Induction chemoradiation compared with induction radiation for lung cancer involving the superior sulcus

doi:10.1016/S0003-4975(02)03471-9

The Annals of Thoracic Surgery

Volume 73, Issue 5, May 2002, Pages 1541-1544

https://doi.org/10.1016/S0003-4975(02)03471-9 Get rights and content

Abstract

Background. The usual approach of induction radiation therapy (RT) followed by resection of superior sulcus tumors results in many incomplete resections, a high local recurrence rate, and suboptimal survival. Induction chemoradiotherapy (CT/RT) has been shown to reduce local and distant recurrences and improve survival in stage III lung cancer. We investigated the role of induction CT/RT in superior sulcus patients.

Methods. This was a single-institution, retrospective study.

Results. From 1985 to 2000, 35 consecutive patients underwent induction treatment followed by resection of a superior sulcus tumor. All patients had mediastinoscopy first to exclude N2 disease, and all were N0 at final pathologic examination. Twenty patients had induction RT (mean, 39 Gy), and 15 had induction CT/RT (mean, 51 Gy) with concurrent cisplatin-based chemotherapy. There was no treatment mortality. Complete resection was performed in 16 of 20 (80%) of the RT patients and in 14 of 15 (93%) of the CT/RT patients (p = 0.15). The pathologic response from the induction treatment was complete or near complete in 7 of 20 (35%) of the RT patients and in 13 of 15 (87%) of the CT/RT patients (p = 0.001). The median follow-up was 167 months in the RT patients and 51 months in the CT/RT patients. Two-year and 4-year survival was 49% and 49% (95% confidence interval, 26% to 71%) in the RT patients and 93% and 84% (95% confidence interval, 63% to 100%) in the CT/RT patients, respectively (p = 0.01). The local recurrence rate was 6 of 20 (30%) in the RT patients and 0 in the CT/RT patients (p = 0.02).

Conclusions. Induction CT/RT for superior sulcus tumors appears to offer improved survival compared with induction RT alone.

Section snippets

Patients and methods

Patients with non–small-cell lung cancer invading the superior pulmonary sulcus were identified from the thoracic surgery database during a 15-year period (1985 to 2000). Only patients undergoing induction therapy followed by resection were reviewed. A retrospective chart review was performed, and the following data were recorded: patient age, sex, presence of pain pretreatment, induction treatment, adjuvant treatment, complete resection status, TNM status, length of stay, treatment-related

Results

Thirty-five patients underwent treatment of a superior sulcus tumor with induction therapy followed by resection from 1985 to 2000. Eighteen patients were men and 17 were women. All patients had mediastinoscopy before treatment, and all were found to be free of mediastinal nodal metastases. Compared with CT/RT patients, those who had induction RT were treated on average 7 years earlier, were of the same age, had less RT, were less often resected by the anterior approach, had the same rate of

Comment

The two different induction groups were fairly evenly matched for the three important prognostic factors for superior sulcus tumor patients (T and N status and complete resection) [5]. All patients were N0. The rate of complete resections was higher in the CT/RT group but not significantly (p = 0.15) so, probably owing to the small numbers of patients in the study. The number of complete resections in the CT/RT group is actually fairly high because more T4 tumors were resected. There were more

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Original article: general thoracicInduction chemoradiation compared with induction radiation for lung cancer involving the superior sulcus

Abstract

Section snippets

Patients and methods

Results

Comment

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Thoracic Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Original article: general thoracic
Induction chemoradiation compared with induction radiation for lung cancer involving the superior sulcus