P2.17-16 Radical en Bloc Resection for Lung Cancer Invading the Spine

Abstract

About 30% of patients with non-small cell lung cancer(NSCLC) have locally advanced cancer at the time of presentation. The best local control for resectable tumors is obviously achieved by surgical intervention, provided the resection is complete and respectful of oncologic principles.However,locally advanced NSCLC with vertebral invasion have been considered a contraindication to surgical resection for a long time and thus associated with a poor prognosis. In the present study, we review 11 cases in our 16-year experience with en bloc partial and hemi vertebrectomy for lung cancer invading the spine and report outcome and survival. Eleven patients with lung cancers involving the spine who underwent en bloc resection. Ten patients underwent radiation therapy(40Gy, in daily fractions of 1.8 Gy, 5 times per week). Preoperative chemotherapy regimens were as follows. Four patients received 2 cycles of cisplatin(80mg/m2 on day1) plus UFT(400-600mg/m2 daily for 14 days), three patients received 2 cycles of cisplatin(80mg/m2 on day1) plus S-1(60-120mg/m2 daily for 14 days), three patients received 2 cycles of carboplatin(AUC5-6) plus paclitaxel(200mg/m2 on day1), one patient with interstitial pneuminitis received no preoperative chemoradiotherapy.The criteria for resection were(1) a histologic diagnosis of NSCLC; (2) a tumor fixed to the vertebral column;(3) absence of mediastinal nodal involvement; and (4) no distant metastasis. Lobectomy was performed in 11 patients. Hemivertebrectomy was performed in 5 patients, and partial vertebrectomy was performed in 6 patients. The number of resected vertebral bodies was 2 or 3 (2,n=4; 3,n=7). Combined resection of the spine and descending aorta was performed in two patients. There was no immediate postoperative mortality. Morbidity was observed in 3 patients, including 1 (27%) complications related to the spinal surgery. The median hospital stay was 30 days. Five patients were alive after a mean follow-up of 112 months (range, 89-132 months). The 1- and 5-year survivals are 64% and 45%, respectively. Two local recurrences were observed.Tumor stage was IIIB in 1 patient, IIIA in 10patients.Surgical nodal status was N0 in 10 patients, N2 in 1 patient. Complete macroscopic and microscopic resection was achieved in 9 (82%) patients. Our results suggest that en bloc vertebrectomy for non–small cell lung cancers attached to the spine may be performed with low morbidity, and long-term disease-free survival can be achieved even in patients with T4 invasion of the vertebral body. En block vertebral resection with preoperative chemoradiotherapy is a treatment option for highly selected patients with NSCLC invading the spine.