Chest Wall Invasion Research Articles

Functional Chest Wall Reconstruction With a Biomechanical Three-Dimensionally Printed Implant

Chest wall resection and reconstruction for neoplastic diseases has unique oncologic, structural, and functional challenges. In a young and fit patient with a mediastinal mass and extensive anterior chest wall invasion, purely structural solutions were deemed insufficient. We hereby present a novel three-dimensionally printed patient-specific titanium implant of sternum and ribs. This osteointegrable implant was designed with biomechanical capabilities using a unique "Greek wave" folding pattern. Postoperative dynamic computed tomography showed that the implant allowed for controlled flexing during the respiratory cycle. Three-dimensional printing with biocompatible materials could enable a new generation of chest wall implants strongly focused on functional reconstruction.

Chest wall resection for non-small cell lung cancer: A case-matched study of postoperative pulmonary function and quality of life

BackgroundTo assess the pulmonary function and quality of life (QOL) after chest wall resection for non-small cell lung cancer. Material and methodsOne hundred and thirty-five patients (cases) who underwent pulmonary resection with chest wall removal were identified from January 1997 to December 2015. Propensity score matching (1:3) was applied to balance known confounders for pulmonary function and QOL between the cases and the control group who underwent pulmonary resection without chest wall invasion. Matched analyses were performed to compare perioperative mortality and morbidity, postoperative pulmonary function, overall QOL, and specific symptoms. ResultsPerioperative mortality and morbidity did not differ significantly between cases and controls, but the hospital stay was longer in cases than in controls (mean, 12.8 vs 8.9days; p<0.001), The decline of postoperative pulmonary forced vital capacity (FVC) and the percentage of predicted FVC (FVC%) was more obvious in cases than in controls at 6 months and 2 years after surgery, but there was no obvious decline in the forced expiratory volume in one second (FEV1), the percentage of predicted FEV1 (FEV1%), the diffusion capacity of the lung for carbon monoxide (DLCO) and the percentage of predicted DLCO (DLCO%) in cases compared with controls. No significant difference was observed between the two groups in scores for overall QOL, pain, fatigue, cough, dyspnea, appetite, hemoptysis, lung cancer symptoms, and normal activities. ConclusionsWhen chest wall resection is inevitable, it does not worse the QOL and pulmonary function of patients who underwent pulmonary resection with chest wall removal obviously compared with patients underwent pulmonary resection without chest wall invasion.

Erratum to: Rib resection using a pneumatic high‑speed power drill system for lung cancer with chest wall invasion: our clinical experience

Erratum to: Rib resection using a pneumatic high‑speed power drill system for lung cancer with chest wall invasion: our clinical experience

SC20.02 What Have We Achieved? Should It Be Performed for Stages Higher Than Stage I Disease?

Since the introduction of the videothoracoscopic anatomical lung resections in the early 90-ties both indications and contraindications for this type of approach have changed dramatically.1,2 There is common agreement that the oncological principles during surgery for lung cancer have to be the same regardless the type of approach: standard, minimally invasive (MIS – VATS multi portal or uniportal, intubated or non-intubated) or robotic. It regards predominantly requirements such like careful and atraumatic dissection, sufficient free-of-neoplasm margins and proper lymphadenectomy (standard or extended). Keeping it in mind we have to admit that stage I NSCLC seems “ideal” indication for MIS, particularly for less experienced surgeons. This type of surgery (MIS for stage I) is widely accepted and performed worldwide in thousands of cases. However, many experienced centers and surgeons have moved the borders forward treating more advanced cases by MIS with acceptable results regarding complications, mortality, conversion rate or quality of lymphadenectomy. Gonzalez-Rivas presented the series of 43 advanced patients (tumors bigger > 5cm, T3 or T4, treated by neoadjuvant chemo- or radiotherapy) who were treated by uniportal VATS with good results comparable with earlier stages.3 Authors stated that, “Skilled VATS surgeons can perform 90% or more of their lobectomies thoracoscopically, reserving thoracotomy only for huge tumors or complex bronchovascular reconstructions.” Large multicenter series of more than 400 advanced cases treated by VATS approach compared with propensity score matched open thoracotomy group with no differences in overall survival was published by Cao et al.4 According to the VATS Consensus Statement (among 50 international experts to establish a standardized practice of VATS lobectomy after 20 years of clinical experience) eligibility for VATS lobectomy should include tumors <7cm and N0 or N1 status. Chest wall involvement was considered contraindication while centrality of tumor was considered a relative contraindication when invading hilar structures.5 This important statement is widely accepted however some surgeons consider it too restrictive regarding chest wall invasion. Currently there is a relatively small (but growing) group of thoracic surgeons who are performing double-sleeve (pulmonary vessels and bronchi) and carinal resections by MIS – extremely complex procedures even in open surgery.6 It requires modern instruments, sutures and definitely is not a procedure for beginners. Published series are small and overall experience is limited but this initial efforts are good example of the continuous drive of thoracic surgeons community to move indications for MIS further and further. Advanced NSCLC cases started to be treated by MIS just few years ago and there are no prospective randomized studies available in medical literature therefore we cannot definitively compare and assess the long term results but keeping in mind that the main oncological principles should be preserved and remain the same in every type of surgical approach we can expect comparable and similar results as it was reported in currently published papers. We all know that generally speaking the future is unpredictable but inevitable from the other side. Considering MIS in advanced NSCLC cases we can state with just minimal exaggeration that the future is now. 1. Roviaro G, Varoli F, Vergani C et al.: Long term survival after videothoracoscopic lobectomy for stage I lung cancer. Chest 2004;126:725-732 2. Hanna JM, Berry MF, D′Amico TA: Contraindications of videoassisted thracoscopic surgical lobectomy and determinants of conversion to open. J Thorac Dis 2013;5:182-189 3. Gonzalez-Rivas D, Fieira E, Delgado M et al.: Is uniportal thoracoscopic surgery a feasible approach for advanced stages of NSCLC? J Thorac Dis 2014;6:641-648 4. Cao C, Zhu ZH, Yan TD et al.: Videoassisted thoracic surgery versus open thoracotomy for NSCLC: a propensity score analysis based on a multi-institutional registry. Eur J Cardiothorac Surg 2013;44:849-54 5. Yan TD, Cao C, D′Amico TA et al.: Videoassisted thoracoscopic surgery lobectomy at 20 years: a consensus statement. Eur J Cardiothorac Surg 2014;45:633-639 6. Lyscov A, Obukhova T, Ryabova V et al.: Double-sleeve and carinal resections using the uniportal VATS technique: a single centre experience. J Thorac Dis 2016;8 (suppl 3):235-241. VATS, advanced cases, future

