Author of

• 10643

  +

  P1.07 - Poster Session 1 - Surgery (ID 184)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10647

    +

    P1.07-004 - Multimodality management and surgical outcomes following post neo-adjuvant chemotherapy, radical chest wall resection and reconstruction for PNET chest wall (ID 668)

    09:30 - 09:30  |  Author(s): S. Bakhshi
    • Abstract

    Background
    Primitive neuroectodermal tumor (PNET) is a rare undifferentiated and highly aggressive tumor , most commonly arising in chest wall in teen age patients. Treatment of these patients is challenging and multimodality treatment had a major impact on their outcome. We present our experience of post neo-adjuvant chemotherapy , radical chest wall resection and reconstruction and surgical outcomes.

    Methods
    A retrospective review of a prospectively maintained computerized database of patients was performed and patients with histologically proven chest wall PNET undergoing surgery were identified and analyzed for clinical profile , surgical details and peri-operative outcomes.

    Results
    A total of 71 patients had surgery for chest wall tumor between 2000 to 2009. Fifteen out of 71 were diagnosed as having PNET chest wall. The mean age of presentation was 21 years (15 - 30 years) and there was a slight male preponderance (1.16 : 1). Most common presenting symptom was chest wall swelling and pain. Mean pre chemotherapy tumor size was 20cm. As per our institutional protocol , all patients received neoadjuvant chemotherapy comprising VAC + IE regime followed by surgery. The number of resected ribs ranged from 2 to 5 and the mean chest wall defect was 15cm. Majority required resection of adjoin pleura and in 5 patients segment of adherent lung was resected. A composite chest wall reconstruction was performed using bi-layered synthetic mesh and latissimus dorsi (10) , pectoralis major (3) and serratus (2) muscle flaps. All patients had an uneventful post operative recovery and the peri-operative mortality was nil. Six patients had complete pathological response to chemotherapy and 9 patients had residual tumor and were given post operative radiotherapy. At a median follow up of 36 months , 8 patients are alive and disease free.

    Conclusion
    Multimodality management and advances in surgical techniques had revolutionized the approach to chest wall PNET in the recent past. Our experience has shown that radical chest wall resection and composite reconstruction can be accomplished with excellent outcomes even in patients with advanced PNET and post intensive chemotherapy sessions.