Search

Objectives: Superior sulcus tumour, which affects the lung's apex, is an uncommon subtype of non-small cell lung cancer (NSCLC). The current study examined the clinical characteristics and management of superior sulcus NSCLC patients in a high-volume referral oncological centre over 22 years. Methods: Retrospective review of 100 surgeries with curative intent for superior sulcus NSCLC over 22 years (July 1998 -- December 2020). The surgical approach was defined according to the lesion site and the anatomy of the thoracic inlet. Survival curves, including non-cancer-related deaths, were drawn using the Kaplan-Meier methods, and the log-rank test was used to evaluate differences in survival across groups of patients. Cox proportional hazards regression was used to assess the association between selected clinical and pathologic characteristics on OS. Results: 54 patients received induction treatments. The surgical approach was anterior thoracotomy in 53 patients, Paulson incision in 30, and a combined in 8. The median postoperative length of stay was 11 days (range: 5 - 27 days). Overall 90-day mortality was 6.93%. The median OS was 24.3 months. After a median follow-up of 3 years, 5-year and 10-year OS rates were 33.9% and 26.4%, respectively. A significantly lower 5-year OS was observed in patients with the nodal disease (46.6% in pN0 vs 13.2% in pN+; p = 0.024), without preoperative treatments (41.0% in patients without preoperative treatments versus 17.4%; p = 0.09) and anteriorly located tumour (anterior vs posterior: 17.4% vs 49.1%; p = 0.032). Cox proportional hazards regression showed better survival in the pT1 stage (HR = 4.6; 95% CI: 1.9 - 11.2; p = 0.00076) and in R0 (HR = 4.2; 95% CI: 1.4 - 12.5; p = 0.010). Conclusions: Superior sulcus tumours still represent a life-threatening condition that, while curable in a significant proportion of cases, requires complex procedures with high surgical risks and a multimodality treatment setting. An optimal surgical approach should be planned to maximise resection completeness and survival. Other factors affecting survival are related to tumour staging, emphasising the importance of a meticulous preoperative workup and candidate selection to identify those expected to benefit from a survival benefit. [ABSTRACT FROM AUTHOR]

ObjectivesSuperior sulcus tumour, which affects the lung’s apex, is an uncommon subtype of non-small cell lung cancer (NSCLC). The current study examined the clinical characteristics and management of superior sulcus NSCLC patients in a high-volume referral oncological centre over 22 years.MethodsRetrospective review of 100 surgeries with curative intent for superior sulcus NSCLC over 22 years (July 1998 – December 2020). The surgical approach was defined according to the lesion site and the anatomy of the thoracic inlet. Survival curves, including non-cancer-related deaths, were drawn using the Kaplan-Meier methods, and the log-rank test was used to evaluate differences in survival across groups of patients. Cox proportional hazards regression was used to assess the association between selected clinical and pathologic characteristics on OS.Results54 patients received induction treatments. The surgical approach was anterior thoracotomy in 53 patients, Paulson incision in 30, and a combined in 8. The median postoperative length of stay was 11 days (range: 5 – 27 days). Overall 90-day mortality was 6.93%. The median OS was 24.3 months. After a median follow-up of 3 years, 5-year and 10-year OS rates were 33.9% and 26.4%, respectively. A significantly lower 5-year OS was observed in patients with the nodal disease (46.6% in pN0 vs 13.2% in pN+; p = 0.024), without preoperative treatments (41.0% in patients without preoperative treatments versus 17.4%; p = 0.09) and anteriorly located tumour (anterior vs posterior: 17.4% vs 49.1%; p = 0.032). Cox proportional hazards regression showed better survival in the pT1 stage (HR = 4.6; 95% CI: 1.9 – 11.2; p = 0.00076) and in R0 (HR = 4.2; 95% CI: 1.4 – 12.5; p = 0.010).ConclusionsSuperior sulcus tumours still represent a life-threatening condition that, while curable in a significant proportion of cases, requires complex procedures with high surgical risks and a multimodality treatment setting. An optimal surgical approach should be planned to maximise resection completeness and survival. Other factors affecting survival are related to tumour staging, emphasising the importance of a meticulous preoperative workup and candidate selection to identify those expected to benefit from a survival benefit.

