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Bishnoi K, Parida GK, Patro PSS, Agrawal K, Singh P. Complex Regional Pain Syndrome-like Pattern in a Case of Pancoast Tumor. Indian J Nucl Med 2023; 38:384-386. [PMID: 38390551 PMCID: PMC10880852 DOI: 10.4103/ijnm.ijnm_38_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/06/2023] [Accepted: 08/09/2023] [Indexed: 02/24/2024] Open
Abstract
We present the case of a 52-year-old male who was recently diagnosed case of a Pancoast tumor and presented to the pulmonary outpatient department with a complaint of pain in the shoulder and chest region which was burning type, associated with shoulder abduction weakness and poor hand grip. Subsequently, he was referred for a 99m-Tc bone scan for metastatic workup, which showed increased uptake in all the joints and long bones of the ipsilateral upper limb. This case highlights the importance of considering nontraumatic cause of pattern similar to complex regional pain syndrome.
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Affiliation(s)
- Komal Bishnoi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Girish Kumar Parida
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - P Sai Sradha Patro
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kanhaiyalal Agrawal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Parneet Singh
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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2
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Kader S, Watkins A, Servais EL. The oncologic efficacy of extended thoracic resections. J Surg Oncol 2023; 127:288-295. [PMID: 36630102 DOI: 10.1002/jso.27151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 01/12/2023]
Abstract
Locally invasive lung cancers pose unique challenges for management. Surgical resection of these tumors can pose high morbidity due to the invasion into surrounding structures, including the spine, chest wall, and great vessels. With advances in immunotherapy and chemoradiation, the role for radical resection of these malignancies and associated oncologic outcomes is evolving. This article reviews the current literature of extended thoracic resections with a focus on technical approach, functional outcomes, and oncologic efficacy.
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Affiliation(s)
- Sarah Kader
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Ammara Watkins
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.,Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Elliot L Servais
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.,Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA
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3
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Current Surgical Indications for Non-Small-Cell Lung Cancer. Cancers (Basel) 2022; 14:cancers14051263. [PMID: 35267572 PMCID: PMC8909782 DOI: 10.3390/cancers14051263] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/05/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary The management strategy for the treatment of non-small-cell lung cancer (NSCLC) has been transformed by our improved understanding of the cancer biology and concomitant development of novel systemic therapies. Complete surgical resection of NSCLC continues to offer the best chance for cure or local and regional disease control, and with improvements in minimally invasive techniques and enhanced recovery, the morbidity associated with surgical resection has been reduced. Patient-centered multi-disciplinary discussions that consider surgical therapy are associated with improved outcomes. Provided with promising novel therapeutic modalities including immune checkpoint inhibitors with or without chemotherapy, stereotactic radiotherapy, and targeted systemic therapies, indications for surgery continue to evolve and have expanded to include selected patients with advanced and metastatic disease. Abstract With recent strides made within the field of thoracic oncology, the management of NSCLC is evolving rapidly. Careful patient selection and timing of multi-modality therapy to permit the optimization of therapeutic benefit must be pursued. While chemotherapy and radiotherapy continue to have a role in the management of lung cancer, surgical therapy remains an essential component of lung cancer treatment in early, locally and regionally advanced, as well as in selected, cases of metastatic disease. Recent and most impactful advances in the treatment of lung cancer relate to the advent of immunotherapy and targeted therapy, molecular profiling, and predictive biomarker discovery. Many of these systemic therapies are a part of the standard of care in metastatic NSCLC, and their indications are expanding towards surgically operable lung cancer to improve survival outcomes. Numerous completed and ongoing clinical trials in the surgically operable NSCLC speak to the interest and importance of the multi-modality therapy even in earlier stages of NSCLC. In this review, we focus on the current standard of care indications for surgical therapy in stage I-IV NSCLC as well as on the anticipated future direction of multi-disciplinary lung cancer therapy.
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Taira A, Nawashiro A, Takeda Y, Shinohara S, Takenaka M, Kuroda K, Oto T, Tanaka F. Lung Auto-transplantation for Bulky Superior Sulcus Tumor with Hilar Involvement. Ann Thorac Surg 2021; 114:e97-e99. [PMID: 34902305 DOI: 10.1016/j.athoracsur.2021.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/21/2021] [Accepted: 10/14/2021] [Indexed: 11/18/2022]
Abstract
Lung auto-transplantation with ex vivo bench surgery is a useful surgical technique for centrally-located and locally-advanced lung cancer to spare lung parenchyma by avoiding pneumonectomy. Here, we present a case of bulky superior sulcus tumor with hilar involvement for which lung-sparing complete resection was achieved with auto-transplantation. After concurrent chemo-radiotherapy, en bloc resection consisting left pneumonectomy combined with apical chest wall resection (1-4ribs), back-table extended double-sleeve resection following lung preservation, and re-implantation of basal segment was performed. Postoperative course was uneventful, and the patient is alive without tumor recurrence at 18 months after surgery.
