Article

Non-small cell lung carcinoma of the superior sulcus: Favorable outcomes of combined modality treatment in carefully selected patients

Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Lung Cancer (Impact Factor: 3.96). 04/2008; 59(3):385-90. DOI: 10.1016/j.lungcan.2007.08.028
Source: PubMed

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 [13]. Therefore surgeons treating these cancers should be able to be familiar and adapt with the various approaches. "
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    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-approach
    Full-text · Chapter · Jun 2013
    • "Lack of endobronchial cytology facility for histopathological confirmation of radiologically enlarged mediastinal nodes and of PET-CT facility in our centre could be other reason for poor survival. Also in patients with superior sulcus tumors, surgical resection after radical chemoradiotherapy could have led to better outcomes.[43] The only reported randomized Indian study by Dasgupta which compared outcomes with radical radiotherapy versus sequential chemoradiotherapy versus concurrent chemoradiotherapy had 75% patients with stage III A and the reported progression free survival of 21 months is the highest survival with concurrent chemoradiation reported in the world.[8] "
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    ABSTRACT: Data supporting use of concurrent chemoradiation in locally advanced lung cancers comes from clinical trials from developed countries. Applicability and outcomes of such schedules in developing countries is not widely reported. There are various challenges in delivering chemoradiation in locally advanced non small cell lung cancer in developing countries which is highlighted by an audit of patients treated with chemoradiation in our center. This article deals with the challenges in the context of a developing country. We conclude that sequential chemoradiotherapy is better tolerated than concurrent chemoradiation in Indian patients with locally advanced non-small cell lung cancers. Patients with stage IIIa, normal weight or overweight, and adequate baseline pulmonary function should be offered concurrent chemoradiation.
    No preview · Article · Mar 2013 · South Asian Journal of Cancer
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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 [7]. Therefore surgeons treating these cancers should be able to be familiar and adapt with the various approaches. "
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    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.
    Full-text · Article · Nov 2010 · Journal of Cardiothoracic Surgery
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