Cargando…

Trimodality Treatment of Superior Sulcus Non-Small Cell Lung Cancer: An Institutional Series of 47 Consecutive Patients

Objectives: Treatment of superior sulcus tumors (SST) using concurrent chemoradiation followed by surgery is a current standard. However, due to the rarity of this entity, clinical experience in its treatment remains scarce. Here, we present the results of a large consecutive series of patients trea...

Descripción completa

Detalles Bibliográficos
Autores principales: Rzyman, Witold, Łazar-Poniatowska, Małgorzata, Dziedzic, Robert, Marjański, Tomasz, Łapiński, Mariusz, Dziadziuszko, Rafał
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10217630/
https://www.ncbi.nlm.nih.gov/pubmed/37232802
http://dx.doi.org/10.3390/curroncol30050344
_version_ 1785048583320371200
author Rzyman, Witold
Łazar-Poniatowska, Małgorzata
Dziedzic, Robert
Marjański, Tomasz
Łapiński, Mariusz
Dziadziuszko, Rafał
author_facet Rzyman, Witold
Łazar-Poniatowska, Małgorzata
Dziedzic, Robert
Marjański, Tomasz
Łapiński, Mariusz
Dziadziuszko, Rafał
author_sort Rzyman, Witold
collection PubMed
description Objectives: Treatment of superior sulcus tumors (SST) using concurrent chemoradiation followed by surgery is a current standard. However, due to the rarity of this entity, clinical experience in its treatment remains scarce. Here, we present the results of a large consecutive series of patients treated with concurrent chemoradiation followed by surgery at a single academic institution. Materials and Methods: The study group included 48 patients with pathologically confirmed SST. The treatment schedule consisted of preoperative 6-MV photon-beam radiotherapy (45–66 Gy delivered in 25–33 fractions over 5–6.5 weeks) and concurrent two cycles of platinum-based chemotherapy. Five weeks after completion of chemoradiation, pulmonary and chest wall resection was performed. Results: From 2006 to 2018, 47 of 48 consecutive patients meeting protocol criteria underwent two cycles of cisplatin-based chemotherapy and concurrent radiotherapy (45–66 Gy) followed by pulmonary resection. One patient did not undergo surgery due to brain metastases that occurred during induction therapy. The median follow-up was 64.7 months. Chemoradiation was well tolerated, with no toxicity-related deaths. Twenty-one patients (44%) developed grade 3–4 side effects, of which the most common was neutropenia (17 patients; 35.4%). Seventeen patients (36.2%) had postoperative complications, and 90-day mortality was 2.1%. Three- and five-year overall survival (OS) were 43.6% and 33.5%, respectively, and three- and five-year recurrence-free survival were 42.1% and 32.4%, respectively. Thirteen (27.7%) and 22 (46.8%) patients had a complete and major pathological response, respectively. Five-year OS in patients with complete tumor regression was 52.7% (95% CI 29.4–94.5). Predictive factors of long-term survival included age below 70 years, complete resection, pathological stage, and response to induction treatment. Conclusions: Chemoradiation followed by surgery is a relatively safe method with satisfactory outcomes.
format Online
Article
Text
id pubmed-10217630
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-102176302023-05-27 Trimodality Treatment of Superior Sulcus Non-Small Cell Lung Cancer: An Institutional Series of 47 Consecutive Patients Rzyman, Witold Łazar-Poniatowska, Małgorzata Dziedzic, Robert Marjański, Tomasz Łapiński, Mariusz Dziadziuszko, Rafał Curr Oncol Article Objectives: Treatment of superior sulcus tumors (SST) using concurrent chemoradiation followed by surgery is a current standard. However, due to the rarity of this entity, clinical experience in its treatment remains scarce. Here, we present the results of a large consecutive series of patients