Comparison of different treatment modalities of NSCLC with chest wall infiltration - a retrospective monocentric observational Study

Abstract

Introduction: Tumours with chest wall invasion form a distinct sub-entity in the heterogeneuous group of locally advanced NSCLC. Despite some available evidence, the best sequence of recommended multimodal therapeutic approaches continues to be subjet of clinical research in view of the improved possibilities of radiation and systemic therapies. Material and Methods: In our mono-centric, retrospective observational study, all NSCLC pts. with chest wall infiltration or pancoast tumour (N0-2, M0), diagnosed between 01/2009 and 12/2013, were analyzed using our hospital information system and cancer registry. Clinical, radiological, tumour biological, therapeutic and follow-up data were recorded for this study. Results: In the 5 year period, 81 pts. were detected with chest wall invasion and pancoast in 72 and 9 pts., respectively. Mean age was 66.4 yrs. (45.7-84,7 yrs.). Histology was dominated by squamous cell (53.1%) and adenocarcinoma (32.1%), followed by large cell carc. (6.2%). Theraputic regimes were: 1. neoadjuvant Tx.+resection (22 pts., 27.2%), 2. planned neoadj. Tx. with change to definite chemoradiotherapy due to progression (13. pts., 16.0%), 3. resection+adjuv. Tx (25 pts., 30.8%), 4. primary definite chemoradiotherapy (19 pts., 23.5%) and 5. best-supportive care only (2 pts., 2.5%). Best median 5-year overall survival was seen in the cohort with neoadjuvant Tx.+resection (11.6-153.4 months) (fig. 1). Discussion: Our retrospective data underline the prognostic significance of neoadjuvant tx followed by resection as treatment regimen in NSCLC with chest wall invasion. However, patient and tumour characteristics havinfluence the choice of treatment.