84P - Trimodality therapy including radical resection for pancoast tumors: T4 is not a contraindication for radical surgery

Date 17 April 2015
Event ELCC 2015
Session Poster lunch
Topics Anti-Cancer Agents & Biologic Therapy
Non-Small-Cell Lung Cancer, Locally Advanced
Surgery and/or Radiotherapy of Cancer
Presenter Mir Hoda
Citation Annals of Oncology (2015) 26 (suppl_1): 24-28. 10.1093/annonc/mdv049
Authors M.A. Hoda1, R. Waseda1, T. Klikovits1, O. Foesleitner2, S. Zoechbauer-Mueller3, K. Dieckmann4, H. Prosch5, R. Pirker3, W. Klepetko1
  • 1Division Of Thoracic Surgery, Department Of Surgery, Vienna General Hospital (AKH) - Medizinische Universität Wien, 1090 - Vienna/AT
  • 2Division Of Thoracic Surgery, Vienna General Hospital (AKH) - Medizinische Universität Wien, 1090 - Vienna/AT
  • 3Division Of Oncology, Department Of Medicine I, Vienna General Hospital (AKH) - Medizinische Universität Wien, 1090 - Vienna/AT
  • 4Department Of Radiation Oncology, Vienna General Hospital (AKH) - Medizinische Universität Wien, 1090 - Vienna/AT
  • 5Department Of Radiology, Vienna General Hospital (AKH) - Medizinische Universität Wien, 1090 - Vienna/AT

Abstract

Aim/Background

Neodajuvant chemoradiotherapy (NCRT) followed by surgical resection is the therapy regimen of choice in patients with Pancoast tumors. However, surgery remains challenging in these patients and extended procedures, particularly in T4 tumors, with resection and reconstruction of vessels and spine structures are required. Therefore this study aims to evaluate the efficacy and safety of trimodality treatment for a locally very advanced Pancoast tumor patient cohort.

Methods

66 consecutive patients with Pancoast tumors treated surgically from 1998 to 2013 were identified in the institutional database. Patient's medical records were reviewed retrospectively and data was analyzed by using PASW Statistics 18.0 package.

Results

Patients mean age was 57 (31-84) years. 47 male and 19 female patients had the following ECOG status: 0 in 54; 1 in 7 and 2 in 5 cases. Main histology was adenocarcinoma in 31, squamous cell carcinoma in 28 and others in 7 patients. 46 (70%) patients underwent NCRT, 12 (18%) neoadjuvant chemotherapy alone prior to surgery and 8 (12%) received no neoadjuvant treatment. The extent of lung resection was: 52(79%) lobectomies, 9(14%) pneumonectomies, and 5(7%) sublobar resections. Extended procedures were performed in 37(56%) cases (12 for big vessels, 10 for spine, 3 for vessels and spine, and 4 for vessels and anterior chest wall). Complete resection was achieved in 58(88%) patients. 30-day mortality was 4.5%. Overall survival (OS) was 53.4% and disease-free survival (DFS) was 42.0% at 3-years. No influence on survival was observed with regard to the extended surgical procedure and the extent of lung resection. Pathological N stage and no NCRT were significant risk factors for OS. No NCRT and absent pathological response were significant risk factor for DFS. Clinical T stage, extended procedure, extent of lung resection did not significantly alter OS or DFS in multivariate analysis.

Conclusions

In the present series, trimodality treatment with radical resection for Pancoast tumors had favorable survival outcomes. Especially T4 tumors with involvement of big vessels and spine structures were not a contraindication for radical resection after NCRT.

Disclosure

All authors have declared no conflicts of interest.