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Affiliation(s)
- Akihiro Taira
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ayako Nawashiro
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yusuke Takeda
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shinji Shinohara
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masaru Takenaka
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koji Kuroda
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takahiro Oto
- Thoracic and Transplant Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Fumihiro Tanaka
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
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5
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The Evolving Landscape of Lung Cancer Surgical Resection: An Update for Radiologists With Focus on Key Chest CT Findings. AJR Am J Roentgenol 2021; 218:52-65. [PMID: 34406062 DOI: 10.2214/ajr.21.26408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Evolution of the multimodality management of early lung cancer, including progress in surgical techniques, has introduced the possibility of resection for lung cancer cases that historically were considered unresectable (e.g., select cases of T4 disease and oligometastatic disease). However, the TNM classification does not uniformly correlate with lung cancer operability and resectability. Radiologic evaluation is therefore critical in identifying patients' suitability to undergo lung cancer resection and in guiding the selection of a surgical approach from among a range of such approaches, including wedge resection, segmentectomy, lobectomy, bilobectomy, and pneumonectomy. The radiologist must understand the available surgical options, along with their advantages and disadvantages, and provide a report that includes critical information on tumor size, location, and extension and anatomic relations that may influence the surgical technique. Preoperative CT findings may also help predict expected postoperative lung function and the associated impact on the postoperative course of the patient. This article reviews the role of chest CT in the preoperative evaluation of lung cancer, focusing on the key CT findings that help direct surgical decision making in the context of an expanding range of patients who may be considered candidates for resection.
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6
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Issa M, Abadin ZU. A Nearly Missed Pancoast Tumour From Isolated Persistent Leg Pain. Cureus 2021; 13:e15328. [PMID: 34221774 PMCID: PMC8240066 DOI: 10.7759/cureus.15328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 11/05/2022] Open
Abstract
Pancoast tumours (PTs) are apical tumours of the lung that manifest with a variety of symptoms. Herein, we describe a rare case of a 56-year-old female with a one-month history of persistent left leg pain despite advanced imaging, such as magnetic resonance imaging (MRI), and orthopaedic input, which was focused onto her left knee being the prime cause of her pain. Her non-resolving symptoms prompted her to attend the Emergency Department. A careful clinical examination pointed towards the left proximal tibia being the most probable cause. Basic radiographic imaging (x-ray) of the left tibia revealed a lytic lesion which was later confirmed to be metastatic disease arising from a Pancoast tumour (PT) following further advanced imaging and diagnostics. This case highlights a unique presentation of a Pancoast tumour that, to our knowledge, has never been reported before in the medical literature. A high index of suspicion, careful examination, and investigation were essential to reach this diagnosis.
