital, Guiyang, China
| | | | - Ping Yang
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
- Mayo Clinic Cancer Center, Rochester, MN, USA
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
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Çitak N, Aksoy Y, İşgörücü Ö, Obuz C, Açıkmeşe B, Büyükkale S, Fener NA, Metin M, Sayar A. The prognostic impact of the mediastinal fat tissue invasion in patients with non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2020; 69:76-83. [PMID: 32676942 DOI: 10.1007/s11748-020-01440-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prognosis of the mediastinal fat tissue invasion in non-small cell lung cancer (NSCLC) patients has not yet been clearly defined. The present study aimed to investigate the prognostic impact of the mediastinal fat tissue invasion in NSCLC patients. METHOD We analyzed 36 patients who were found mediastinal fat tissue invasion by pathological evaluation (mediastinal fat group) and 248 patients who were classified as T4-NSCLC according to the 8th TNM classification (T4 group; invasion of other mediastinal structures in 78 patients, ipsilateral different lobe satellite pulmonary nodule in 32 patients, and tumor diameter > 7 cm in 138 patients). RESULT Resection was regarded as complete (R0) in 255 patients (89.7%). Mediastinal fat group showed significantly higher incidence of incomplete resection (R1) and more left-sided tumors than the T4 group (p = 0.01, and p = 0.002, respectively). The survival was better in T4 group than mediastinal fat group (median 57 months versus 31 months), although it was not significant (p = 0.205). Even when only N0/1 or R0 patients were analyzed, the survival was not different between two groups (p = 0.420, and p = 0.418, respectively). 5-year survival rates for T4 subcategories (invasion of other structures, ipsilateral different lobe pulmonary nodule, and tumor diameter > 7 cm) were 39.4%, 41.9%, and 50.3%, respectively (p = 0.109). Multivariate analysis showed that age (p < 0.0001), nodal status (p = 0.0003), and complete resection (p < 0.0001) were independently influenced survival. CONCLUSION There is no significant difference in the prognosis between mediastinal fat tissue invasion and T4 disease in NSCLC patients.
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Affiliation(s)
- Necati Çitak
- Bakirkoy Dr. Sadi Konuk Research and Education Hospital, Tevfik Saglam Cd No 1 Dr. Sadi Konuk Hastanesi, Bakirköy, 34010, Istanbul, Turkey.
| | - Yunus Aksoy
- Yedikule Thoracic Surgery and Chest Disease Hospital, Istanbul, Turkey
| | - Özgür İşgörücü
- Bakirkoy Dr. Sadi Konuk Research and Education Hospital, Tevfik Saglam Cd No 1 Dr. Sadi Konuk Hastanesi, Bakirköy, 34010, Istanbul, Turkey
| | - Ciğdem Obuz
- Yedikule Thoracic Surgery and Chest Disease Hospital, Istanbul, Turkey
| | - Barış Açıkmeşe
- Bakirkoy Dr. Sadi Konuk Research and Education Hospital, Tevfik Saglam Cd No 1 Dr. Sadi Konuk Hastanesi, Bakirköy, 34010, Istanbul, Turkey
| | | | | | - Muzaffer Metin
- Yedikule Thoracic Surgery and Chest Disease Hospital, Istanbul, Turkey
| | - Adnan Sayar
- Private Memorial Hospital Istanbul, Istanbul, Turkey
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Mody GN, Janko M, Vasudeva V, Chi JH, Davidson MJ, Swanson S. Thoracic Endovascular Aortic Stent Graft to Facilitate Aortic Resection During Pneumonectomy and Vertebrectomy for Locally Invasive Lung Cancer. Ann Thorac Surg 2016; 101:1587-9. [PMID: 27000584 DOI: 10.1016/j.athoracsur.2015.05.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/12/2015] [Accepted: 05/15/2015] [Indexed: 10/22/2022]
Abstract
Endovascular stent graft placement has been used to facilitate resection of tumors invading the thoracic aorta. Here we describe the first use of an aortic endograft for preoperative protection of the thoracic descending aorta before left pneumonectomy for a primary lung cancer invading the thoracic spine and thoracic descending aorta.
