Primary malignant chest wall tumors: analysis of 40 patients

Abstract

BackgroundPrimary chest wall tumors originate from different constructions of thoracic wall. We report our multidisciplinary experience on primary thoracic tumor resection and thoracic reconstruction, the need to additional therapy and evaluating prognostic factors affecting survival.MethodsWe performed a retrospective review of our prospectively maintained database of 40 patients treated for malignant primary chest wall tumor from 1989 to 2009. Patients were evaluated in terms of age, sex, clinical presentation, type of imaging, tissue diagnosis methods, pathology, surgical technique, early complications, hospital mortality, prevalence of recurrence and distant metastases, additional treatment, 3 years survival and factors affecting survival.ResultsMale/Female (F/M) = 1, with median age of 43.72 years. Mass was the most common symptoms and the soft tissue sarcoma was the most common pathology. Resection without reconstruction was performed in 5 patients and Thirty-five patients (87.5%) had extensive resection and reconstruction with rotatory muscular flap, prosthetic mesh and/or cement. Overall, 12.5% (5/40) of patients received neoadjuvant therapy and 75% (30/40) of patients were treated with adjuvant therapy. The 3-year survival rate was 65%. Recurrences occurred in 24 patients (60%), 14 developed local recurrences, and 10 developed distant metastases. The primary treatment modality for both local and distant recurrences was surgical resection; among them, 10 underwent repeated resection, 9 adjuvant therapy and 5 were treated with lung metastasectomy. The most common site of distant metastasis was lung (n = 7). Factors that affected survival were type of pathology and evidence of distant metastasis.ConclusionSurgery with wide margin is the safe and good technique for treatment of primary chest wall tumors with acceptable morbidity and mortality.

Management of chest wall tumors: a single-center experience

“…Therefore, these tumors can be diagnosed with needle aspiration, incisional or excisional biopsy [2,7,8]. We choose to perform excisional biopsy in tumors less than 5 cm and incisional biopsy in tumors larger than 5 cm.…”

“…It is stated that postoperative mortality and morbidity were better in the cases with reconstruction [2,9]. Reconstruction was performed in 2 cases with anterior chest wall defects larger than 5 cm.…”

“…The most common cause of PCWT in adults is soft tissue where 68% of the cases originated from [1,2]. Chest x-ray, computed tomography and magnetic resonance imaging methods are used for preoperative evaluation.…”

“…The most common symptoms of chest wall tumors are swelling, pain and palpable mass [1,2,4,5]. The most common cause of PCWT in adults is soft tissue where 68% of the cases originated from [1,2].…”

“…Therefore, chest wall tumors include a wide variety of tumors and more than half of these tumors are reported to be malignant [1]. Most of the chest wall tumors originate from soft tissue [2]. Primary chest wall tumors (PCWT) can be diagnosed with needle aspiration, incisional or excisional biopsy.…”