title: Combined treatment modalities in Pancoast tumor: results of a monocentric retrospective study.
abstract: BACKGROUND
  A retrospective monocentric study of consecutive patients with superior sulcus tumor non-small cell lung cancer (SS-NSCLC), treated by induction concurrent chemoradiotherapy (CRT), article management.
  
  
  METHODS
  From 1994 to 2005, 36 patients (15 T3, 21 T4 tumors, including N2-N3 node involvement) received induction CRT with cisplatin/vinorelbine/fluorouracil combined with 44 Gy radiotherapy (5 daily 2 Gy fractions/week). After CRT completion, RECIST evaluation and operability were assessed. In resectable patients, surgery was performed one month after CRT. Patients with unresectable disease followed CRT up to 66 Gy. The median of follow-up period was 38.6 months [2-206].
  
  
  RESULTS
  Induction CRT was completed for 94.4% with 71% radiological objective response (OR). Sixteen patients (44%) underwent surgical resection, and pathologic complete resection was performed in 93.8%. There were 7 patients (44%) with pathologic complete response. The median disease-free survival (DFS) time was 12.9 months with DFS rates at 1 and 2 years 53.6% and 39.1% respectively. The median overall survival (OS) was 46.4 months. The OS rates at 2 and 5 years were 68.8% and 37.5% respectively with no difference between T3 and T4 tumors. In unresectable disease, the median DFS time was 8.1 months. The DFS rate at 1 year was 25.2%. The median OS was 9.1 months. The OS rates at 1 and 2 years were 45% and 16.9% respectively. Recurrences were found in 72% of patients. Brain metastasis was the most common site of recurrence. Prognostic factors for OS were the response to induction treatment, the possibility of surgery, and pathologic complete response.
  
  
  CONCLUSIONS
  This trimodality treatment regimen confers a survival outcome in agreement with previous studies. Patients with pretreatment N3 lymph node should be included in trimodality treatment.
authors.affiliation: Thoracic Oncology Unit, Clermont-Ferrand University Hospital, Rue Montalembert, BP 69, 63003 Clermont-Ferrand, France. gjeannin@chu-clermontferrand.fr.
authors.forename: Gaelle
authors.initials: G
authors.lastname: Jeannin
authors.affiliation: Thoracic Oncology Unit, Clermont-Ferrand University Hospital, 63003 Clermont-Ferrand, France; Clermont University, Université d'Auvergne, 63003 Clermont-Ferrand, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Merle
authors.affiliation: Thoracic Oncology Unit, Clermont-Ferrand University Hospital, 63003 Clermont-Ferrand, France; Clermont University, Université d'Auvergne, 63003 Clermont-Ferrand, France.
authors.forename: Henri
authors.initials: H
authors.lastname: Janicot
authors.affiliation: Thoracic Oncology Unit, Clermont-Ferrand University Hospital, 63003 Clermont-Ferrand, France.
authors.forename: Lise
authors.initials: L
authors.lastname: Thibonnier
authors.affiliation: Medical Informatic Department, Jean Perrin Anti-Cancer Center, 63011 Clermont-Ferrand, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Kwiatkowski
authors.affiliation: Thoracic Surgery Unit, Jean Perrin Anti-Cancer Center, 63011 Clermont-Ferrand, France.
authors.forename: Adel
authors.initials: A
authors.lastname: Naame
authors.affiliation: Thoracic Surgery Unit, Jean Perrin Anti-Cancer Center, 63011 Clermont-Ferrand, France.
authors.forename: J Baptiste
authors.initials: JB
authors.lastname: Chadeyras
authors.affiliation: Thoracic Surgery Unit, Jean Perrin Anti-Cancer Center, 63011 Clermont-Ferrand, France.
authors.forename: Géraud
authors.initials: G
authors.lastname: Galvaing
authors.affiliation: Radiotherapy Department, Jean Perrin Anti-Cancer Center, 63011 Clermont-Ferrand, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Belliere
authors.affiliation: Thoracic Surgery Unit, Jean Perrin Anti-Cancer Center, 63011 Clermont-Ferrand, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Filaire
authors.affiliation: Clermont University, Université d'Auvergne, 63003 Clermont-Ferrand, France; Radiotherapy Department, Jean Perrin Anti-Cancer Center, 63011 Clermont-Ferrand, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Verrelle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage; D018450:Disease Progression; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010178:Pancoast Syndrome / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine
chemical_list: D014747:Vinblastine; D002945:Cisplatin; D000077235:Vinorelbine; D005472:Fluorouracil
keywords: Sulcus non-small cell lung cancer (Sulcus NSCLC); chemoradiotherapy (CRT); prognosis; surgery