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...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-04-01
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| Series: | Current Oncology |
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| Online Access: | https://www.mdpi.com/1718-7729/30/5/344 |
| _version_ | 1797600455194312704 |
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| author | Witold Rzyman Małgorzata Łazar-Poniatowska Robert Dziedzic Tomasz Marjański Mariusz Łapiński Rafał Dziadziuszko |
| author_facet | Witold Rzyman Małgorzata Łazar-Poniatowska Robert Dziedzic Tomasz Marjański Mariusz Łapiński Rafał Dziadziuszko |
| author_sort | Witold Rzyman |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-11T03:49:20Z |
| format | Article |
| id | doaj.art-10fa31ad8ba44a279d2749fcc6d78148 |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-11T03:49:20Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-10fa31ad8ba44a279d2749fcc6d781482023-11-18T01:01:22ZengMDPI AGCurrent Oncology1198-00521718-77292023-04-013054551456210.3390/curroncol30050344Trimodality Treatment of Superior Sulcus Non-Small Cell Lung Cancer: An Institutional Series of 47 Consecutive PatientsWitold Rzyman0Małgorzata Łazar-Poniatowska1Robert Dziedzic2Tomasz Marjański3Mariusz Łapiński4Rafał Dziadziuszko5Department of Thoracic Surgery, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, PolandDepartment of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, PolandDepartment of Thoracic Surgery, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, PolandDepartment of Thoracic Surgery, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, PolandDepartment of Thoracic Surgery, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, PolandDepartment of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, PolandObjectives: 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.https://www.mdpi.com/1718-7729/30/5/344superior sulcus tumorsmultimodality treatmentneoadjuvant chemoradiationsurgerysurvival |
| spellingShingle | Witold Rzyman Małgorzata Łazar-Poniatowska Robert Dziedzic Tomasz Marjański Mariusz Łapiński Rafał Dziadziuszko Trimodality Treatment of Superior Sulcus Non-Small Cell Lung Cancer: An Institutional Series of 47 Consecutive Patients Current Oncology superior sulcus tumors multimodality treatment neoadjuvant chemoradiation surgery survival |
| 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 | superior sulcus tumors multimodality treatment neoadjuvant chemoradiation surgery survival |
| url | https://www.mdpi.com/1718-7729/30/5/344 |
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