Multimodality therapy for lung cancer invading the chest wall: A study of the French EPITHOR database

Tricard, Jérémy; Filaire, Marc; Vergé, Romain; Pagès, P; Brichon, Pierre-Yves; Loundou, Anderson; Boyer, Laurent; Thomas, Pascal

doi:10.1016/j.lungcan.2023.107224

Cited by 1 publication

(1 citation statement)

References 29 publications

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“…However, in a recent series of 123 patients with SSTs, nearly 40% of which were T4 tumors (TNM 7 th edition), extended resections were reported as feasible and safe, and resulted in high local control rates and good overall survival ( 8 ). Therefore, in the absence of a specialised team including vascular, orthopaedic, and neurosurgical expertise, patients should be referred to a center experienced with this type of extensive surgery; the trimodality approach, including surgery, probably offers the best chance of long-term disease control and survival ( 24 ).…”

Section: Sstmentioning

confidence: 99%

Chest wall resections for sulcus superior tumors

Ünal,

Heineman,

van Dorp

et al. 2024

J Thorac Dis

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Chemoradiotherapy followed by surgical resection (trimodality therapy) is a guideline recommended treatment for sulcus superior tumors (SST). By definition, SSTs invade the chest wall and therefore require en-bloc chest wall resection with the upper lung lobe or segments. The addition of a chest wall resection, potentially results in higher morbidity and mortality rates when compared to standard anatomical pulmonary resection. This, together with their anatomical location in the thoracic outlet, and varying grades of fibrosis and adhesions resulting from induction chemoradiotherapy in the operation field, make surgery challenging. Depending on the exact location of the tumor and extent to which it invades the surrounding structures, the preferred surgical approach may vary, e.g., anterior, posterolateral, hemi-clamshell, or combined approach; all with their own potential advantages and morbidities. Careful patient selection, adequate staging and discussion in a multidisciplinary tumor board in a center experienced in complex thoracic oncology leads to the best long-term survival outcomes with the least morbidity and mortality. Enhanced recovery guidelines are now available for thoracic surgery, promoting faster recovery and helping to minimize complications and morbidity, including infections and thoracotomy pain. Although minimally invasive surgery can enhance recovery and reduce chest wall morbidity, and is in widespread use in thoracic oncology, its use for SST has been limited. However, this is an evolving area and hybrid surgical approaches (including use of the robot) are being reported. Chest wall reconstruction is rarely necessary, but if so, the prosthetic materials are preferably radiolucent/non-scattering, rigid enough while still being somewhat flexible, and inert, providing structural support, allowing chest wall movement, and closing defects, while inciting a limited inflammatory response. New techniques such as 3D image reconstructions/volume rendering, 3D-printing, and virtual reality modules may help pre-operative planning and informed patient consent.

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Section: Sstmentioning

confidence: 99%