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Affiliation(s)
- Moussa Issa
- Emergency Medicine Department, Midland Regional Hospital at Tullamore, Tullamore, IRL
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7
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Wong SL, Alshaikhi J, Grimes H, Amos RA, Poynter A, Rompokos V, Gulliford S, Royle G, Liao Z, Sharma RA, Mendes R. Retrospective Planning Study of Patients with Superior Sulcus Tumours Comparing Pencil Beam Scanning Protons to Volumetric-Modulated Arc Therapy. Clin Oncol (R Coll Radiol) 2021; 33:e118-e131. [PMID: 32798157 PMCID: PMC7883303 DOI: 10.1016/j.clon.2020.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/30/2020] [Accepted: 07/22/2020] [Indexed: 12/25/2022]
Abstract
AIMS Twenty per cent of patients with non-small cell lung cancer present with stage III locally advanced disease. Precision radiotherapy with pencil beam scanning (PBS) protons may improve outcomes. However, stage III is a heterogeneous group and accounting for complex tumour motion is challenging. As yet, it remains unclear as to whom will benefit. In our retrospective planning study, we explored if patients with superior sulcus tumours (SSTs) are a select cohort who might benefit from this treatment. MATERIALS AND METHODS Patients with SSTs treated with radical radiotherapy using four-dimensional planning computed tomography between 2010 and 2015 were identified. Tumour motion was assessed and excluded if greater than 5 mm. Photon volumetric-modulated arc therapy (VMAT) and PBS proton single-field optimisation plans, with and without inhomogeneity corrections, were generated retrospectively. Robustness analysis was assessed for VMAT and PBS plans involving: (i) 5 mm geometric uncertainty, with an additional 3.5% range uncertainty for proton plans; (ii) verification plans at maximal inhalation and exhalation. Comparative dosimetric and robustness analyses were carried out. RESULTS Ten patients were suitable. The mean clinical target volume D95 was 98.1% ± 0.4 (97.5-98.8) and 98.4% ± 0.2 (98.1-98.9) for PBS and VMAT plans, respectively. All normal tissue tolerances were achieved. The same four PBS and VMAT plans failed robustness assessment. Inhomogeneity corrections minimally impacted proton plan robustness and made it worse in one case. The most important factor affecting target coverage and robustness was the clinical target volume entering the spinal canal. Proton plans significantly reduced the mean lung dose (by 21.9%), lung V5, V10, V20 (by 47.9%, 36.4%, 12.1%, respectively), mean heart dose (by 21.4%) and thoracic vertebra dose (by 29.2%) (P < 0.05). CONCLUSIONS In this planning study, robust PBS plans were achievable in carefully selected patients. Considerable dose reductions to the lung, heart and thoracic vertebra were possible without compromising target coverage. Sparing these lymphopenia-related organs may be particularly important in this era of immunotherapy.
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Affiliation(s)
- S-L Wong
- University College London Cancer Institute, London, UK; Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK.
| | - J Alshaikhi
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK; Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK; Saudi Particle Therapy Centre, Riyadh, Saudi Arabia
| | - H Grimes
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
| | - R A Amos
- Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK; Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - A Poynter
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Rompokos
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Gulliford
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK; Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
| | - G Royle
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Z Liao
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - R A Sharma
- University College London Cancer Institute, London, UK; Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - R Mendes
- Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
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8
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Yuan L, Mao Y. [Advance of Treatment for Superior Sulcus Tumor of the Lung]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:493-497. [PMID: 29945709 PMCID: PMC6022026 DOI: 10.3779/j.issn.1009-3419.2018.06.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
肺上沟瘤是指发生在肺上沟区的的支气管源性肿瘤, 是非小细胞肺癌(non-small cell lung cancer, NSCLC)的一个独特的临床亚型, 占肺癌总数不足5%。它常侵犯第1肋、臂丛、锁骨下动静脉、交感神经链、星状神经节和(或)椎体等胸廓入口结构。近几十年, 肺上沟瘤的治疗取得了不断的进展, 最新发布的几个临床试验证实了同期放化疗加手术切除能够改善肿瘤的完整切除率、局部控制率和病理缓解率, 延长患者的总生存时间。已经成为肺上沟瘤的治疗最为有效的方式, 并成为美国国立综合癌症网络(National Comprehensive Cancer Network, NCCN)和美国胸科医师协会(American College of Chest Physicians, ACCP)指南推荐的肺上沟瘤治疗方案。本文回顾国内外相关文献, 简要介绍肺上沟瘤手术治疗及综合治疗的进展情况。
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Affiliation(s)
- Ligong Yuan
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
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9
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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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10
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Waseda R, Klikovits T, Hoda MA, Hoetzenecker K, Bertoglio P, Dieckmann K, Zöchbauer-Müller S, Pirker R, Prosch H, Döme B, Klepetko W. Trimodality therapy for Pancoast tumors: T4 is not a contraindication to radical surgery. J Surg Oncol 2017; 116:227-235. [PMID: 28407246 DOI: 10.1002/jso.24629] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 03/04/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study aims to evaluate the impact of T stage and extended surgery on the outcome of patients with Pancoast tumors after induction chemoradiation therapy. METHODS Forty-six consecutive patients who underwent chemoradiation therapy (platin-based, 45-66 Gy) followed by surgery between 1998 and 2013 were retrospectively reviewed and analyzed. RESULTS In 28 (61%) patients with T4 tumors, extended procedures (more than rib resection) were performed. There were 37 (80%) lobectomies, 6 (13%) pneumonectomies, and 3 (7%) sublobar resections. A total of 44 (96%) patients had R0 resection. About 30-day mortality was 0%, major surgical complications occurred in 9 (19.6%) patients. Overall survival (OS) at 5-years was 63%. Disease-free survival (DFS) at 5-years was 45%. At multivariate cox regression analysis adjusted for clinical factors, T factor (T3/T4) and extended surgical procedures did not impact survival. However, pathological positive N stage had a negative impact on OS and lack of pathological response negatively impacted both OS and DFS. CONCLUSION Trimodality treatment including radical resection for Pancoast tumors provides good surgical outcome and favorable long-term results. Survival of patients with T4 tumors and extended surgical procedures comparable to that of patients with T3 tumors undergoing rib resection only.
