O9. Results of multimodality therapy including radical resections for Pancoast tumors: a retrospective study in high-volume center

Background: Pancoast tumors are preferably treated with induction chemoradiotherapy followed by surgery. However, after induction therapy, surgery remains complex and extended procedures with resection and reconstruction of vessels and spine might be required. This study aims to evaluate the efficacy and safety of multimodality therapy for Pancoast tumors especially from the surgical point of view.

Methods: A total of 67 patients with Pancoast tumors treated surgically in our center from 1998 to 2014 were included. Clinical data, imaging and pathology reports were retrospectively reviewed. Survival was analysed using the Kaplan-Meier method. Our preferred induction treatment regimen consisted of conventional radiation with concurrent platinum-doublet chemotherapy. Our surgical policy was to achieve complete resection of the tumor with extended procedures.

Results: Patients background was as follows: mean age was 57 (31 to 84); gender: 48 male/20 female; ECOG status: 0 for 55, 1 for 7, 2 for 5; Histology: adenocarcinoma in 32, squamous cell carcinoma in 28 and others in seven patients. As an induction therapy, 46 (69%) underwent chemoradiotherapy, 13 (19%) chemotherapy, and 8 (12%) without any therapy. The surgical approach consisted of 30 (45%) posterolateral incisions including Paulson, 16 (24%) anterolateral incisions, 16 (24%) hemiclamshell incisions with/without clavicular incision, and 5 (7%) other incisions. The extent of lung resection consisted of 53 (79%) lobectomies, 9 (13%) pneumonectomies, and 5 (8%) sublobar resections. A total of 26 (39%) extended procedures excluding chest wall resection were performed (14 with vascular reconstruction, 10 with spine resection, two with both); 59 (88%) complete resections (R0) and eight resections with microscopic positive margin (R1) were performed. The 30-day mortality was 4.5% (three cases). Overall 3-year survival was 45.6%. No influence on survival was observed with regard to the extended surgical procedure, surgical approach, and the extent of lung resection. Patients with pathological N positive, incomplete resection, and without induction therapy had worse prognosis.

Conclusions: Our intensive multimodality treatment with radical resection for Pancoast tumors was feasible and improved local resectability rates. The tumor involvement of vessels and spine was not contraindication of surgery after induction therapy. The newest follow-up data will be available at the time of presentation.

Keywords: Non-small cell lung cancer (NSCLC); pancoast tumor; multimodality therapy; surgery