Author of

• 11595

  +

  P2.07 - Poster Session 2 - Surgery (ID 190)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11604

    +

    P2.07-009 - What is an appropriate treatment strategy for superior sulcus tumors? (ID 1057)

    09:30 - 09:30  |  Author(s): K. Tei
    • Abstract

    Background
    Superior sulcus tumors (SST) comprise a subgroup of non-small-cell lung cancers that arise near the pulmonary apex or superior sulcus. They generally invade the chest wall and brachial plexus, and occasionally the subclavian vessels. Induction chemoradiation therapy followed by surgery is the recommended treatment for SST. However, surgical approaches for SST remain controversial, partly because of their infrequent use. Several approaches to resecting these tumors have been described, depending on the precise localization and involvement of the surrounding organs. These include posterolateral thoracotomy, hemi-clamshell and transmanubrial osteomuscular-sparing approaches. It is necessary to establish the appropriate multimodality therapy for SST, including the optimal surgical approaches.

    Methods
    We retrospectively analyzed the clinical courses of patients with SST treated with surgery at our institution. A total of 2765 patients with non-small-cell lung cancer were treated surgically at Osaka City General Hospital, Japan, from January 1995 to December 2012. Among these, 34 patients with SST were investigated in this study.

    Results
    The mean age of the patients was 62 years (range, 42–90 years). There were 32 men and two women. Seventeen patients had squamous cell carcinoma, 12 had adenocarcinoma, and five patients had tumors of other histological types. There were 21 patients with stage 2B, 10 with stage 3A, and three patients with stage 3B disease. Two patients received induction chemotherapy, and 22 patients received induction chemoradiotherapy. Posterolateral thoracotomy was performed in 11 patients and anterior thoracotomy (hemi-clamshell, transmanubrial osteomuscular-sparing approaches) in 22 patients. A combination of anterior and lateral thoracotomies was applied in one patient. Pulmonary lobectomy was performed in 25 patients, segmentectomy in one patient, and pulmonary partial resection in nine patients. The resected surrounding organs, other than the chest wall, were the subclavian artery in two patients, the superior vena cava in two, and the aortic arch and vertebral body in two patients each. The median follow-up period was 16 months (range, 3–154 months). Postoperative 1-, 3- and 5-year survival rates were 72%, 46%, and 34%, respectively. Investigation of clinicopathological factors with potential impacts on postoperative outcome identified pathological nodal extension as the only significant factor indicating poor prognosis (p < 0.01). Tumor markers, surgical approach, type of pulmonary resection, and type of resected surrounding organ had no effect on postoperative outcome. No viable tumor was observed in seven of 22 patients treated with induction chemoradiotherapy, and the postoperative 5-year survival rate in these seven patients was 86%. Recurrent disease was observed in 17 patients during the postoperative follow-up period. Local recurrence was observed in five patients and recurrence in distant organs was observed in 13 patients.

    Conclusion
    Patients with node-positive SST have a poor prognosis, and surgical indications should be investigated fully in these patients. Induction chemoradiotherapy is necessary to treat SST. The major sites of recurrence are in distant organs, and the type of pulmonary resection does not affect postoperative outcome. Partial resection may be an acceptable option in patients with no detectable viable tumor after induction chemoradiotherapy.