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Rzyman W, Łazar-Poniatowska M, Dziedzic R, Marjański T, Łapiński M, Dziadziuszko R. Trimodality Treatment of Superior Sulcus Non-Small Cell Lung Cancer: An Institutional Series of 47 Consecutive Patients. Curr Oncol 2023; 30:4551-4562. [PMID: 37232802 DOI: 10.3390/curroncol30050344] [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: 02/08/2023] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Treatment of superior sulcus tumors (SST) using concurrent chemoradiation followed by surgery is a current standard. However, due to the rarity of this entity, clinical experience in its treatment remains scarce. Here, we present the results of a large consecutive series of patients treated with concurrent chemoradiation followed by surgery at a single academic institution. MATERIALS AND METHODS The study group included 48 patients with pathologically confirmed SST. The treatment schedule consisted of preoperative 6-MV photon-beam radiotherapy (45-66 Gy delivered in 25-33 fractions over 5-6.5 weeks) and concurrent two cycles of platinum-based chemotherapy. Five weeks after completion of chemoradiation, pulmonary and chest wall resection was performed. RESULTS From 2006 to 2018, 47 of 48 consecutive patients meeting protocol criteria underwent two cycles of cisplatin-based chemotherapy and concurrent radiotherapy (45-66 Gy) followed by pulmonary resection. One patient did not undergo surgery due to brain metastases that occurred during induction therapy. The median follow-up was 64.7 months. Chemoradiation was well tolerated, with no toxicity-related deaths. Twenty-one patients (44%) developed grade 3-4 side effects, of which the most common was neutropenia (17 patients; 35.4%). Seventeen patients (36.2%) had postoperative complications, and 90-day mortality was 2.1%. Three- and five-year overall survival (OS) were 43.6% and 33.5%, respectively, and three- and five-year recurrence-free survival were 42.1% and 32.4%, respectively. Thirteen (27.7%) and 22 (46.8%) patients had a complete and major pathological response, respectively. Five-year OS in patients with complete tumor regression was 52.7% (95% CI 29.4-94.5). Predictive factors of long-term survival included age below 70 years, complete resection, pathological stage, and response to induction treatment. CONCLUSIONS Chemoradiation followed by surgery is a relatively safe method with satisfactory outcomes.
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Affiliation(s)
- Witold Rzyman
- Department of Thoracic Surgery, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Małgorzata Łazar-Poniatowska
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Robert Dziedzic
- Department of Thoracic Surgery, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Tomasz Marjański
- Department of Thoracic Surgery, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Mariusz Łapiński
- Department of Thoracic Surgery, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Rafał Dziadziuszko
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
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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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Kuckelman J, Debarros M, Bueno R. Extended Resections for Lung Cancer. Surg Clin North Am 2022; 102:345-363. [DOI: 10.1016/j.suc.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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4
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Lin TYY, Atrchian S, Humer M, Siever J, Lin A. Clinical outcomes of pancoast tumors treated with trimodality therapy. J Thorac Dis 2021; 13:3529-3538. [PMID: 34277048 PMCID: PMC8264722 DOI: 10.21037/jtd-21-380] [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: 03/07/2021] [Accepted: 05/02/2021] [Indexed: 11/13/2022]
Abstract
Background Superior sulcus tumors, or Pancoast tumors, are challenging thoracic malignancies to treat due to their anatomical location posing difficult surgical access and potential involvement of adjacent vital structures. The current standard of care is trimodality treatment, which consists of induction chemoradiotherapy followed by radical surgical resection. This study aims to report the clinical outcomes of trimodality approach in British Columbia, Canada. Methods Patients with Pancoast tumors who underwent trimodality treatment between 2000–2015 were included in this provincial multi-center retrospective study. Patient-, disease-, and treatment-related data were collected, and treatment outcomes were recorded. Results We identified 32 patients who underwent induction chemoradiotherapy and subsequent surgical resection. Mean age was 59 (43–75 years) with median follow-up of 43 months (5–216 months). Complete resection was achieved in 31 patients (97%). Fourteen patients (44%) had pathological complete response after induction chemoradiotherapy. Thirteen (41%) showed minimal microscopic (>90% tumor necrosis) and 5 (16%) macroscopic residual disease (<90% tumor necrosis). Fourteen patients (44%) developed recurrence, which was distant in 9 cases. The 2-, 5-, and 10-year overall survival rates were 67.9%, 50.1%, 31.8% and the 2-, 5-, and 10-year disease-free survival rates were 65.1%, 47.1% and 28.2% respectively. There were no statistically significant differences in overall survival or disease-free survival rates with or without pathological complete response. Conclusions Complete surgical resection with negative margins can be achieved after induction chemoradiotherapy, and curative-intent trimodality treatment can lead to long-term survival in some patients. This study did not demonstrate any prognostic value of pathological complete response, likely due to small sample size.