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Affiliation(s)
- Gita N Mody
- Division of Thoracic Surgery, Department of General Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Matthew Janko
- Division of Cardiac Surgery, Department of General Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Viren Vasudeva
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - John H Chi
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael J Davidson
- Division of Cardiac Surgery, Department of General Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Scott Swanson
- Division of Thoracic Surgery, Department of General Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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8
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Reardon ES, Schrump DS. Extended resections of non-small cell lung cancers invading the aorta, pulmonary artery, left atrium, or esophagus: can they be justified? Thorac Surg Clin 2014; 24:457-64. [PMID: 25441139 PMCID: PMC6301020 DOI: 10.1016/j.thorsurg.2014.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
T4 tumors that invade the heart, great vessels, or esophagus comprise a heterogenous group of locally invasive lung cancers. Prognosis depends on nodal status; this relationship has been consistently demonstrated in many of the small series of extended resection. Current National Comprehensive Cancer Network guidelines do not recommend surgery for T4 extension with N2-3 disease (stage IIIB). However, biopsy-proven T4 N0-1 (stage IIIA) may be operable. Localized tumors with invasion of the aorta, pulmonary artery, left atrium, or esophagus represent a small subset of T4 disease. Acquiring sufficient randomized data to provide statistical proof of a survival advantage for patients undergoing extended resections for these neoplasms will likely never be possible.Therefore, we are left to critically analyze current documented experience to make clinical decisions on a case-by-case basis.It is clear that the operative morbidity and mortality of extended resections for locally advanced T4 tumors have significantly improved over time,yet the risks are still high. The indications for such procedures and the anticipated outcomes should be clearly weighed in terms of potential perioperative complications and expertise of the surgical team. Patients with T4 N0-1 have the best prognosis and with complete resection may have the potential for cure. The use of induction therapy and surgery for advanced T4 tumors may improve survival. Current data suggest that for tumors that invade the aorta, pulmonary artery,left atrium, or esophagus, resection should be considered in relation to multidisciplinary care.For properly selected patients receiving treatment at high volume, experienced centers, extended resections may be warranted.
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Affiliation(s)
- Emily S Reardon
- Thoracic Surgery Section, Thoracic and GI Oncology Branch, CCR/NCI, National Institutes of Health, Building 10, 4-3942, 10 Center Drive, MSC 1201, Bethesda, MD 20892-1201, USA
| | - David S Schrump
- Thoracic Surgery Section, Thoracic and GI Oncology Branch, CCR/NCI, National Institutes of Health, Building 10, 4-3942, 10 Center Drive, MSC 1201, Bethesda, MD 20892-1201, USA.
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Pricopi C, Alimi F, Achouh P, Mordant P, Le Pimpec-Barthes F, Arame A, Badia A, Riquet M. [Lung cancer with heart failure--a cardiac and thoracic surgeon's collaboration]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:122-125. [PMID: 24566033 DOI: 10.1016/j.pneumo.2013.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/30/2013] [Accepted: 08/04/2013] [Indexed: 06/03/2023]
Abstract
Surgical resection is a validated therapeutic option for selected cases of pulmonary tumors invading the important mediastinal structures (caval vein, atrium, aorta or supra-aortic trunks). Here, we present a patient with a necrosed pulmonary tumor invading the left atrium, causing cardiac insufficiency. A complete surgical resection under extracorporeal circulation was performed by the thoracic and cardiac teams. Admitted in a bed-ridden state, the patient was discharged completely rehabilitated on postoperative day 13. He survived 1 year at home with a good quality of life.
