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Induction chemoradiotherapy facilitates radical resection of T4 non–small cell lung cancer invading the spine
- Source :
- The Journal of Thoracic and Cardiovascular Surgery. 137:441-447.e1
- Publication Year :
- 2009
- Publisher :
- Elsevier BV, 2009.
-
Abstract
- ObjectiveWe evaluated the outcome, long-term results, and factors affecting outcome of induction chemoradiotherapy followed by surgical resection for T4 non–small cell lung cancer invading the spine.MethodsRetrospective analysis of 23 consecutive patients undergoing radical vertebral resection for non–small cell lung cancer invading the spine between 1996 and 2007 was performed. In most cases, induction chemoradiotherapy consisted of cisplatin and etoposide followed by 45 Gy of radiation. Surgical resection with vertebrectomy was performed en bloc in either a 1-stage or 2-stage operation. Survival was estimated by Kaplan–Meier techniques. The log–rank comparison was used to compare groups.ResultsThere were 13 men and 10 women with a median age of 61 years (range 32–75). Twenty-two patients had induction chemoradiotherapy and 1 had induction chemotherapy alone. Vertebral resections included 6 total vertebrectomies, 15 hemivertebrectomies, and 2 partial vertebrectomies. Complete resection was achieved in 19 (83%) patients. Two (8.7%) patients died postoperatively. Pathologic complete response was observed in 10 (43%) patients. The 3-year survival was 58% (median follow-up, 34 months). Patients who achieved pathologic complete response or near complete response (viable tumor cells < 1%) demonstrated significantly better survival than those who did not (3-year survival, 92% vs 20%; P = .006).ConclusionHighly selected patients with lung cancer invading the spine can potentially be cured with induction chemoradiation therapy followed by radical en bloc resection of the tumor. A multidisciplinary operative strategy allows a significant chance of achieving complete resection in patients requiring multilevel hemivertebrectomy or total vertebrectomy and an appreciable cure rate.
- Subjects :
- Adult
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Lung Neoplasms
medicine.medical_treatment
Antineoplastic Agents
Carcinoma, Non-Small-Cell Lung
Carcinoma
Humans
Medicine
Neoplasm Invasiveness
Lung cancer
Etoposide
Aged
Retrospective Studies
Spinal Neoplasms
business.industry
Cancer
Induction chemotherapy
Radiotherapy Dosage
Middle Aged
medicine.disease
Neoadjuvant Therapy
Surgery
Radiography
Radiation therapy
Chemotherapy, Adjuvant
Vertebrectomy
Female
Radiotherapy, Adjuvant
Cisplatin
Cardiology and Cardiovascular Medicine
business
Chemoradiotherapy
medicine.drug
Subjects
Details
- ISSN :
- 00225223
- Volume :
- 137
- Database :
- OpenAIRE
- Journal :
- The Journal of Thoracic and Cardiovascular Surgery
- Accession number :
- edsair.doi.dedup.....fb466b50932831ca6b3c034a77b6d2b8