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Affiliation(s)
- Tami Yu-Yu Lin
- Southern Medical Program, Faculty of Medicine, Kelowna, BC, Canada
| | | | - Michael Humer
- Department of Surgery, Faculty of Medicine, Kelowna, BC, Canada
| | - Jodi Siever
- Southern Medical Program, Faculty of Medicine, Kelowna, BC, Canada
| | - Angela Lin
- Radiation Oncology, BC Cancer Kelowna, Kelowna, BC, Canada
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Hao X, Wang Z, Cheng D, Zhou J, Chen N, Pu Q, Liu L. The Favorable Prognostic Factors for Superior Sulcus Tumor: A Systematic Review and Meta-Analysis. Front Oncol 2020; 10:561935. [PMID: 33194629 PMCID: PMC7606951 DOI: 10.3389/fonc.2020.561935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Superior sulcus tumor is a rare non-small cell lung cancer with poor prognosis. Exploring the potential prognostic factors of patients with superior sulcus tumor and adopting individualized treatment for patients with different prognostic factors are of great significance for the prolongation of patients' lives. To figure out the prognostic factors of upper sulcus tumors, a meta-analysis was conducted. Method: We searched all the articles published until January 2020 in PubMed, Embase, and Web of Science databases, and the search strategy included the following terms, combining superior sulcus tumor and prognosis. Hazard ratio (HR) with associated confidential interval (CI) was evaluated for the purpose of investigating prognostic factors for superior sulcus tumor. STATA 16.0 was used for analysis of extracted data and assessment of publication bias. Result: Fifteen eligible studies, which had 1,009 patients with superior sulcus tumor, were included in this meta-analysis. The studies were published between 1994 and 2018, and the patient recruitment periods ranged from 1974 to 2016. The median follow-up time ranged from 18 to 95 months. The meta-analysis indicated that lower T stage (HR, 1.63; 95% CI, 1.35–1.97), lower N stage (HR, 3.08; 95% CI: 2.37–3.99), negative surgical margin (HR, 0.25; 95% CI, 0.17–0.38), and pathologic complete response (HR, 0.55; 95% CI, 0.39–0.77) were favorable prognostic factors. Conclusion: We found that T stage, N stage, surgical margin, and pathologic complete response are prognostic factors for superior sulcus tumor. To reach a better long-term survival, patients with these negative prognostic factors may need a more aggressive treatment, while more studies should be conducted to further validate these results and explore a more effective treatment.
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Affiliation(s)
- Xiaohu Hao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Zihuai Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Diou Cheng
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
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6
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Uchida S, Yoshida Y, Ohe Y, Nakayama Y, Motoi N, Kobayashi A, Asakura K, Nakagawa K, Watanabe SI. Trimodality therapy for superior sulcus tumour: experience of a single institution over 19 years. Eur J Cardiothorac Surg 2020; 56:167-173. [PMID: 30689794 DOI: 10.1093/ejcts/ezy480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Induction chemoradiotherapy followed by surgery is the standard treatment for superior sulcus tumours (SSTs). However, the protocols, chemotherapy agents and cycles used as well as the mode and intensity of radiotherapy vary between institutions. Thus, the objective of the study was to investigate the effects of trimodality therapy on the outcomes of patients with SSTs. METHODS Sixty patients with SSTs were enrolled between January 1999 and December 2017. Induction therapy consisted primarily of 2 cycles of mitomycin-vindesine-cisplatin or cisplatin-vinorelbine delivered concurrently to the tumour with 40-45 Gy of radiation. Surgery was performed 2-6 weeks after completion of induction therapy. RESULTS Fifty-four (90%) patients underwent radical surgical resection. Complete pathological resection was achieved in 44 patients (81%). There was no 30-day mortality. After a median follow-up of 57.0 months, 19 (35%) patients experienced recurrence, and 8 (15%) patients showed brain metastasis. A pathological complete response (PCR) was observed in 12 (22%) patients. The 5-year survival rate for the entire population (n = 54) was 69% (95% confidence interval 55-81%). The survival rate was better for patients who underwent complete resection than for those who underwent incomplete resection (73% vs 51%, P = 0.46). A better survival rate was evident in patients with PCR than in those without PCR (92% vs 62%, P = 0.12). CONCLUSIONS Trimodality therapy for SSTs was efficacious and associated with favourable outcomes, with acceptable morbidity and mortality. PCR in patients with resected SSTs reveals promising long-term survival prospects with the trimodality therapy.
