title: Long-term outcome after resection of non-small cell lung cancer invading the thoracic inlet.
abstract: BACKGROUND
  The aim of this study was to update our previous experience and describe long-term results after resection of non-small-cell lung cancer (NSCLC) invading the thoracic inlet.
  
  
  METHODS
  Patients from a single center undergoing resection of NSCLC invading the thoracic inlet were reviewed with data retrieved retrospectively from their charts.
  
  
  RESULTS
  Sixty-five consecutive patients with a median age of 61 (32-76) years underwent resection of NSCLC invading the thoracic inlet from 1991 to 2011. Tumor location was divided into 5 anatomic zones from anterior to posterior. Fifty-two (80%) patients had induction therapy, mostly with 2 cycles of cisplatin-etoposide and 45 Gy of concurrent irradiation. All patients underwent at least first rib resection. Lobectomy was performed in 60 patients (92%). Twenty-four patients (37%) had vertebral resection. Arterial resections were performed in 7 patients (11%). Postoperative morbidity and mortality were 46% and 6%, respectively. Pathologic response to induction was complete (pCR) (n = 19) or nearly complete (pNR) (n = 12) in 31 patients (48%). Adjuvant treatment was administered in 14 (25%) patients. After a median follow-up of 20 (0-193) months, 34 patients are alive without recurrence. The overall 5-year survival reached 69%. Univariate analysis identified site of tumor within the thoracic inlet (p = 0.050), response to induction (p = 0.004), and presence of adjuvant treatment (p = 0.028) as survival predictors.
  
  
  CONCLUSIONS
  Survival after resection of NSCLC invading the thoracic inlet in highly selected patients reached 69% at 5 years. Tumor location within the thoracic inlet, pathologic response to induction therapy, and adjuvant treatments were significant survival predictors.
authors: Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Stéphane
authors: S
authors: Collaud
authors: Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Tiago
authors: T
authors: Machuca
authors: Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Olaf
authors: O
authors: Mercier
authors: Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Thomas K
authors: TK
authors: Waddell
authors: Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Kazuhiro
authors: K
authors: Yasufuku
authors: Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Andrew F
authors: AF
authors: Pierre
authors: Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Gail E
authors: GE
authors: Darling
authors: Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Marcelo
authors: M
authors: Cypel
authors: Division of Orthopedic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Yoga R
authors: YR
authors: Rampersaud
authors: Division of Orthopedic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Stephen J
authors: SJ
authors: Lewis
authors: Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada.
authors: Frances A
authors: FA
authors: Shepherd
authors: Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada.
authors: Natasha B
authors: NB
authors: Leighl
authors: Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada.
authors: John B C
authors: JB
authors: Cho
authors: Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada.
authors: Andrea
authors: A
authors: Bezjak
authors: Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Shaf
authors: S
authors: Keshavjee
authors: Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: marc.deperrot@uhn.ca.
authors: Marc
authors: M
authors: de Perrot
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome