title: Complete pathological response is predictive for clinical outcome after tri-modality therapy for carcinomas of the superior pulmonary sulcus.
abstract: The objective was to define the relationship between histopathological changes after pre-operative chemo-radiotherapy (CRT) and clinical outcome following tri-modality therapy in patients with superior sulcus tumours. A retrospective analysis of tumour material was performed in a series of 46 patients who received tri-modality therapy between 1997 and 2007. Median follow-up was 34 months (5-154). Pathological complete response (pCR) was present in 20/46 tumours (43 %). The most common RECIST score after CRT in patients with pCR was a partial response (PR; 10/17, three unknown), whereas in patients without a pCR, stable disease was the most common (22/26) (p = 0.002). In 26 specimens with residual tumour, this was mainly located in the periphery of the lesion rather than the centre (Spearman's correlation = 0.67, p < 0.001). Prognosis was significantly better after a pCR compared to residual tumour (70 % 5-year overall survival vs. 20 %; p = 0.001) and in patients with fewer than 10 % vital tumour cells as compared to those with >10 % (65 % 5-year overall survival vs. 18 %; p < 0.001). A low mitotic count was associated with a longer disease-free survival (p = 0.02). Complete pathological response and the presence of fewer than 10 % vital tumour cells after pre-operative CRT are both associated with a more favourable prognosis. A modification of the pathological staging system after radiotherapy, incorporating the percentage of vital tumour cells, is proposed.
authors.affiliation: Department of Pathology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1090, HM, Amsterdam, The Netherlands. hansblaauwgeers@pathology.nl
authors.forename: Johannes L
authors.initials: JL
authors.lastname: Blaauwgeers
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kappers
authors.forename: Houke M
authors.initials: HM
authors.lastname: Klomp
authors.forename: José S
authors.initials: JS
authors.lastname: Belderbos
authors.forename: Lea M
authors.initials: LM
authors.lastname: Dijksman
authors.forename: Egbert F
authors.initials: EF
authors.lastname: Smit
authors.forename: Pieter E
authors.initials: PE
authors.lastname: Postmus
authors.forename: Marinus A
authors.initials: MA
authors.lastname: Paul
authors.forename: Jan W
authors.initials: JW
authors.lastname: Oosterhuis
authors.forename: Koen J
authors.initials: KJ
authors.lastname: Hartemink
authors.forename: Cornelis G
authors.initials: CG
authors.lastname: Vos
authors.forename: Jacobus A
authors.initials: JA
authors.lastname: Burgers
authors.forename: Max
authors.initials: M
authors.lastname: Dahele
authors.forename: Erik C
authors.initials: EC
authors.lastname: Phernambucq
authors.forename: Birgit I
authors.initials: BI
authors.lastname: Witte
authors.forename: Erik
authors.initials: E
authors.lastname: Thunnissen
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010178:Pancoast Syndrome / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D011013:Pneumonectomy; D011379:Prognosis; D011878:Radiotherapy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
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