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Affiliation(s)
- Shinsuke Uchida
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihiro Yoshida
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Noriko Motoi
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Aki Kobayashi
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Keisuke Asakura
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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7
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Significant prognostic determinants in lung cancers of the superior sulcus: comparable analysis of resected and unresected cases. Gen Thorac Cardiovasc Surg 2020; 68:801-811. [PMID: 32125634 DOI: 10.1007/s11748-020-01322-5] [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: 03/01/2019] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In this study, we aimed to identify prognostic determinants and to comparably analyze clinical features of patients with both resected and unresected superior sulcus tumors (SSTs). METHODS The data of 56 patients who underwent any treatment for an SST from 2004 through 2016 in our hospital were reviewed. Overall survival (OS) rates were estimated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to determine independent prognostic factors for patients with resected and unresected SST separately. RESULTS The number of patients with resected and unresected SSTs was 24 (43%) and 32 (57%), respectively. Of the 24 patients who underwent surgery, 20 received induction therapy, with 32% achieving pathological complete response. Complete resection (R0) was performed in 22 patients (92%). On multivariate survival analysis, preoperative serum carcinoembryonic antigen (CEA) level (median 8.3 ng/ml, p = 0.021) was identified as the independent determinant of OS in surgical patients; whereas, initial treatment response (complete response or partial response, p = 0.032) was the independent OS indicator in non-surgical patients. The 5-year OS of the patient with resected and unresected SST was 68.8% and 29.1% (p = 0.008), respectively. CONCLUSION Significant prognostic factors differ among patients stratified by the presence of surgical resection for SSTs. Preoperative CEA level in surgical candidates and initial treatment response in non-surgical patients were the independent factors associated with OS. Surgical candidates are expected to have more favorable survival than patients with unresectable SSTs.
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8
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Robinson LA, Tanvetyanon T, Grubbs D, Antonia S, Creelan B, Fontaine J, Toloza E, Keenan R, Dilling T, Stevens CW, Sommers KE, Vrionis F. Induction chemoradiotherapy versus chemotherapy alone for superior sulcus lung cancer. Lung Cancer 2018; 122:206-213. [PMID: 30032833 DOI: 10.1016/j.lungcan.2018.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/31/2018] [Accepted: 06/17/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Although treatment of superior sulcus tumors with induction chemoradiotherapy (CRT) followed by surgery employed in the Intergroup INT-0160 trial is widely adopted as a standard of care, there may be significant associated morbidity and mortality. We describe our experience using standard and alternative induction regimens to assess survival rates and treatment toxicity in these patients. MATERIALS AND METHODS Electronic medical records of all patients who underwent multimodality treatment including resection of lung cancer invading the superior pulmonary sulcus between 1994 and 2016 were retrospectively reviewed. Multivariable Cox Proportional Hazards model was constructed. RESULTS Of 102 consecutive patients, 53 (52%) underwent induction CRT, 34 (33%) underwent induction chemotherapy only (Ch) followed by adjuvant radiotherapy, and 15 (15%) underwent no induction therapy followed by adjuvant therapy. There were 2 postoperative deaths (1.9%). To date, 42 patients are alive with a median follow-up 72.5 months. Overall 5-year survival rate was 45.4%. Survival was significantly influenced by age, FEV1, positive resection margins, surgical complications, but not the induction regimen. CRT resulted in higher complete pathological response rate than Ch: 38% vs. 3% (p < 0.001). CRT was associated with higher post-operative re-intubation rate: 13% vs. 0% (p = 0.03). CONCLUSIONS Our single-institutional experience indicated that while induction CRT produced greater complete pathological response than Ch, it also increased the risk of post-operative complications. With careful patient selection, induction Ch followed by adjuvant radiotherapy may provide comparable survival outcomes to induction CRT. Since induction Ch is associated with lower risk of complications, it may be a particularly desirable choice for patients with impaired performance status.
