Superior sulcus tumors with vertebral body involvement: A multimodality approach

Objective Superior sulcus tumors with involvement of the spine have historically been considered unresectable. We have previously documented a 2-year survival of 54% in patients treated with a multimodality approach. This work builds on our previous experience and examines the long-term outcomes. Me...

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Veröffentlicht in:The Journal of thoracic and cardiovascular surgery 2009-06, Vol.137 (6), p.1379-1387
Hauptverfasser: Bolton, William D., MD, Rice, David C., MD, Goodyear, Adam, MD, Correa, Arlene M., PhD, Erasmus, Jeremy, MD, Hofstetter, Wayne, MD, Komaki, Ritsuko, MD, Mehran, Reza, MD, Pisters, Katherine, MD, Roth, Jack A., MD, Swisher, Stephen G., MD, Vaporciyan, Ara A., MD, Walsh, Garrett L., MD, Weaver, Jason, MD, Rhines, Laurence, MD
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Sprache:eng
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Zusammenfassung:Objective Superior sulcus tumors with involvement of the spine have historically been considered unresectable. We have previously documented a 2-year survival of 54% in patients treated with a multimodality approach. This work builds on our previous experience and examines the long-term outcomes. Methods A retrospective review was performed on patients with superior sulcus non–small cell lung cancer tumors with involvement of the vertebral column (n = 39) treated at The University of Texas MD Anderson Cancer Center from 1990 to 2006. Their clinical and pathologic data were analyzed for short- and long-term outcomes. Results Group 1 included 8 (21%) patients with neuroforamen or transverse process involvement, group 2 had 16 (41%) patients with partial vertebrectomy, and group 3 had 15 (38%) patients with total vertebrectomy. There were 2 (5%) postoperative deaths, and 11 (28%) patients had major complications. Margins were positive in 17 (44%) patients. Recurrence occurred in 23 (59%) patients and was local in 11 (28%) patients, distant in 11 (28%) patients, and both in 1 (3%) patient. Median time to local recurrence was 7 months in patients with positive margins and has not been reached for patients with negative margins ( P = .007). Median, 2-year, and 5-year overall survival was 18 months, 47%, and 27%, respectively. On multivariate analysis, the only independent predictor of shorter survival was nodal metastases ( P = .001; hazard ratio, 6.5; 95% confidence interval, 2.2–19.2). Conclusion An aggressive multimodality approach involving surgical resection can be performed with acceptable morbidity in highly selected patients with superior sulcus tumors and vertebral invasion at a specialized center. Encouraging long-term survival can be achieved in patients with negative margins and no lymph node involvement.
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2009.01.015