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Affiliation(s)
- Ryuichi Waseda
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Austria.,Department of General Thoracic, Breast and Pediatric Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Thomas Klikovits
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Mir Alireza Hoda
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Konrad Hoetzenecker
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Pietro Bertoglio
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Sabine Zöchbauer-Müller
- Division of Oncology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Robert Pirker
- Division of Oncology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Helmut Prosch
- Department of Radiology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Balazs Döme
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Austria.,National Korányi Institute of Pulmonology, Budapest, Hungary.,Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Austria
| | - Walter Klepetko
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Austria
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11
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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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12
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Deng HY, Li ZH, Wang ZQ, Wang YC, Li G, Lin YD, Liu LX. Small cervical incision facilitates minimally invasive resection of non-invasive thoracic inlet tumor. J Thorac Dis 2016; 8:2931-2935. [PMID: 27867570 DOI: 10.21037/jtd.2016.10.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND A challenge for resection of thoracic inlet tumors lies in that high risk of injuring vital blood vessels and brachial plexus still exists during the resection. And the standard surgical approach for resection of thoracic inlet tumors has not yet been well established. METHODS Small cervical incision-assisted minimally invasive surgical technique was developed and carried out in patients with non-invasive thoracic inlet tumor in our department. RESULTS We successfully performed the small cervical incision-assisted minimally invasive surgery in two patients with thoracic inlet tumors. The thoracic inlet tumors of the two patients were removed completely without any postoperative complications, and the patients achieved quick rehabilitation after surgery. This combined approach compensates the blind area of thoracoscope in visualizing the superior end of thoracic inlet tumors, and thus enables us to complete the resection safely and confidently. CONCLUSIONS Small cervical incision did facilitate the minimally invasive resection of non-invasive thoracic inlet tumor. Hopefully, this combined approach of video-assisted thoracoscopic surgery (VATS) with small cervical incision could be widely utilized in resecting thoracic inlet tumors by general thoracic surgeon.
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Affiliation(s)
- Han-Yu Deng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhi-Hui Li
- Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhi-Qiang Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yun-Cang Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Gang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yi-Dan Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lun-Xu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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13
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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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Li WW, Burgers JA, Klomp HM, Hartemink KJ. COUNTERPOINT: Is N2 Disease a Contraindication for Surgical Resection for Superior Sulcus Tumors? No. Chest 2016; 148:1375-1379. [PMID: 26110487 DOI: 10.1378/chest.15-1196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Wilson W Li
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Houke M Klomp
- Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Koen J Hartemink
- Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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15
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Lin A, Bezjak A. Clinical and research priorities for combined modality therapy in stage III NSCLC. Lung Cancer Manag 2016; 5:43-50. [PMID: 30643548 DOI: 10.2217/lmt-2015-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/01/2016] [Indexed: 11/21/2022] Open
Abstract
Stage III NSCLC comprises of a heterogeneous group of patients with regard to stage, extent of disease and prognosis. Disease presentation can often be complex in clinical practice, and the challenges are not well-defined in clinical trials or practice guidelines. In order to improve the therapeutic ratio of treatment, one needs to either increase the benefit of treatment or reduce toxicities, or both. Priorities in radiation therapy include dose escalation, imaging advances, improved target delineation, reduced planning target volume margin, intensity-modulated radiotherapy, image-guided radiotherapy, motion management and the use of cytoprotectants. Priorities in systemic therapy include the incorporation of molecularly targeted and immune-modulatory agents.