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Affiliation(s)
- Lary A Robinson
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA.
| | - Tawee Tanvetyanon
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Deanna Grubbs
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Scott Antonia
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Ben Creelan
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jacques Fontaine
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Eric Toloza
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Robert Keenan
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Thomas Dilling
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Craig W Stevens
- Department of Radiation Oncology, Beaumont Hospital, Royal Oak, MI, USA
| | | | - Frank Vrionis
- Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, FL, USA
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Bertaglia V, Vallone S, Pacchiana MV, Novello S. Advanced squamous lung cancer: therapeutic options, future directions, unmet needs and results of a monocentric survey. Lung Cancer Manag 2017; 6:93-107. [PMID: 30643575 PMCID: PMC6310352 DOI: 10.2217/lmt-2017-0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/23/2017] [Indexed: 11/21/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths in worldwide, and NSCLC represents around 85% of all lung cancers. Squamous cell lung cancer (SqCLC) is the second most common subtype and it is challenging to treat. New options have been discovered but progresses are still limited for the lack of 'druggable' mutations. Specific resources for SqCLC are limited and this condition affects treatment and outcomes. This paper describes available and emerging therapeutic options and resources that may help patients to face their disease. We have also performed a monocentric survey collecting information about smoking habit and sense of guilty and analyzed the possibility for patients to find helpful sources for their disease. The results suggest that more materials focused on SqCLC are still needed.
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Affiliation(s)
- Valentina Bertaglia
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | | | | | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
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10
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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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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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12
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Luchtefeld WB. Superior Sulcus Tumors: Early Detection Is the Key. J Nurse Pract 2017. [DOI: 10.1016/j.nurpra.2016.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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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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Buderi SI, Shackcloth M, Woolley S. Does induction chemoradiotherapy increase survival in patients with Pancoast tumour? Interact Cardiovasc Thorac Surg 2016; 23:821-825. [PMID: 27365009 DOI: 10.1093/icvts/ivw216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 05/01/2016] [Accepted: 05/31/2016] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether induction (neoadjuvant) chemoradiotherapy (iCRT) compared with other therapeutic strategies improves survival in patients with Pancoast tumours. Altogether 248 papers were identified using the below-mentioned search. Ten of them represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group, relevant outcomes and weaknesses were tabulated. Four studies were retrospective comparative studies of induction chemoradiotherapy and surgery (trimodal therapy) versus other therapeutic strategies. Two studies were retrospective and four were prospective investigating trimodal therapy. These papers comprised a total of 550 patients. The overall survival was better with trimodal therapy compared with RT (radiotherapy) followed by surgery group in all three comparative studies. The 2-year survival varied in the trimodal therapy group from 70 to 93%, in comparison to RT group where variation was from 22 to 49%. Five-year survival for trimodal therapy varied between 36.4 and 84% in the results of two comparative studies, compared with 11 and 49% for RT and surgery, respectively. One paper looked at survival in patients who underwent surgery alone [30% at 2-year and 20% at 4-year overall survival (OS)]. The 5-year OS in the retrospective group varied between 38 and 59%. Similar results were reported for the prospective group with 5-year OS between 44 and 56%. Despite a large variation in pCR (complete pathological response) (15-93%) and R0 (77-100%) reported, both represented a positive prognostic factor for survival. Three papers looked at the impact of staging following induction chemoradiotherapy. The majority of patients had T3 disease. An advantage in survival was seen in patients with early disease compared with advanced stage. No randomized controlled trials were identified. All the 10 articles suggested there was a benefit in trimodal therapy with improvement in overall survival. We conclude that combining induction chemoradiotherapy with surgery for Pancoast tumour may offer a survival benefit compared with radiotherapy with surgery or surgery alone.
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Affiliation(s)
- Silviu I Buderi
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Steven Woolley
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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