Objective: The impairment of arm functions can be observed after trimodality therapy for superior sulcus tumors due to several reasons, such as the tumor invasion of the brachial plexus and subclavian arteries, fibrosis secondary to radiotherapy, neuropathy secondary to chemotherapy, and morbidity caused by surgical resection. This study aimed to evaluate patients' arm functions and functional exercise capacities after Pancoast tumor surgery. Methods: The study included patients that underwent surgery for superior sulcus tumors in our clinic after neoadjuvant therapy between April 2017 and April 2022. The patients were evaluated in terms of age, gender, pathology, neoadjuvant treatment, resection, reconstruction material used, mean hospital stay, drain withdrawal time, amount of drainage, morbidity, mortality, arm functions, and functional exercise capacities. Results: Between the specified dates, 18 patients underwent surgery for Pancoast tumors in our clinic. All the patients were male. The mean age was calculated as 62.7±8.0 years. The operation was performed on the right side in 12 patients and the left in six. The most frequently performed procedure was upper lobectomy, while bilobectomy was performed in one patient. Prolonged air leak was the most common morbidity (n=5, 27.7%), but no surgical mortality was observed. Non-surgical upper extremity ranges of motion were complete, and joint limitations were found in the extremity on the surgical side at a rate varying between 28 and 78%, depending on shoulder motion. The patients' mean postoperative six-minute walk test distance was recorded as 536.6±85.7 meters. Conclusion: Preserving the arm and shoulder functions of these patients has gained more importance since it increases the quality of life of these patients. Unfortunately, this study showed that the patients' arm functions were restricted, and functional exercise capacities decreased after Pancoast tumor surgery. Therefore, we recommend that intensive physiotherapy programs be planned for these patients starting from the pre-operative period. [ABSTRACT FROM AUTHOR]

Resumen: Se presenta el caso de un paciente con dolor en el hemitórax derecho de larga duración manejado como síndrome de manguito rotador, al que se le toma radiografía de tórax con reporte de imagen mal definida en hemitórax superior derecho; posteriormente, se toma tomografía de tórax con masa de apariencia neoplásica descrita en el lóbulo superior derecho que luego confirma sus características malignas con diagnóstico histológico. Abstract: We present the case of a patient with long-term right hemithorax pain managed as rotator cuff syndrome who underwent a chest X-ray with a report of an ill-defined image in the right upper hemithorax and later a chest CT scan with a mass of neoplastic appearance described in the right upper lobe that was later confirmed as malignant with histological diagnosis.

A primary pulmonary angiosarcoma is an extremely rare entity with fewer than 30 cases reported in the literature. We found no reports of primary pulmonary angiosarcoma presenting as a Pancoast tumor. We describe a case of pulmonary angiosarcoma located in the right superior sulcus that was treated by surgery. [ABSTRACT FROM AUTHOR]

Copyright of Agri: Journal of the Turkish Society of Algology / Türk Algoloji (Ağrı) Derneği'nin Yayın Organıdır is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Superior sulcus tumors are a challenging subset of non–small cell lung carcinomas invading the thoracic inlet. In this study, we determined whether the location of the tumor along the first rib had an influence on survival. We performed a review of 92 consecutive patients undergoing surgery for non–small cell lung carcinomas invading the thoracic inlet between January 1996 and June 2021. Tumor location was categorized into anterior and posterior based on predefined zones. In total, 21 tumors were located anteriorly (23%) and 71 posteriorly (77%). The rate of R0 resection (81% vs 87%; P =.4) and pathological complete response to induction therapy (33% vs 37%; P =.8) were similar between locations. After a median follow-up of 5.8 years (range, 0.8-24 years), 49 patients died for an overall survival of 48% (95% CI, 38%-59%) at 5 years. The 5-year survival was favorably influenced by R0 (vs R1) resection (51% vs 29%; P =.02), pathological complete response (vs no pathological complete response) (69% vs 31%; P =.03), posterior (vs anterior) location (56% vs 22%; P =.01), and ≤60 (vs >60) years of age (61% vs 37%; P =.007). Compared with posterior tumors, anterior tumors were associated with higher risk of systemic recurrence and significantly greater survival benefit from pathological complete response. Anterior tumors remained an independent predictor of worse survival in multivariate analysis (hazard ratio, 2.3; 95% CI, 1.2-4.5; P =.01). The anatomical location of the tumor affects survival after resection of non–small cell lung carcinomas invading the thoracic inlet. Anterior tumors have greater propensity to metastasize and may derive greater benefit from optimal systemic therapy than posterior tumors. Graphical abstract summarizing methods and main findings of the study. [Display omitted] [ABSTRACT FROM AUTHOR]