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Affiliation(s)
- Angela Lin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Bezjak
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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16
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Ozmen O, Yilmaz U, Dadali Y, Tatci E, Gokcek A, Aydin E, Okuyucu K, Arslan N. Use of FDG PET/CT in Patients with Pancoast Tumors: Does It Add Any Contribution to Patient Management? Cancer Biother Radiopharm 2015; 30:359-67. [PMID: 26367245 DOI: 10.1089/cbr.2014.1809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate any potential value of 2-deoxy-2-[18F] fluoro-D-glucose with positron emission tomography/computerized tomography (FDG PET/CT) in staging of patients with Pancoast tumors and to investigate the relationship between volume-based quantitative PET parameters and prognosis. MATERIALS AND METHODS The authors retrospectively reviewed data of the 47 patients with Pancoast tumors who underwent initial staging by conventional imaging methods and FDG PET/CT. FDG-PET images were visually and quantitatively evaluated, and metabolic tumor volume (MTV), total lesion glycolysis, and maximum standardized uptake values of primary tumors were calculated. The correlations between quantitative PET parameters and tumor stages, as well as overall survival, were analyzed. RESULTS By detecting unknown distant metastasis, PET/CT upstaged 21% of patients. The sensitivity and specificity for detection of lymphatic involvement were 100% and 83.75%, respectively. Having surgery (p = 0.01) and being at an early stage (p = 0.004) were the most predictive factors for overall survival. Although there was no significant correlation between quantitative PET parameters and overall survival, MTV was the most powerful discriminator for operability and preoperative staging (p < 0.05). CONCLUSIONS FDG-PET imaging was found to be a valuable method for an accurate staging in the management of patients with Pancoast tumor. Having surgery and being at an early stage at presentation were found to be significant predictors for survival. Quantitative metabolic parameters may contribute to clarification of operable patient subgroups having an early disease stage with low MTV.
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Affiliation(s)
- Ozlem Ozmen
- 1 Department of Nuclear Medicine, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital , Ankara, Turkey
| | - Ulku Yilmaz
- 2 Department of Chest Diseases, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital , Ankara, Turkey
| | - Yeliz Dadali
- 3 Department of Radiology, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital , Ankara, Turkey
| | - Ebru Tatci
- 1 Department of Nuclear Medicine, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital , Ankara, Turkey
| | - Atila Gokcek
- 3 Department of Radiology, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital , Ankara, Turkey
| | - Ertan Aydin
- 4 Department of Chest Surgery, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital , Ankara, Turkey
| | - Kursat Okuyucu
- 5 Department of Nuclear Medicine, Gulhane Military Medical Academy and Medical Faculty , Ankara, Turkey
| | - Nuri Arslan
- 5 Department of Nuclear Medicine, Gulhane Military Medical Academy and Medical Faculty , Ankara, Turkey
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17
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De Ruysscher D, Peeters S, Troost EG. Approaches in patients with locally advanced NSCLC: a radiation oncologist's perspective. Lung Cancer 2015. [DOI: 10.1183/2312508x.10010314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Eberhardt WEE, De Ruysscher D, Weder W, Le Péchoux C, De Leyn P, Hoffmann H, Westeel V, Stahel R, Felip E, Peters S. 2nd ESMO Consensus Conference in Lung Cancer: locally advanced stage III non-small-cell lung cancer. Ann Oncol 2015; 26:1573-88. [PMID: 25897013 DOI: 10.1093/annonc/mdv187] [Citation(s) in RCA: 273] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 04/09/2015] [Indexed: 12/25/2022] Open
Abstract
To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The 2nd ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, first-line/second and further lines of treatment in advanced disease, early-stage disease and locally advanced disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on locally advanced disease.