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Affiliation(s)
- C Pricopi
- Service de chirurgie thoracique, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - F Alimi
- Service de chirurgie thoracique, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - P Achouh
- Service de chirurgie cardiovasculaire, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - P Mordant
- Service de chirurgie thoracique, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec-Barthes
- Service de chirurgie thoracique, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Arame
- Service de chirurgie thoracique, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Badia
- Service de chirurgie thoracique, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen G.-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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Reymen B, van Baardwijk A, Wanders R, Borger J, Dingemans AMC, Bootsma G, Pitz C, Lunde R, Geraedts W, Lambin P, De Ruysscher D. Long-term survival of stage T4N0-1 and single station IIIA-N2 NSCLC patients treated with definitive chemo-radiotherapy using individualised isotoxic accelerated radiotherapy (INDAR). Radiother Oncol 2014; 110:482-7. [PMID: 24444527 DOI: 10.1016/j.radonc.2013.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 12/10/2013] [Accepted: 12/18/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) stage T4N0-1 or single nodal station IIIA-N2 are two stage III sub-groups for which the outcome of non-surgical therapy is not well known. We investigated the results of individualised isotoxic accelerated radiotherapy (INDAR) and chemotherapy in this setting. METHODS Analysis of NSCLC patients included in 2 prospective trials (NCT00573040 and NCT00572325) stage T4N0-1 or IIIA-N2 with 1 pathologic nodal station, treated with chemo-radiotherapy (CRT) using INDAR with concurrent or sequential platinum-based chemotherapy. Overall survival (OS) was updated and calculated from date of diagnosis (Kaplan-Meier). Toxicity was scored following CTCAEv3.0. To allow comparison with other articles the subgroups were also analysed separately for toxicity, progression free and overall survival. RESULTS 83 patients (42 T4N0-1 and 41 IIIA-N2) were identified: the median radiotherapy dose was 65Gy. Thirty-seven percent of patients received sequential CRT and 63% received concurrent CRT. At a median follow-up of 48 months the median OS for T4N0-1 patients was 34 months with 55% 2-year survival and 25% 5-year survival. For stage IIIA-N2 at a median follow-up of 50 months the median OS was 26 months with 2- and 5-year survival rates of 53% and 24%, respectively. CONCLUSION Chemo-radiation using INDAR yields promising survival results in patients with single-station stage IIIA-N2 or T4N0-1 NSCLC.
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Affiliation(s)
- Bart Reymen
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands.
| | | | - Rinus Wanders
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands
| | - Jacques Borger
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonology, University Medical Centre Maastricht, GROW-School for Oncology and Developmental Biology, The Netherlands
| | - Gerben Bootsma
- Department of Pulmonology, Atrium Medical Centre, Heerlen, The Netherlands
| | - Cordula Pitz
- Department of Pulmonology, Laurentius Hospital, Roermond, The Netherlands
| | - Ragnar Lunde
- Department of Pulmonology, St. Jansgasthuis, Weert, The Netherlands
| | - Wiel Geraedts
- Department of Pulmonology, Orbis Medical Centre, Sittard, The Netherlands
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands; University Hospital Leuven/KU Leuven, Belgium
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A Prediction Model for Pathologic N2 Disease in Lung Cancer Patients with a Negative Mediastinum by Positron Emission Tomography. J Thorac Oncol 2013; 8:1170-80. [DOI: 10.1097/jto.0b013e3182992421] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Imai K, Minamiya Y, Ishiyama K, Hashimoto M, Saito H, Motoyama S, Sato Y, Ogawa JI. Use of CT to evaluate pleural invasion in non-small cell lung cancer: measurement of the ratio of the interface between tumor and neighboring structures to maximum tumor diameter. Radiology 2013; 267:619-26. [PMID: 23329658 DOI: 10.1148/radiol.12120864] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop a simple noninvasive technique for evaluating pleural invasion by using routine preoperative computed tomography (CT). MATERIALS AND METHODS The institutional review board approved this retrospective study, and written informed consent was obtained for performing the initial and follow-up CT studies. Preoperative CT findings (169 patients with possible pleural invasion) and pathologic diagnoses after surgical resection were evaluated. The length of the interface between the primary tumor and neighboring structures (arch distance) and the maximum tumor diameter were measured on CT images, after which arch distance-to-maximum tumor diameter ratios were calculated. Receiver operating characteristic (ROC) curves were used to analyze the ratios. RESULTS Median arch distance-to-maximum tumor diameter ratios for pleural invasion categories (pl1, pl2, pl3) assessed by using the Union Internationale Contre le Cancer TNM staging system were as follows: pl1, 0.206 (25th-75th percentile, 0-0.486); pl2, 0.638 (25th-75th percentile, 0.385-0.830); and pl3, 1.092 (25th-75th percentile, 1.045-1.214) (P < .001 between groups). On the basis of the ROC curves, the cut-off value for invasion was an arch distance-to-maximum tumor diameter ratio of 0.9. When the ratio was greater than 0.9, the sensitivity and specificity for thoracic invasion and area under the ROC curve were 89.7%, 96.0%, and 0.976, respectively, which represents an improvement over values obtained by using conventional criteria (radiologists A and B: 46.7% and 74.2% and 91.3% and 84.8%, respectively). CONCLUSION When diagnosing T3 or T4 lung cancer based on arch distance-to-maximum tumor diameter ratios, a higher performance level was achieved than that with use of conventional criteria. Measurement of the ratios is a simple noninvasive technique for evaluating pleural invasion at CT.