treated with concurrent chemoradiation followed by surgery at a single academic institution. Materials and Methods: The study group included 48 patients with pathologically confirmed SST. The treatment schedule consisted of preoperative 6-MV photon-beam radiotherapy (45–66 Gy delivered in 25–33 fractions over 5–6.5 weeks) and concurrent two cycles of platinum-based chemotherapy. Five weeks after completion of chemoradiation, pulmonary and chest wall resection was performed. Results: From 2006 to 2018, 47 of 48 consecutive patients meeting protocol criteria underwent two cycles of cisplatin-based chemotherapy and concurrent radiotherapy (45–66 Gy) followed by pulmonary resection. One patient did not undergo surgery due to brain metastases that occurred during induction therapy. The median follow-up was 64.7 months. Chemoradiation was well tolerated, with no toxicity-related deaths. Twenty-one patients (44%) developed grade 3–4 side effects, of which the most common was neutropenia (17 patients; 35.4%). Seventeen patients (36.2%) had postoperative complications, and 90-day mortality was 2.1%. Three- and five-year overall survival (OS) were 43.6% and 33.5%, respectively, and three- and five-year recurrence-free survival were 42.1% and 32.4%, respectively. Thirteen (27.7%) and 22 (46.8%) patients had a complete and major pathological response, respectively. Five-year OS in patients with complete tumor regression was 52.7% (95% CI 29.4–94.5). Predictive factors of long-term survival included age below 70 years, complete resection, pathological stage, and response to induction treatment. Conclusions: Chemoradiation followed by surgery is a relatively safe method with satisfactory outcomes. MDPI 2023-04-27 /pmc/articles/PMC10217630/ /pubmed/37232802 http://dx.doi.org/10.3390/curroncol30050344 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Rzyman, Witold
Łazar-Poniatowska, Małgorzata
Dziedzic, Robert
Marjański, Tomasz
Łapiński, Mariusz
Dziadziuszko, Rafał
Trimodality Treatment of Superior Sulcus Non-Small Cell Lung Cancer: An Institutional Series of 47 Consecutive Patients
title Trimodality Treatment of Superior Sulcus Non-Small Cell Lung Cancer: An Institutional Series of 47 Consecutive Patients
title_full Trimodality Treatment of Superior Sulcus Non-Small Cell Lung Cancer: An Institutional Series of 47 Consecutive Patients
title_fullStr Trimodality Treatment of Superior Sulcus Non-Small Cell Lung Cancer: An Institutional Series of 47 Consecutive Patients
title_full_unstemmed Trimodality Treatment of Superior Sulcus Non-Small Cell Lung Cancer: An Institutional Series of 47 Consecutive Patients
title_short Trimodality Treatment of Superior Sulcus Non-Small Cell Lung Cancer: An Institutional Series of 47 Consecutive Patients
title_sort trimodality treatment of superior sulcus non-small cell lung cancer: an institutional series of 47 consecutive patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10217630/
https://www.ncbi.nlm.nih.gov/pubmed/37232802
http://dx.doi.org/10.3390/curroncol30050344
work_keys_str_mv AT rzymanwitold trimodalitytreatmentofsuperiorsulcusnonsmallcelllungcanceraninstitutionalseriesof47consecutivepatients
AT łazarponiatowskamałgorzata trimodalitytreatmentofsuperiorsulcusnonsmallcelllungcanceraninstitutionalseriesof47consecutivepatients
AT dziedzicrobert trimodalitytreatmentofsuperiorsulcusnonsmallcelllungcanceraninstitutionalseriesof47consecutivepatients
AT marjanskitomasz trimodalitytreatmentofsuperiorsulcusnonsmallcelllungcanceraninstitutionalseriesof47consecutivepatients
AT łapinskimariusz trimodalitytreatmentofsuperiorsulcusnonsmallcelllungcanceraninstitutionalseriesof47consecutivepatients
AT dziadziuszkorafał trimodalitytreatmentofsuperiorsulcusnonsmallcelllungcanceraninstitutionalseriesof47consecutivepatients