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Affiliation(s)
- W E E Eberhardt
- Department of Medical Oncology, West German Cancer Centre, University Hospital, University Duisburg-Essen, Ruhrlandklinik, Essen, Germany
| | - D De Ruysscher
- Department of Radiation Oncology, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - W Weder
- Division of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - C Le Péchoux
- Department of Radiation Oncology, Gustave Roussy Cancer Institute, Villejuif, France
| | - P De Leyn
- Department of Thoracic Surgery, University Hospitals, KU Leuven, Leuven, Belgium
| | - H Hoffmann
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - V Westeel
- Department of Chest Disease, University Hospital, Besançon, France
| | - R Stahel
- Clinic of Oncology, University Hospital Zürich, Zürich, Switzerland
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - S Peters
- Département d'Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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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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20
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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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21
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Weber DJ, Okereke IC, Birdas TJ, Ceppa DP, Rieger KM, Kesler KA. The "cut-in patch-out" technique for Pancoast tumor resections results in postoperative pain reduction: a case control study. J Cardiothorac Surg 2014; 9:163. [PMID: 25265907 PMCID: PMC4180969 DOI: 10.1186/s13019-014-0163-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 09/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since 2001 we have utilized a novel surgical approach for Pancoast tumors in which lobectomy and mediastinal lymph node dissection are performed directly though the chest wall defect. The defect is then patched at the completion of the procedure ("cut-in patch-out") thereby avoiding a separate thoracotomy with rib spreading. We undertook a study to compare outcomes of this novel "cut-in patch-out" technique with traditional thoracotomy for patients with Pancoast tumors. METHODS We retrospectively identified 41 patients undergoing surgical resection of Pancoast tumors requiring en-bloc removal of at least 3 ribs at our institution from 1999 to 2012. Surgery was accomplished by either a "cut-in patch-out" technique (n = 25) or traditional posterolateral thoracotomy and separate chest wall resection (n = 16). Multiple variables including patient demographics, neoadjuvant therapy, extent of resection, and pathology were analyzed with respect to outcomes from morbidity, narcotic use, and oncologic perspectives. RESULTS Baseline demographics, neoadjuvant therapy, and perioperative factors including extent of surgery, complete resections (R0), nodal status and lymph node number, morbidity, and mortality were similar between the two groups. The mean duration of out-patient narcotic use was significantly lower in the "cut-in patch-out" group compared to the thoracotomy group (80.6 days ± 62.4 vs. 158.2 days ± 119.2, p < 0.01). Using multivariate regression analysis, the traditional thoracotomy technique (OR 7.72; p = 0.01) was independently associated with prolonged oral narcotic requirements (>100 days). Additionally, five year survival for the "cut-in patch-out" group was 48% versus the traditional group at 12.5% (p = 0.04). CONCLUSIONS Compared with a traditional thoracotomy and separate chest wall resection approach for P-NSCLC, a "cut-in patch-out" technique offers an alternative approach that appears to have at least oncologic equivalence while decreasing pain. We have more recently adapted this technique to select patients with pulmonary neoplasms involving chest wall invasion and believe further investigation is warranted.
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Affiliation(s)
| | | | | | | | | | - Kenneth A Kesler
- Division of Cardiothoracic Surgery, Department of Surgery, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA.
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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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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: 20] [Impact Index Per Article: 2.0] [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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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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Ronan L, D'Souza S. Pancoast's tumour presenting as shoulder pain in an orthopaedic clinic. BMJ Case Rep 2013; 2013:bcr-2012-008131. [PMID: 23389720 DOI: 10.1136/bcr-2012-008131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 71-year-old lady was referred by her general practitioner to an orthopaedic clinic for management of shoulder pain. The patient complained of pain in the shoulder and chest region but also described reduced sensation and power in her arm and a worsening of her respiratory symptoms. These prompted further investigation with an isotope bone scan which showed a large soft tissue mass posteriorly in the apex of the right lung with chest wall extension and destruction of adjacent ribs. A subsequent CT scan identified Pancoast's tumour. This case highlights the importance of considering non-musculoskeletal causes of shoulder region pain.
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Affiliation(s)
- Lynne Ronan
- Department of Orthopaedics, Royal Bolton Foundation Trust, Bolton, UK.
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Squamous-cell carcinomas of the lung: emerging biology, controversies, and the promise of targeted therapy. Lancet Oncol 2012; 13:e418-26. [PMID: 23026827 DOI: 10.1016/s1470-2045(12)70291-7] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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de Perrot M, Rampersaud R. Surgical approaches to apical thoracic malignancies. J Thorac Cardiovasc Surg 2012; 144:72-80. [DOI: 10.1016/j.jtcvs.2012.03.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/14/2012] [Accepted: 03/19/2012] [Indexed: 12/01/2022]
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Nakajima T, Watanabe A, Nakazawa J, Higami T. Transmanubrial approach with video-assisted thoracoscopic surgery for left superior sulcus tumour with dense adhesion after replacement of descending thoracic aorta. Interact Cardiovasc Thorac Surg 2012; 14:906-8. [PMID: 22402502 DOI: 10.1093/icvts/ivr166] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There are various surgical approaches to superior sulcus tumours according to the location of the tumour. The chief difficulties in the operation are broadening of the operative field and adhesiolysis. This study presents the case of surgical treatment of superior sulcus tumour following chemoradiation therapy with dense pleural adhesion due to a history of graft replacement of the descending thoracic aorta. The patient underwent left upper lobectomy via a transmanubrial osteomuscular-sparing approach combined with video-assisted thoracoscopic surgery (VATS). Transmanubrial approach combined with VATS offered a good overview during local tumour dissection.
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Affiliation(s)
- Tomohiro Nakajima
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University of Medicine, Sapporo, Japan.