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Affiliation(s)
- Kazuhiro Imai
- Department of Chest, Breast and Endocrinologic Surgery and Department of Integrated Medicine, Division of Radiology and Radiation Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo Akita City 010-8543, Japan.
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Sigel K, Mhango G, Cohen J, Halm EA, Mandeli J, Strauss G, Wisnivesky J. Outcomes after adjuvant platinum-based chemotherapy in elderly NSCLC patients with T4 disease. Ann Surg Oncol 2012; 20:1013-9. [PMID: 23115004 DOI: 10.1245/s10434-012-2717-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The postoperative management of elderly patients with T4, N0-1, M0 non-small cell lung cancer (NSCLC) remains controversial. The objective of this study was to evaluate the association of adjuvant chemotherapy with survival and toxicity among these patients. METHODS Using surveillance, epidemiology and end results registry data linked to Medicare claims, we identified 389 elderly patients with resected T4, N0-1, M0 NSCLC diagnosed between 1992 and 2007. We compared survival of patients treated with and without platinum-based chemotherapy using a Cox regression adjusting for propensity scores for chemotherapy use and use of radiotherapy. We used logistic regression to assess the risk of adverse events in patients receiving chemotherapy. RESULTS No benefit was noted in overall survival with adjuvant chemotherapy after PS adjustment for both N0 (hazard ratio 0.78, 95% confidence interval 0.50-1.23) and N1 (hazard ratio 1.01, 95% confidence interval 0.67-1.53) cancers. Patients receiving adjuvant chemotherapy experienced severe adverse events more frequently than patients who did not receive chemotherapy. CONCLUSIONS Use of adjuvant chemotherapy in elderly patients with T4, N0-1, M0 NSCLC was not associated with a survival advantage and was associated with higher rates of severe toxicity.
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Affiliation(s)
- Keith Sigel
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA.
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Nimmo C, Lyons O, Clough R, Landau D, Routledge T, Taylor P. Novel use of endoluminal repair as prophylaxis of aortic rupture secondary to radiotherapy for lung cancer. J Vasc Surg 2011; 54:1795-7. [PMID: 21890305 DOI: 10.1016/j.jvs.2011.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 05/31/2011] [Accepted: 06/11/2011] [Indexed: 11/17/2022]
Abstract
Non-small-cell lung cancer (NSCLC) invading the aorta is staged as T(4). Only 9% of T(4) tumors are resected; the alternative is chemoradiotherapy, but for peri-aortic NSCLC, radiation damage to the aortic wall can induce fatal rupture. We report the case of a 76 year-old man with a 3-cm left lower lobe NSCLC clearly invading the aortic wall. A thoracic stent graft was inserted prophylactically to prevent aortic rupture. He then received 64 Gy radiotherapy in 32 fractions, resulting in tumor shrinkage. Prophylactic aortic endografting, a less invasive treatment than open surgery, may enable high dose irradiation of the aortic wall.
