P3.17-05 Multimodality Treatment for Superior Sulcus Non-Small-Cell Lung Carcinomas

Abstract

Superior sulcus tumor (SST), to this day remain a complex and challenging condition. The SWOG9416 (Intergroup0160) and the JCOG9806 trial culminated in showing that trimodality therapy with chemotherapy, radiation and surgery provided optimal outcomes. Since that time, the treatment of SST is evolving and preoperative chemoradiotherapy is increasingly used. Dramatic survival benefit, however, has not been reported recently. We reviewed our experience with patients undergoing thoracotomy for lung cancers invading the superior sulcus. Analysis of all consecutive patients in our retrospective database, who had potentially resectable SST (cT3-T4) and were treated with multimodality treatment. In the induction chemoradiotherapy cases, surgery with attempted complete resection was performed in patients showing response or stable disease on computed tomography after multidisciplinary discussion. From 2009 to 2017, 10 patients, included 9(90%) men and 1(10%) women with a median age of 63 years, underwent thoracotomy. Pathology revealed Ad.5(50%), Sq.4(40%) and La.1(10%) patient(s). The majority (80%) underwent preoperative therapy; chemoradiation in 7(70%) (i.e. CDDP+S-1+concurrent RT 66Gy in 5, CDDP+VNR+concurrent RT 45Gy in 2) and radiation alone in 1(10%) patient(s). Two cases(20%) did not have any preoperative treatment although they received adjuvant chemotherapy using platinum doublet (CDDP+VNR in 1(10%) and CDDP+DTX in 1(10%) patient). Clinical stages were IIB(T3N0) in 5(50%), IIIA(T3N1 or T4N0) in 4(40%), and IIIB(T3N2) in 1(10%) patient(s). Of 8 patients with induction therapy, down stage was obtained in 2(20%); c-T3N1 to yc-T3N0 in 1 and c-T3N2 to yc-T3N0 in 1 patient. Complete resection was achieved in all patients (100%) and pathologic therapeutic response was Ef3,Ef2,Ef1b in 4,3,1 patient(s), respectively. Operative mortality was 0%. With a mean observation time of 20 M, 8(80%) were alive and 2(20%) were dead. Of these one died from cancer relapse in small intestine and the other from diabetes mellitus. Actuarial 5-year overall survival (OS) was 43.8% and cancer specific survival (CSS) was 87.5%. In patients with induction chemoradiotherapy, 5-year OS and CSS were both 83.3%. In selected patients with SST, multimodrity treatment was feasible with acceptable morbidity and mortality. The complete resectability was high, and long-term survival was promising especially in whom underwent induction chemoradiotherapy followed by surgery. Our results may provide a benchmark against which new treatment regimens can be evaluated. The potential benefit of preoperative chemoradiotherapy must be assessed by whether it leads to higher rates of complete resection and a lower risk of local relapse. Further evaluation and long term follow up would be necessary.