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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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Rocco G, Morabito A, Muto P. Induction therapy for lung cancer: sailing across the pillars of Hercules. Thorac Surg Clin 2011; 22:67-75, vi. [PMID: 22108690 DOI: 10.1016/j.thorsurg.2011.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In spite of numerous clinical trials, the jury is still out on the value of induction therapy for locally advanced lung cancer. We elected to address this topic from the multifaceted views of the clinicians often involved in lung cancer management and according the most recent views on locally advanced NSCLC. The concept of a prognostic stratification of N2 disease subsets, especially single vs multiple zone, has been introduced and this may lead to a new interpretation of locally advanced NSCLC. Ten crucial issues were identified that may have an impact on the approach to patients with locally advanced lung cancer in everyday practice.
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Affiliation(s)
- Gaetano Rocco
- Lung Cancer Multidisciplinary Team, Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Naples, Italy.
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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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Eberhardt W, Gauler T, Welter S, Krbek T, Stuschke M, Pöttgen C. Multimodale Therapie des lokal-fortgeschrittenen nichtkleinzelligen Lungenkarzinoms. DER ONKOLOGE 2011. [DOI: 10.1007/s00761-011-2035-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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En Bloc Resection of 3 Vertebra in a Pancoast Patient: Long-Term Stability Using a Free Vascularized Fibular Graft. Ann Thorac Surg 2011; 91:295-8. [DOI: 10.1016/j.athoracsur.2010.07.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 07/29/2010] [Accepted: 07/29/2010] [Indexed: 11/22/2022]
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Tumoren van long, pleura en mediastinum. ONCOLOGIE 2011. [DOI: 10.1007/978-90-313-8476-1_16] [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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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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Truin W, Siebenga J, Belgers E, Bollen EC. The role of video-assisted thoracic surgery in the surgical treatment of superior sulcus tumors. Interact Cardiovasc Thorac Surg 2010; 11:512-4. [DOI: 10.1510/icvts.2010.237941] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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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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Javadi H, Mogharrabi M, Asli IN, Shafiei B, Bahtoee M, Seyedabadi M, Nabipour I, Assadi M. Bone single photon emission computed tomography (SPECT) in a patient with Pancoast tumor: a case report. SAO PAULO MED J 2010; 128:239-43. [PMID: 21120438 PMCID: PMC10938993 DOI: 10.1590/s1516-31802010000400013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 06/10/2010] [Accepted: 06/18/2010] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Non-small cell lung carcinomas (NSCLCs) of the superior sulcus are considered to be the most challenging type of malignant thoracic disease. In this disease, neoplasms originating mostly from the extreme apex of the lung expand to the chest wall and thoracic inlet structures. Multiple imaging procedures have been applied to identify tumors and to stage and predict tumor resectability in surgical operations. Clinical examinations to localize pain complaints in shoulders and down the arms, and to screen for Horner's syndrome and abnormalities seen in paraclinical assessments, have been applied extensively for differential diagnosis of superior sulcus tumors. Although several types of imaging have been utilized for diagnosing and staging Pancoast tumors, there have been almost no reports on the efficiency of whole-body bone scans (WBBS) for detecting the level of abnormality in cases of superior sulcus tumors. CASE REPORT We describe a case of Pancoast tumor in which technetium-99m methylene diphosphonate (Tc-99m MDP) bone single-photon emission-computed tomography (SPECT) was able to accurately detect multiple areas of abnormality in the vertebrae and ribs. In describing this case, we stress the clinical and diagnostic points, in the hope of stimulating a higher degree of suspicion and thereby facilitating appropriate diagnosis and treatment. From the results of this study, further clinical trials to evaluate the potential of SPECT as an efficient imaging tool for the work-up on cases of Pancoast tumor are recommended.
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Affiliation(s)
- Hamid Javadi
- MD. Head of Department of Nuclear Medicine, 5 Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran.
| | - Mehdi Mogharrabi
- MD. Assistant professor of Nuclear Medicine, Department of Nuclear Medicine, 5 Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran.
