title: Patterns of Failure After Surgery for Non-Small-cell Lung Cancer Invading the Chest Wall.
abstract: The patterns of failure after resection of non-small-cell lung cancer (NSCLC) invading the chest wall are not well documented, and the role of adjuvant radiation therapy (RT) is unclear, prompting the present analysis.
  
  
  
  The present institutional review board-approved study evaluated patients who had undergone surgery from 1995 to 2014 for localized NSCLC invading the chest wall. Patients with superior sulcus tumors were excluded. The clinical outcomes were estimated using the Kaplan-Meier method and compared using a log-rank test. The prognostic factors were assessed using a multivariate analysis, and the patterns of failure were scored.
  
  
  
  Seventy-four patients were evaluated. Most patients had undergone lobectomy or pneumonectomy (85%) with en bloc chest wall resection (80%) and had pathologically node negative findings (81%). The surgical margins were positive in 10 patients (14%) and most commonly involved the chest wall (7 of 10). Adjuvant treatment included RT in 21 (28%) and chemotherapy in 28 (38%). A total of 24 local recurrences developed. The chest wall was a component of local disease recurrence in 19 of 24 cases (79%). The local control rate at 5 years for the entire population was 60% (95% confidence interval, 46%-74%). The local control rate was 74% with adjuvant RT versus 55% without RT (P = .43). On multivariate analysis, only resection less than lobectomy or pneumonectomy was associated with worse local control. The overall survival rate was 38% with RT versus 34% without RT (P = .59).
  
  
  
  Positive surgical margins and local disease recurrence were common after resection of NSCLC invading the chest wall. The primary pattern of failure was local recurrence in the chest wall. Adjuvant RT was not associated with improved local control or survival.
authors.affiliation: Department of Radiation Oncology, Duke University School of Medicine, Durham, NC. Electronic address: daniel.tandberg@duke.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tandberg
authors.affiliation: Department of Radiation Oncology, Duke University School of Medicine, Durham, NC.
authors.forename: Chris R
authors.initials: CR
authors.lastname: Kelsey
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.affiliation: Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Crawford
authors.affiliation: Department of Radiation Oncology, Duke University School of Medicine, Durham, NC.
authors.forename: Junzo P
authors.initials: JP
authors.lastname: Chino
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC.
authors.forename: Betty C
authors.initials: BC
authors.lastname: Tong
authors.affiliation: Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Neal E
authors.initials: NE
authors.lastname: Ready
authors.affiliation: Department of Radiation Oncology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Ato
authors.initials: A
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D011013:Pneumonectomy; D016019:Survival Analysis; D035441:Thoracic Wall / Q000473:pathology*; D017211:Treatment Failure
keywords: Adjuvant treatment; Chemotherapy; Chest wall invasion; NSCLC; Radiation therapy