Long-Term Outcomes After Chemoradiotherapy and Surgery for Superior Sulcus Tumors

S. Ünal, BS; J.A. Winkelman, MD; D.J. Heineman, MD, PhD; I. Bahce, MD, PhD; M. van Dorp, MD; J.A. Braun, MD, PhD; S. Hashemi, MD; S. Senan, MD, PhD; M.A. Paul, MD, PhD; M. Dahele, MD, PhD; C. Dickhoff, MD, PhD

JTO Clinical and Research Reports (Apr 2023)

Long-Term Outcomes After Chemoradiotherapy and Surgery for Superior Sulcus Tumors

S. Ünal, BS,
J.A. Winkelman, MD,
D.J. Heineman, MD, PhD,
I. Bahce, MD, PhD,
M. van Dorp, MD,
J.A. Braun, MD, PhD,
S. Hashemi, MD,
S. Senan, MD, PhD,
M.A. Paul, MD, PhD,
M. Dahele, MD, PhD,
C. Dickhoff, MD, PhD

Affiliations

S. Ünal, BS: Department of Cardiothoracic Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
J.A. Winkelman, MD: Department of Cardiothoracic Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
D.J. Heineman, MD, PhD: Department of Cardiothoracic Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
I. Bahce, MD, PhD: Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
M. van Dorp, MD: Department of Cardiothoracic Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
J.A. Braun, MD, PhD: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
S. Hashemi, MD: Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
S. Senan, MD, PhD: Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
M.A. Paul, MD, PhD: Department of Cardiothoracic Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
M. Dahele, MD, PhD: Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
C. Dickhoff, MD, PhD: Department of Cardiothoracic Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands; Corresponding author. Address for correspondence: C. Dickhoff, MD, PhD, Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV Amsterdam, The Netherlands.

Journal volume & issue: Vol. 4, no. 4
p. 100475

Abstract

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Introduction: Superior sulcus tumors (SSTs) are uncommon, and their anatomical location can make treatment challenging. We analyzed late outcomes of patients with SST treated with concurrent chemoradiotherapy followed by surgical resection (trimodality) in a single tertiary institution. Methods: Patients with non–small cell SSTs, who underwent trimodality therapy between 2002 and 2017, were selected from a prospective institutional surgical database. Patients were uniformly staged with 18F-fluorodeoxyglucose–positron emission tomography, computed tomography scan of the chest and upper abdomen, and brain imaging. Patients undergoing resection of the lung plus chest wall were grouped as limited SST and those needing extensive resections (e.g., including the vertebral body) as extended SST. Kaplan-Meier survival analysis was performed to determine difference in survival. Multivariate Cox regression was used to identify prognostic factors. Results: A total of 123 patients were identified with a median follow-up of 4.9 years (interquartile range: 1.6–8.9 y). The 90-day postoperative mortality and morbidity (Clavien-Dindo grades III–V) were 6.5% and 21.1%, respectively. Patients with a radical resection (R0: 92.7%) had better survival (p = 0.002), as did those who had major pathologic response (73%) (p = 0.001). Ten-year overall survival (OS) and disease-free survival were 48.1% and 42.6%, respectively. There were no differences in 90-day mortality (p = 0.31) and OS (p = 0.79) between extended SST and limited SST patients. Conclusions: In patients with SST, trimodality resulted in a 10-year estimated OS and disease-free survival of 48.1% and 42.6%, respectively, which were improved after radical resection (R0) and major pathologic response. Survival for limited and extended resections was comparable, and distant relapse was the main pattern of failure. Better systemic treatments are therefore needed.

Published in JTO Clinical and Research Reports

ISSN: 2666-3643 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jto-clinical-and-research-reports/

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