Results of surgical resection after induction chemoradiation for Pancoast tumours

Abstract

This combined approach is feasible, and allows for a good rate of complete resection. Long-term survival rates are acceptable, especially for early stage tumours radically resected. Systemic control of disease still remains poor, with distant recurrence being the most common cause of death.

Trimodality therapy for Pancoast tumors: T4 is not a contraindication to radical surgery

“…A retrospective and rather historical publication from 2000 by Rusch et al described an inferior outcome for T4 tumors. Moreover, in another very recent published work from Marulli et al reported significantly lower survival rates for patients with T4 tumors. However, their patients did not have uniform induction chemoradiation therapy which might have influenced the results negatively.…”

Superior sulcus tumors (Pancoast tumors)

“…Subsequently, several modifications of this technique were reported (26)(27)(28). Radical surgery with acceptable local tumor control became a real possibility thanks to new surgical techniques such as laminectomy, partial or hemivertebrectomy, complete resection of vertebral body, and vascular by-pass, as well as the common practice of working in a multidisciplinary team (thoracic surgeon, neurosurgeon, orthopedic surgeon, vascular surgeon) (24,(29)(30)(31)(32)(33). During the 1990s, the increasing experience with combined modality therapy suggested that induction chemo-radiotherapy followed by resection could become an effective treatment strategy for stage III NSCLC (34).…”

“…Even long-term (5-year) survival rates resulted improved reaching 44% (SWOG 9416) and 56% (JCO 9806), respectively. Based on these data, the modern standard treatment for sulcus superior tumors has become the combination of induction CT/RT followed by radical surgical resection (25,29,(35)(36)(37)(38)(39)(40)(41)(42)(43) (Table 1).…”

“…Operative mortality rate ranges from 0% to 6.9% and morbidity from 11% to 47% (25,29,(35)(36)(37)(38)(39)(40)(41)(42)(43). In particular, the SWOG 9416 (35) and JCO 9806 (36) phase II trials showed operative mortality rates of 2.3% and 3% and morbidity rates of 52% and 14%, respectively.…”

“…Many authors have tried to identify them and a various number of tumor characteristics seems to be involved. After reviewing the body of literature, (I) complete resection and (II) complete pathological response to therapy turned out to be positive prognostic factors in various series (17,29,(35)(36)(37)(38)40,52,55,(59)(60)(61)(62); (III) T status has been recognized as a poor prognostic factor (11,17,21,29,36,(52)(53)(54)(55)59). In particular brachial plexus invasion (59), vertebral body (11,52,53) and great vessels involvements (11,53) are correlated to an higher risk of tumor recurrence.…”