TY - JOUR
T1 - Long-Term Outcomes After Chemoradiotherapy and Surgery for Superior Sulcus Tumors
AU - Ünal, S.
AU - Winkelman, J. A.
AU - Heineman, D. J.
AU - Bahce, I.
AU - van Dorp, M.
AU - Braun, J. A.
AU - Hashemi, S.
AU - Senan, S.
AU - Paul, M. A.
AU - Dahele, M.
AU - Dickhoff, C.
N1 - Publisher Copyright: © 2023 The Authors
PY - 2023/4/1
Y1 - 2023/4/1
N2 - Introduction: Superior sulcus tumors (SSTs) are uncommon, and their anatomical location can make treatment challenging. We analyzed late outcomes of patients with SST treated with concurrent chemoradiotherapy followed by surgical resection (trimodality) in a single tertiary institution. Methods: Patients with non–small cell SSTs, who underwent trimodality therapy between 2002 and 2017, were selected from a prospective institutional surgical database. Patients were uniformly staged with 18F-fluorodeoxyglucose–positron emission tomography, computed tomography scan of the chest and upper abdomen, and brain imaging. Patients undergoing resection of the lung plus chest wall were grouped as limited SST and those needing extensive resections (e.g., including the vertebral body) as extended SST. Kaplan-Meier survival analysis was performed to determine difference in survival. Multivariate Cox regression was used to identify prognostic factors. Results: A total of 123 patients were identified with a median follow-up of 4.9 years (interquartile range: 1.6–8.9 y). The 90-day postoperative mortality and morbidity (Clavien-Dindo grades III–V) were 6.5% and 21.1%, respectively. Patients with a radical resection (R0: 92.7%) had better survival (p = 0.002), as did those who had major pathologic response (73%) (p = 0.001). Ten-year overall survival (OS) and disease-free survival were 48.1% and 42.6%, respectively. There were no differences in 90-day mortality (p = 0.31) and OS (p = 0.79) between extended SST and limited SST patients. Conclusions: In patients with SST, trimodality resulted in a 10-year estimated OS and disease-free survival of 48.1% and 42.6%, respectively, which were improved after radical resection (R0) and major pathologic response. Survival for limited and extended resections was comparable, and distant relapse was the main pattern of failure. Better systemic treatments are therefore needed.
AB - Introduction: Superior sulcus tumors (SSTs) are uncommon, and their anatomical location can make treatment challenging. We analyzed late outcomes of patients with SST treated with concurrent chemoradiotherapy followed by surgical resection (trimodality) in a single tertiary institution. Methods: Patients with non–small cell SSTs, who underwent trimodality therapy between 2002 and 2017, were selected from a prospective institutional surgical database. Patients were uniformly staged with 18F-fluorodeoxyglucose–positron emission tomography, computed tomography scan of the chest and upper abdomen, and brain imaging. Patients undergoing resection of the lung plus chest wall were grouped as limited SST and those needing extensive resections (e.g., including the vertebral body) as extended SST. Kaplan-Meier survival analysis was performed to determine difference in survival. Multivariate Cox regression was used to identify prognostic factors. Results: A total of 123 patients were identified with a median follow-up of 4.9 years (interquartile range: 1.6–8.9 y). The 90-day postoperative mortality and morbidity (Clavien-Dindo grades III–V) were 6.5% and 21.1%, respectively. Patients with a radical resection (R0: 92.7%) had better survival (p = 0.002), as did those who had major pathologic response (73%) (p = 0.001). Ten-year overall survival (OS) and disease-free survival were 48.1% and 42.6%, respectively. There were no differences in 90-day mortality (p = 0.31) and OS (p = 0.79) between extended SST and limited SST patients. Conclusions: In patients with SST, trimodality resulted in a 10-year estimated OS and disease-free survival of 48.1% and 42.6%, respectively, which were improved after radical resection (R0) and major pathologic response. Survival for limited and extended resections was comparable, and distant relapse was the main pattern of failure. Better systemic treatments are therefore needed.
KW - Clinical outcomes
KW - Non–small cell lung cancer
KW - Pancoast tumor
KW - Pathologic response
KW - Superior sulcus
KW - Trimodality therapy
UR - http://www.scopus.com/inward/record.url?scp=85150308178&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85150308178&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36969550
U2 - https://doi.org/10.1016/j.jtocrr.2023.100475
DO - https://doi.org/10.1016/j.jtocrr.2023.100475
M3 - Article
C2 - 36969550
SN - 2666-3643
VL - 4
JO - JTO Clinical and Research Reports
JF - JTO Clinical and Research Reports
IS - 4
M1 - 100475
ER -