INTRODUCTION: For sulcus superior tumors and central cT4 tumors, low resectability and poor long-term survival rates are obtained with single-modality treatment. METHODS: Analysis of all consecutive patients in our prospective database, who had potentially resectable superior sulcus (cT3-T4) and central cT4 tumors and were treated with induction chemoradiotherapy (two courses of cisplatin-etoposide) and concomitant radiotherapy (45 Gy/1.8 Gy) after multidisciplinary discussion. Surgery with attempted complete resection was performed in patients showing response or stable disease on computed tomography. RESULTS: Between April 2002 and February 2008, 32 consecutive patients were enrolled. Two patients did not complete the induction chemoradiotherapy. Thirty patients were reassessed after induction, 28 had response or stable disease by conventional imaging. Twenty-seven patients were surgically explored since one patient became medically inoperable during induction treatment. The overall complete resectability was 78% (25/32). Resection was microscopically incomplete (R1) in two patients. In 11 patients (41%), a pneumonectomy was performed, and in 14 patients (52%), a chest wall resection was necessary. In 74% of the resected patients, there was a complete pathologic response or minimal residual microscopic disease. The mean postoperative hospital stay was 9.2 days with no hospital mortality and no bronchopleural fistula. With a median follow-up of 26.5 months, 5-year survival rates are 74% in the intent-to-treat population (n = 32) and 77% in completely resected patients (n = 25), with no statistically significant difference between sulcus superior tumors and centrally located T4 tumors. CONCLUSION: In patients with sulcus superior tumors and in selected patients with centrally located T4 tumors, trimodality treatment is feasible with acceptable morbidity and mortality. The complete resectability is high, and long-term survival is promising.
INTRODUCTION: For sulcus superior tumors and central cT4 tumors, low resectability and poor long-term survival rates are obtained with single-modality treatment. METHODS: Analysis of all consecutive patients in our prospective database, who had potentially resectable superior sulcus (cT3-T4) and central cT4 tumors and were treated with induction chemoradiotherapy (two courses of cisplatin-etoposide) and concomitant radiotherapy (45 Gy/1.8 Gy) after multidisciplinary discussion. Surgery with attempted complete resection was performed in patients showing response or stable disease on computed tomography. RESULTS: Between April 2002 and February 2008, 32 consecutive patients were enrolled. Two patients did not complete the induction chemoradiotherapy. Thirty patients were reassessed after induction, 28 had response or stable disease by conventional imaging. Twenty-seven patients were surgically explored since one patient became medically inoperable during induction treatment. The overall complete resectability was 78% (25/32). Resection was microscopically incomplete (R1) in two patients. In 11 patients (41%), a pneumonectomy was performed, and in 14 patients (52%), a chest wall resection was necessary. In 74% of the resected patients, there was a complete pathologic response or minimal residual microscopic disease. The mean postoperative hospital stay was 9.2 days with no hospital mortality and no bronchopleural fistula. With a median follow-up of 26.5 months, 5-year survival rates are 74% in the intent-to-treat population (n = 32) and 77% in completely resected patients (n = 25), with no statistically significant difference between sulcus superior tumors and centrally located T4 tumors. CONCLUSION: In patients with sulcus superior tumors and in selected patients with centrally located T4 tumors, trimodality treatment is feasible with acceptable morbidity and mortality. The complete resectability is high, and long-term survival is promising.
Authors: Nika Guberina; Christoph Pöttgen; Martin Schuler; Maja Guberina; Georgios Stamatis; Till Plönes; Martin Metzenmacher; Dirk Theegarten; Thomas Gauler; Kaid Darwiche; Clemens Aigner; Wilfried E E Eberhardt; Martin Stuschke Journal: Radiat Oncol Date: 2022-07-16 Impact factor: 4.309
Authors: B S van der Meij; J A E Langius; M D Spreeuwenberg; S M Slootmaker; M A Paul; E F Smit; P A M van Leeuwen Journal: Eur J Clin Nutr Date: 2012-01-11 Impact factor: 4.016
Authors: Simon A Keek; Esma Kayan; Avishek Chatterjee; José S A Belderbos; Gerben Bootsma; Ben van den Borne; Anne-Marie C Dingemans; Hester A Gietema; Harry J M Groen; Judith Herder; Cordula Pitz; John Praag; Dirk De Ruysscher; Janna Schoenmaekers; Hans J M Smit; Jos Stigt; Marcel Westenend; Haiyan Zeng; Henry C Woodruff; Philippe Lambin; Lizza Hendriks Journal: Ther Adv Med Oncol Date: 2022-08-22 Impact factor: 5.485