Survival after trimodality treatment for superior sulcus and central T4 non-small cell lung cancer.
BACKGROUND
For sulcus superior tumors and central cT4 tumors, low resectability and poor long-term survival rates are obtained with single-modality treatment.


METHODS
Analysis of all consecutive patients in our prospective database, who had potentially resectable superior sulcus (cT3-T4) and central cT4 tumors and were treated with induction chemoradiotherapy (two courses of cisplatin-etoposide) and concomitant radiotherapy (45 Gy/1.8 Gy) after multidisciplinary discussion. Surgery with attempted complete resection was performed in patients showing response or stable disease on computed tomography.


RESULTS
Between April 2002 and February 2008, 32 consecutive patients were enrolled. Two patients did not complete the induction chemoradiotherapy. Thirty patients were reassessed after induction, 28 had response or stable disease by conventional imaging. Twenty-seven patients were surgically explored since one patient became medically inoperable during induction treatment. The overall complete resectability was 78% (25/32). Resection was microscopically incomplete (R1) in two patients. In 11 patients (41%), a pneumonectomy was performed, and in 14 patients (52%), a chest wall resection was necessary. In 74% of the resected patients, there was a complete pathologic response or minimal residual microscopic disease. The mean postoperative hospital stay was 9.2 days with no hospital mortality and no bronchopleural fistula. With a median follow-up of 26.5 months, 5-year survival rates are 74% in the intent-to-treat population (n = 32) and 77% in completely resected patients (n = 25), with no statistically significant difference between sulcus superior tumors and centrally located T4 tumors.


CONCLUSIONS
In patients with sulcus superior tumors and in selected patients with centrally located T4 tumors, trimodality treatment is feasible with acceptable morbidity and mortality. The complete resectability is high, and long-term survival is promising.
De Leyn
Paul
P
Department of Thoracic Surgery, University Hospitals and Leuven Lung Cancer Group, Leuven, Belgium. Paul.Deleyn@uzleuven.be
Vansteenkiste
Johan
J
Lievens
Yolande
Y
Van Raemdonck
Dirk
D
Nafteux
Philippe
P
Decker
Georges
G
Coosemans
Willy
W
Decaluwé
Herbert
H
Moons
Johny
J
Lerut
Tony
T
D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000628:therapy; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018287:Carcinoma, Large Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D012074:Remission Induction; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
D005047:Etoposide; D002945:Cisplatin