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Affiliation(s)
- Camus Nimmo
- King's Health Partners Vascular Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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李 旸, 徐 澄, 孙 威, 张 霓, 付 向. [Left main bronchus root prolongation to cure 3 patients whose carina is involved by lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2011; 14:271-4. [PMID: 21426672 PMCID: PMC5999652 DOI: 10.3779/j.issn.1009-3419.2011.03.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 10/13/2010] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Patient whose carina is involved by carcinoma is difficult to treat by surgery. The aim of this study is to evaluate the safety and effectiveness of left main bronchus root prolongation to cure these patients. METHODS Three patients with lung carcinoma received tumor, right upper lung and carina excision. And then the trachea and the carina was rebuilt by continuous suture, so that the left main bronchus root was extended by 3 cm, then the middle and lower lobe bronchus were sutured to the right lateral wall of the moved up eminence. RESULTS All the patients left hospital successfully after three-week treatment, without anastomotic stoma fistula. And they got good quality of life after 30, 21 and 11 months' follow-up, no recurrence or metabasis was found. CONCLUSIONS The left main bronchus root prolongation can preserve the left lateral wall, however, part of the tracheal mucous membrane and arteria trachealis can be protected without injury. It's benifit for making productive cough and lowering complications after operation. The new carinal reconstruction process has definite indication, which refer to patient with normal left main bronchus root and the right inferior segment trachea involved by carcinoma.
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Affiliation(s)
- 旸凯 李
- />430030 武汉,华中科技大学同济医学院附属同济医院普胸外科Departmentof General Thoracic Surgery, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science andTechnology, Wuhan430030, China
| | - 澄澄 徐
- />430030 武汉,华中科技大学同济医学院附属同济医院普胸外科Departmentof General Thoracic Surgery, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science andTechnology, Wuhan430030, China
| | - 威 孙
- />430030 武汉,华中科技大学同济医学院附属同济医院普胸外科Departmentof General Thoracic Surgery, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science andTechnology, Wuhan430030, China
| | - 霓 张
- />430030 武汉,华中科技大学同济医学院附属同济医院普胸外科Departmentof General Thoracic Surgery, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science andTechnology, Wuhan430030, China
| | - 向宁 付
- />430030 武汉,华中科技大学同济医学院附属同济医院普胸外科Departmentof General Thoracic Surgery, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science andTechnology, Wuhan430030, China
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Chambers A, Routledge T, Billè A, Scarci M. Does surgery have a role in T4N0 and T4N1 lung cancer? Interact Cardiovasc Thorac Surg 2010; 11:473-9. [DOI: 10.1510/icvts.2010.235119] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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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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What is the role for surgery in patients with stage III non-small cell lung cancer? Curr Opin Pulm Med 2009; 15:295-302. [PMID: 19465855 DOI: 10.1097/mcp.0b013e32832cbefc] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Locally advanced non-small cell lung cancer (NSCLC) represents a therapeutic challenge. Although combined modality has become the standard treatment in stage III NSCLC, the role of surgery in it remains controversial. This review will address recent evidence on the potential role of surgery in either superior sulcus tumors, T4N0-1 tumors with central extension multifocal tumors with nodule(s) in the same lobe, or stage III disease with mediastinal lymph node involvement. RECENT FINDINGS Two recent phase 2 trials, exploring surgical resection preceded by induction chemoradiotherapy for tumors of the superior sulcus, have reported an impressive survival with acceptable mortality rate. They confirm the outcome observed in other prospective and retrospective series for T3-4N0-1. For subsets of T4 NSCLC with central extension or with satellite nodule(s) in the primary lobe, cumulative data suggest that these tumors behave differently than other stage IIIB tumors and might benefit from upfront surgery, possibly followed by postoperative chemotherapy and/or radiotherapy. Whenever clinical mediastinal lymph node invasion is present, surgery after induction treatment is not proven superior to radiotherapy, and is best restricted to clinical trials. SUMMARY Combined modality treatment is the standard of care for locally advanced NSCLC and the optimal role for surgery remains a challenging issue for the clinicians.
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Farjah F, Flum DR, Varghese TK, Symons RG, Wood DE. Surgeon Specialty and Long-Term Survival After Pulmonary Resection for Lung Cancer. Ann Thorac Surg 2009; 87:995-1004; discussion 1005-6. [DOI: 10.1016/j.athoracsur.2008.12.030] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Revised: 11/25/2008] [Accepted: 12/01/2008] [Indexed: 12/20/2022]
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