P40.11 Trimodality Therapy Protocol in 144 Superior Sulcus Patients: Good Results Even for Extended Resections and Indications

Abstract

To define whether our extended indications for resection were justified, we assessed the results of a new protocol on staging and resection of sulcus superior tumors, treated in the years 2003 – 2017. All patients were uniformly staged using PET scanning and all received trimodality therapy. Because SST are seen as “local growers” with low metastatic potential, inclusion criteria were liberal, including vertebral involvement, clinical N2 disease and oligomestatic disease. The only contra-indication for resection, progression on induction treatment, did not occur. Our prospective database revealed 144 SST patients who were uniformly staged (with CT and PET scan) and treated (Chemo-radiotherapy and Surgery). They were divided in two groups: A) Standard cases, involvement of lung & chestwall only. B) Complex cases, with either vertebral invasion (14), encasement subclavian artery (5), involvement sternum (2), positive mediastinal nodal station (7), , supraclavicular or axillary lymphnodes (2) or (treated) oligometastasis (9) All patients also underwent mediastinal lymphnode dissection, with axillairy or Supraclavicular lymphnode dissection if needed Follow-up was complete (3 - 17 years) with no patient lost to follow-up. Clinical endpoint was overall survival. Data: Numbers: Group A / B: 105 / 39 . Gender: M / F : 92 / 52 Age: 32 – 77 (med 57 yrs) Side: Left / Right: 39 / 105! Incision: Shaw/Paulson 127; Hemiclamshell 15; Both: 2 Resection: Lung: Lobectomy 134; Segmentectomy 1; Wedgeresection: 9 Vertebra (1-3): 4 Hemivertebra: 4 Vertebral wedge: 5 Pedicle 1 Subclavian artery: 5 (Anastomosis: 3 Graft: 2) Chest wall: No ribs: 5 1 rib: 6 2 ribs: 20 3 ribs: 45 4 ribs: 58 5 ribs: 10 Sternum (partial): 2 Clavicle: 1 Pathology: R0 resection: 123 R1 resection: 21 (14.5%) R2 resection: 0 Survival: Group A: 5-yr survival 67% 10 yr survival 61,7% Group B: 5-yr survival 41.8% 10-yr survival 41.8% Mortality: In hospital mortality: 2 Ninety-days mortality: 7 Complete staging, including PET, and trimodality therapy, give adequate results in SST patients, even in a group that is not always considered for resection (Group B). But more research on subcategories in this last group is wanted. . We have no explanation for the Left - Right distribution, but it is in according with our national database. The role of immunotherapy in the inductiontreatment is presently investigated