En Bloc Resection of Pulmonary Sulcus Non-small Cell Lung Cancer Invading the Spine: A Systematic Literature Review and Pooled Data Analysis. Issue 1 (July 2015)

• Record Type: Journal Article
• Authors: Collaud, Stéphane; Fadel, Elie; Schirren, Joachim; Yokomise, Hiroyasu; Bolukbas, Servet; Dartevelle, Philippe; Keshavjee, Shaf; Waddell, Thomas K.; de Perrot, Marc
• Is Part Of: Annals of surgery. Volume 262:Issue 1(2015:Jul.)
• Publication Date: 2015-07
• Subjects: en bloc -- non-small cell lung cancer -- spine -- surgery -- vertebrectomy; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000000797
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To conduct a systematic literature review and pooled data analysis focusing on outcome after en bloc resection of pulmonary sulcus non-small cell lung cancer (NSCLC) invading the spine. Background: This rare type of NSCLC has historically been considered unresectable and fatal. Nowadays, carefully selected patients can be cured when treated surgically within a multimodality concept. Methods: The MEDLINE database was searched using the PubMed engine to retrieve relevant articles. Corresponding authors were contacted, and shared data were pooled and analyzed. Results: Search strategy yielded 134 articles. Six were relevant and nonduplicative. Four authors shared updated data on 135 patients. All tumors were resected en bloc with the lung, chest wall, and spine. Induction was administered in 85 patients (63%) and consisted of chemotherapy (n = 32), radiation (n = 1), or concurrent chemoradiation (n = 52). Spine resections included total (n = 23), hemi- (n = 94), and partial (n = 18) vertebrectomies. R0 resection was achieved in 120 patients (89%). Adjuvant treatment was administered to 70 patients (52%) and included chemotherapy (n = 16), radiotherapy (n = 22), or chemoradiation (n = 32). Overall, 3-, 5-, and 10-year survival rates were 57%, 43%, and 27%, respectively. Univariate analysis identified the type of resection (R0 vs R1/R2, P < 0.001) as significant prognostic factor among the variables tested (age, histology, pT/pN, type of induction/adjuvant treatment, type of lung/spine resection). Conclusions: Multimodality therapy including en bloc resection for pulmonary sulcus NSCLC invading the spine provides excellent long-term survival in selected patients. This result establishes a benchmark against which the effects of new treatments can be compared in the future. Abstract : Multicenter pooled data analysis including 135 patients after en bloc resection of a rare and historically unresectable lung cancer showed an excellent 5-year survival rate of 43%. These results establish a benchmark against which the effects of new treatments can be compared in the future.