Radiation-induced lung diseases are common after radiotherapy of the chest wall or intrathoracic organs. The damage of radiations is ground-glass opacity, consolidation, fibrosis, traction bronchiectasis, and volume loss. Development of pleural fluid or a new mass is rarely seen. A solid lesion was detected in the computed thoracic tomography of 53 year-old male patient. The lesion was at the apex of the right lung, 66x61 mm in size and invading the trachea, esophagus and right subclavian artery. Weekly chemotherapy and radiotherapy were applied concurrently, and the tumor was quickly disappeared, leaving its place to an unexpected cavitary lesion. The case has been reported because of its rarity in the literature. [ABSTRACT FROM AUTHOR]

The objective was to define the relationship between histopathological changes after pre-operative chemo-radiotherapy (CRT) and clinical outcome following tri-modality therapy in patients with superior sulcus tumours. A retrospective analysis of tumour material was performed in a series of 46 patients who received tri-modality therapy between 1997 and 2007. Median follow-up was 34 months (5-154). Pathological complete response (pCR) was present in 20/46 tumours (43 %). The most common RECIST score after CRT in patients with pCR was a partial response (PR; 10/17, three unknown), whereas in patients without a pCR, stable disease was the most common (22/26) ( p = 0.002). In 26 specimens with residual tumour, this was mainly located in the periphery of the lesion rather than the centre (Spearman's correlation = 0.67, p < 0.001). Prognosis was significantly better after a pCR compared to residual tumour (70 % 5-year overall survival vs. 20 %; p = 0.001) and in patients with fewer than 10 % vital tumour cells as compared to those with >10 % (65 % 5-year overall survival vs. 18 %; p < 0.001). A low mitotic count was associated with a longer disease-free survival ( p = 0.02). Complete pathological response and the presence of fewer than 10 % vital tumour cells after pre-operative CRT are both associated with a more favourable prognosis. A modification of the pathological staging system after radiotherapy, incorporating the percentage of vital tumour cells, is proposed. [ABSTRACT FROM AUTHOR]

Abstract: Aim: We studied the clinical outcomes of a trimodality protocol used for the treatment of superior sulcus tumours (SST) in a tertiary referral centre. Methods: The details of all patients who underwent treatment for a SST between January 2003 and December 2009 were retrospectively analysed. Following pre-treatment staging, all patients underwent concurrent chemoradiotherapy with cisplatin/etoposide, followed by surgery. Outcomes studied were treatment-related complications, pathological response rates, recurrence rates and survival. Results: Fifty-four patients were treated by chemotherapy (cisplatin/etoposide) and concurrent radiotherapy (46–66 Gy) followed by surgical resection. Minimum follow-up was 23 months. No 30-day mortality was observed. A complete (R0) resection was performed in 44 out of 54 patients. None had an R2 resection. Two-year survival was 50% (95%CI: 36.7–63.3). Patients who achieved a pathological complete response (n = 16) had a 2-year survival of 81% (95%CI: 62.1–100.0) versus a 37% 2-year survival (95%CI: 21.5–52.1) in patients with remaining vital tumour in their resection specimens (n = 38; P = 0.003). Five patients developed a local recurrence, and 23 patients a distant metastasis, mainly to the brain (n = 15). Two patients died from causes unrelated to cancer. Conclusions: Trimodality treatment of SST in accordance to our protocol achieved results comparable to previous reports. Pathological response rates to induction were an important prognostic factor, and distant metastasis remains a major problem. [Copyright &y& Elsevier]

