Non-small cell lung carcinoma of the superior sulcus: Favorable outcomes of combined modality treatment in carefully selected patients
ABSTRACT The combination of radiotherapy and concurrent chemotherapy followed by surgery (trimodality treatment) is currently regarded as optimal treatment for non-small cell lung cancer of the superior sulcus (SST) or Pancoast tumour. The possibility to administer intensive combined modality treatment is influenced by tumour stage, comorbidity and performance status of these patients, and therefore a strict patient selection is necessary. This study focuses on patient selection and its results. We retrospectively evaluated choices of treatment and outcome of all patients with SST treated in the Netherlands Cancer Institute from 1994 to 2004. After identification of patients with SST in registration databases, the following characteristics were analyzed: symptoms, comorbidity, tumour stage, treatment characteristics, toxicity, local control, disease-free and overall survival. Fifty-two patients, 37 men and 15 women, were identified. They were diagnosed with stage IIB (27%), stage IIIA (8%), stage IIIB (42%) and stage IV (23%). Twelve patients after induction (chemo)radiotherapy underwent surgical resection. In eight patients a pathologic complete response was found. The 2- and 5-year survival after induction treatment and surgery was 75 and 39%, respectively. Other patients did not receive surgical treatment because of stage IV disease (n=12), comorbidity (n=8), irresectability (extensive tumour growth and/or persisting N2-3 status; n=14) or insufficient response to induction treatment (n=6). Eleven patients were treated with concurrent chemoradiotherapy (5-year survival 20%) and 17 patients with (sequential) radiotherapy and/or chemotherapy (5-year survival 6%). Local recurrence rates were 0% after induction treatment and surgical resection, 32% after concurrent chemoradiotherapy and 72% after (sequential) radiotherapy and/or chemotherapy. In conclusion, only 30% of M0 patients with SST were eligible for combined modality treatment followed by surgery. In this subgroup, concurrent chemoradiotherapy followed by surgery was associated with excellent local control and acceptable survival.
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- "A percentage of these lesions might also be located at the front, with vascular rather than neuro-vertebral involvement. Various reports suggested spinal involvement in 15%, brachial plexus in 15% and subclavian vessels in 6% of the cases . Therefore surgeons treating these cancers should be able to be familiar and adapt with the various approaches. "
ABSTRACT: Haralabos Parissis, Alan Soo and Bassel Al-Alao (2013). Superior Sulcus Tumour with some Emphasis on the Anterior Approach, Principles and Practice of Cardiothoracic Surgery, Dr. Michael Firstenberg (Ed.), ISBN: 978-953-51-1156-6, InTech, Available from: http://www.intechopen.com/books/principles-and-practice-of-cardiothoracic-surgery/superior-sulcus-tumour-with-some-emphasis-on-the-anterior-approachPrinciples and Practice of Cardiothoracic Surgery, Edited by Michael S. Firstenberg, 06/2013: chapter Superior Sulcus Tumour with some Emphasis on the Anterior Approach; InTech., ISBN: 978-953-51-1156-6
Conference Paper: Application of the genetic algorithm to nutritional counseling[Show abstract] [Hide abstract]
ABSTRACT: Malnutrition and poverty are interacting problems in the developing nations of the world. One of the causes contributing to malnutrition is incorrect dietary selection. We developed a component of an information system for selection of a nutritionally, culturally, economically and geographically appropriate diet. This selection algorithm is based on a commercially available implementation of the genetic algorithm. This proof of concept suggests a way that computer systems developed in the industrialized world can be adapted to help in the developing worldBiomedical Engineering Conference, 1997., Proceedings of the 1997 Sixteenth Southern; 05/1997
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ABSTRACT: This study aims to investigate the treatment modalities and factors influencing survival in surgically treated superior sulcus tumors. Sixty-five cases of surgically treated non-small cell carcinoma of the lung occurring as superior sulcus tumors between 1994 and 2007 were retrospectively reviewed. Twenty-five patients underwent induction radiotherapy (RT), 10 had induction chemoradiotherapy (CT/RT). In thirty patients surgery was performed directly. The mortality rate was 6.2 %. Pathological stage was T3 in 55, T4 in 10, N0 in 52, and N1 in 5 and N2 in 8 patients. Overall 5- and 10-year survival rates were 31 % and 28 %, respectively. Complete resection rate was 90 % for patients who received induction CT/RT and 80 % for patients who either received induction RT alone or patients in whom surgery was performed directly. In patients who received neoadjuvant therapy with complete tumor resection, the median survival time was 33 months (28 months for patients who received induction RT alone and 36 months for patients who received induction CT/RT), and the 5-year survival rate was 41 %. Median survival time and 5-year survival rate of patients treated by direct surgery with complete resection was 24 months and 37 %, respectively ( P = 0.87). Five-year survival and 10-year survival rates were significantly higher after complete resection than after incomplete resection (38 % and 34 % vs. 0 %, P = 0.0001). In multivariate analysis, only N2 disease ( P = 0.04) and incomplete resection ( P = 0.03) were found to be poor prognostic factors. The presence of N2 disease and incomplete resection are the two most important factors affecting survival. Induction CT/RT may increase the ability to achieve complete surgical resection.The Thoracic and Cardiovascular Surgeon 04/2009; 57(2):96-101. DOI:10.1055/s-2008-1039112 · 1.08 Impact Factor