En bloc resection for bronchogenic carcinoma with chest wall invasion Value of pre-operative radiotherapy

Abstract

A small number of patients with lung cancer will have a tumour invading the chest wall. Pre-operative radiotherapy and surgical resection provide the best results in patients with Pancoast's tumours, although chest wall invasion is often considered to indicate incurability. We reviewed the outcome in 46 patients with bronchogenic carcinoma and non-apical chest wall invasion and have tried to clarify the role of adjuvant pre-operative radiotherapy. All patients underwent combined chest wall and lung resection for treatment of lung cancer which had extended grossly and microscopically into the chest wall. In this retrospective study, we identified two groups of patients, those (n = 21) who received and those (n = 25) who did not receive pre-operative radiotherapy. Curative resection had been possible in 80% of the patients. There was one early post-operative death, due to pneumonia. The survival in all 46 patients is 32% at 5 years. In the most favourable cases, those without nodal involvement and who received pre-operative radiotherapy, the 5-year survival is 56%. In our series, there was a notable difference in 5-year survival between irradiated and non-irradiated patients at every stage of disease.

Surgical Treatment of Chest Wall Tumors

“…Various experiences using the transcervical [70,71] or supraclavicular [72] approach for apical tumor diagnosis and treatment, the use of scalenectomy and first rib resection in the thoracic outlet syndrome [73], and the supraclavicular approach with clavicle removal to obtain adequate subclavian artery control [74,75] led Dartevelle and colleagues to practice the anterior transcervical thoracic approach (ATA) with removal of the internal half of the clavicle for radical resection of lung tumors invading the thoracic inlet. The main advantage of [63] this technique is complete exposure of the thoracic inlet and consequent radical resection, which results in good long-term survival [65].…”

The impact on quality of life after en‐bloc resection for non‐small‐cell lung cancer involving the chest wall

“…The most striking result was that the extension of the chest wall removal and preoperative FEV 1 were, by far, the most important factors affecting postoperative QOL‐physical domains changes. This finding could raise questions as to whether oncologic or surgical strategies aimed at reducing the extent of surgical traumatism, such as induction therapy 11,12,13 or videothoracoscopic surgery, 14 should be beneficial in preserving a patient's overall health. Unfortunately, data on this topic is limited to single small series or case reports, and is thus at this time, insufficient to provide reliable answers to this question.…”

Surgical treatment of 125 patients with non-small cell lung cancer and chest wall involvement

“…The tumour was opened peroperatively in seven patients and none of these patients lived more than 16 months. The difference in mean five year survival between patients with and without intrapleural tumour spill was significant (0% and 32%, respectively).…”

“…The tumour was opened peroperatively in seven of 121 hospital survivors, all of whom died within 16 months because of distant metastases (n = 4), respiratory failure (n = 2), and local recurrence (n = 1). Patients without intrapleural tumour spill had a mean five year survival of 32% (p < 0.0001).…”