Abstract: Objective: The role of induction therapy for non-small cell lung cancer (NSCLC) invading the thoracic inlet is unclear. We reviewed our experience with induction chemoradiation followed by surgical resection for NSCLC invading the thoracic inlet. Methods: We performed a retrospective review of 44 consecutive patients with NSCLC invading the thoracic inlet, treated with induction chemoradiation (two cycles of cisplatin and etoposide concurrently with 45Gy of radiation) followed by surgical resection between 1996 and 2007. Results: All patients underwent chest wall resection (1–5 ribs, mean 3) with resection of the first rib through an anterior (n =15), a posterior (n =18), or a combined approach (n =11). Lobectomy was performed in 40 cases (90%), pneumonectomy in two (5%), and wedge resection in two (5%). Resection of subclavian vessels or portions of vertebrae was performed in five (11%) and 15 (34%) patients, respectively. Hospital mortality was 5% (n =2). R0-resection was achieved in 39 patients (89%). On pathologic examination, 13 patients (30%) showed complete response (pCR) to induction therapy, and 15 (34%) showed minimal microscopic residual disease (90–99% tumor necrosis). The median follow-up was 2 years (range, 2 month–10 years) with an overall cumulative 5-year survival of 59%. Sixteen patients (36%) developed recurrence, which was local in five cases and distant in 11 patients. The 5-year survival in patients with pCR was 90%; 69% in those with minimal residual disease, and 12% in patients with no relevant response (p =0.0005). Conclusions: Resection of NSCLC invading the thoracic inlet can be performed safely after induction chemoradiation therapy. The response rate after induction therapy is a strong predictor of survival. [Copyright &y& Elsevier]

Summary: Multimodal management of lung cancer extending to chest wall and type of surgical procedure to be performed are still debated. The aim of this retrospective analysis was to analyze the predictive factors of long-term survival after surgery, focusing on depth of infiltration, type of surgical intervention and possible role of preoperative therapies, comparing survival of these patients with that of a group of patients affected by a Pancoast tumour and surgical treated in the same period. Materials and methods: We reviewed records of 83 consecutive patients with NSCLC in stage T3 (owing to direct extension to chest wall), who underwent surgical resection in our Thoracic Surgery Unit between January 1994 and December 2003. Patients were classified in two groups: pancoast tumours (PT) or chest wall extending tumours (CW): survival and prognostic factors of each category were analyzed. Results: In the CW group we had 68 patients: 45 were in stage IIB (pT3N0), 23 in stage IIIA (pT3-N1-2). Histology revealed adenocarcinoma in 23 cases, squamous cell carcinoma in 34, large cells anaplastic carcinoma in 8, adenosquamous carcinoma in 3. An involvement of chest wall tissues beyond the endothoracic fascia was found in 21 patients, while in the remaining 47 the invasion of chest wall tissues was confined to the parietal pleura. An extrapleural dissection was performed in 48 patients while combined pulmonary and chest wall en bloc resection was required in 20 patients. Resection was incomplete in three cases. In the PT group we had 15 patients: 11 were in stage IIB and 4 in stage IIIA. Histological type was adenocarcinoma in 10 cases, squamous cell carcinoma in 4 and adenosquamous carcinoma in 1. A univariate analysis performed in the CW group showed that survival was significantly affected by nodal status, stage, extension of chest wall invasion, type of lung resection and residual disease. In a multivariate analysis we found that nodal status, completeness of resection and extension of chest wall involvement maintained a significant prognostic value. There was no difference between the survival curve of CW and PT group: considering the two subset of CW patients, on the basis of depth of infiltration, survival of PT patients was significantly better than that of CW patients with involvement of muscular tissues and ribs (p =0.02). Conclusion: Nodal status, radical resection and depth of chest wall infiltration are the main predictive factors affecting long-term survival, while surgical procedure does not impact on it if margins of resection are free from disease. The better survival observed in PT patients let us to hypothesize that an induction chemo-radiation therapy, as routinely administered to PT patients, could have a potential benefit in survival of patients with CW tumour extending beyond parietal pleura. [Copyright &y& Elsevier]

Abstract: Background: Horner syndrome is caused by a lesion affecting the sympathetic innervation of the lids and pupil. The most common factor producing the preganglionic Horner''s syndrome is malignant tumors. Methods: We report here a case of Horner syndrome in young women with the history of breast cancer. The patient underwent extensive neurological examinations, including MRI of head and neck, together with chest radiograph and CT thorax scan. Results: Present radiographic methods revealed one-sided metastatic pleural effusion as a cause of sympathetic lesion. Conclusion: Metastatic breast disease usually affects lungs, bone, liver, adrenals and skin, and it is highly unusual for ocular involvement to be the first sign of its existence. This report presents a rare case of pleural metastatic breast cancer causing Horner''s syndrome/Pancoast syndrome without lung involvement. [Copyright &y& Elsevier]