| | - Isa Neshandar Asli
- MD. Head of Department of Nuclear Medicine, Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
| | - Babak Shafiei
- Assistant professor of Nuclear Medicine, Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mehrzad Bahtoee
- MD. Assistant professor of Internal Medicine, Tropical and Geographical Research Center, Persian Gulf Biomedical Sciences Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Mohammad Seyedabadi
- PhD. Pharmacologist and researcher in the Bushehr Research Center for Nuclear Medicine, Persian Gulf Biomedical Sciences Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Iraj Nabipour
- MD. Professor of Internal Medicine, Tropical and Geographical Research Center, Persian Gulf Biomedical Sciences Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Majid Assadi
- MD. Head of Bushehr Research Center for Nuclear Medicine, Persian Gulf Biomedical Sciences Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
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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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Abstract
Thoracic surgeons must be familiar with available surgical approaches for posterior mediastinal tumors in order to choose the approach that will contribute to better prognosis and patient quality of life. An open surgical approach should be decided on based on the tumor size, location, and pathology. This article discusses the indications for the open approach in adults and outlines the surgical procedure.
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Affiliation(s)
- Tetsuhiko Go
- General Thoracic and Breast-Endcrinological Surgery, Kagawa University Miki-Cho, Kita-gun, Kagawa 761-0973, Japan
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Millward M. Treatment of superior sulcus non-small cell lung cancer. Asia Pac J Clin Oncol 2010; 6:1-2. [PMID: 20398031 DOI: 10.1111/j.1743-7563.2010.01280.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sagerup CMT, Brustugun OT, Jørgensen L. [A 67-year old man with right arm paresthesias]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:2613-5. [PMID: 20029558 DOI: 10.4045/tidsskr.09.0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
A 63-year-old man was admitted to the emergency room with chest pain. He had experienced a painful, tingling sensation in the right arm for the last three months, as well as pain in the right scapula. ECG and standard blood samples were normal. An X-ray of the thorax showed a mass in the superior sulcus on the right side. Further investigation with CT and MRI identified a large tumour, about 6 cm in size, with infiltrative growth involving the upper costae. Biopsy revealed a non-small cell carcinoma of the lung. The patient underwent a tri-modal treatment regimen with induction chemotherapy (two courses of cisplatin and etopside) and concomitant radiotherapy (50 Gy in 2 Gy fractions) before a right upper lobectomy was performed. 1 year after surgery the patient is alive, with no signs of recurrent or metastatic disease. Pancoast tumours are an infrequent subtype of lung cancers. Diagnostic delay is not uncommon. The peripheral location of the tumour generates symptoms that may easily be attributed to other causes, such as those of a musculoskeletal origin. Pre-operative chemo-radiotherapy has showed improved survival outcomes compared to pre-operative radiotherapy alone.
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Affiliation(s)
- Camilla M T Sagerup
- Kreftklinikken, Oslo universitetssykehus, Radiumhospitalet, 0310 Oslo, Norway.
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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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Yıldızeli B, Dartevelle PG, Fadel E, Mussot S, Chapelier A. Results of Primary Surgery With T4 Non–Small Cell Lung Cancer During a 25-Year Period in a Single Center: The Benefit is Worth the Risk. Ann Thorac Surg 2008; 86:1065-75; discussion 1074-5. [PMID: 18805134 DOI: 10.1016/j.athoracsur.2008.07.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 07/01/2008] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
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Inoperable Pancoast tumors treated with hyperthermia-inclusive multimodality therapies. Lung Cancer 2008; 63:247-50. [PMID: 18620779 DOI: 10.1016/j.lungcan.2008.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Revised: 05/03/2008] [Accepted: 05/22/2008] [Indexed: 11/23/2022]
Abstract
PURPOSE This study aimed to assess the feasibility, efficacy and complication of hyperthermia-inclusive multimodality therapies for patient with inoperable Pancoast tumor. MATERIAL AND METHODS Five patients with inoperable Pancoast tumor were treated with hyperthermia-inclusive multimodality therapies. They received thermoradiotherapy with/without chemotherapy. Radiation therapy was delivered using 10 MV X-rays with total dose of 68-70 Gy. In the latter half of the radiation therapy hyperthermia was performed for 2-4 sessions once a week with 8 MHz radiofrequency device. RESULTS For primary response, 4 tumors showed partial response to the treatment with the exception of 1 tumor who showed stable disease. Only one patient was with a short follow-up period (9 months), all other patients survived 3 years or more without recurrence. Of them, 2 patients were recognized with local recurrence at 38.7 and 42.7 months after treatment and died at 66.9 and 78.5 months after treatment. The other 2 patients are disease-free survivor for 4 and 5 years after treatment. No severe non-hematological toxicity was observed in each patient. CONCLUSION These data suggested that hyperthermia-inclusive multimodality therapies might be a promising approach for inoperable Pancoast tumor.
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