P1.08-061 Clinical Experience of Rib Resection for Lung Cancer with Chest Wall Invasion Using a Pneumatic High Speed Power Drill System

Rib resection is sometimes required for chest wall tumors or lung cancer with localized chest wall invasion. There are some reports on thoracoscopic rib resection, which may be much less invasive and provide an excellent surgical view of the target. We have used a pneumatic high speed power drill system, commonly used as a dentist’s drill, in order to be accomplished less invasive thoracoscopic rib resection. A pneumatic high speed power drill (HiLAN® GA520R B Braun Aesculap, Tokyo, Japan) was inserted in the thoracic cavity and the head of the drill, which has a diamond burr, adequately attached to the rib surface. The rib was then sheared by whittling until dislocated. Cut pieces of bone tissue were removed by suction with saline dropping on the head of the drill. Soft tissue including the parietal pleura, intercostal muscle and vessels were dissected using power devices or an electrical scalpel after cutting the ribs. From February 2014 to date, we have experienced seven patients with chest wall resection using a drill. Hybrid-VATS was performed for four of the patients, while complete-VATS was performed for the remaining three patients. There were no intraoperative issues and the postoperative courses were all eventless. The mean follow-up period is about 13 months. Two of the 7 patients had recurrence of the disease with distant metastasis. However, there is no local recurrence. A pneumatic high speed power drill is easy to handle and useful for rib resection in lung cancer surgery and possibly better suited even when compared to the Gigli saw or endoscopic rib cutter for selective patients undergoing thoracoscopic surgery. Rib resection using a drill might be less invasive procedure.

P1.01-031 Does Malignant Pleual Mesothelioma (MPM) Behaviour Differ among Decades?

MPM is extremely aggressive and has a long-latency period. Hence, detected at advanced stages resulting in an unfavorable prognosis (1-2years). However, MPM prognosis has been improving over the past few years with availability of better diagnostic and treatment regimens. We aim to compare clinico-pathologic characteristics of old-MPM cases referred to National Cancer Institute(NCI)-Cairo university between (2002-2003)and new MPM cases (2012-2015) Retrospective review of MPM cases presented to NCI. Data regarding demographics, histology, symptoms and signs, tumor staging and CT-findings were obtained from all patients’ records. Pearson's Chi(X2)and Fisher's Exact t-tests were used for statistical analysis. 1) Old cohort (n=100): 100 patients were encountered. Median age was 46 years. Males were 59% of cases. 30% has PS1. Asbestos exposure was documented in 74 cases. 44 cases were smokers, 25 cases were industrial-workers. Family history was positive in 12 cases. Dyspnea was the presenting symptom in 92 cases, chest pain in 83% and tuberculous pleuritis in 2 cases, effusion in all cases, pleural thickening in 80%, tracheal shift to the opposite-side in 23%, T2 represented 41%. Epithelioid subtype 46.6%. Pathological T2= 34%. 2) New cohort (n=194): 194 patients were encountered. Median age was 53 years. Males and females were nearly equally distributed. Epithelioid subtype was 63.4%. Rt-sided lesions were evident in nearly two-thirds of the cases. Pleural thickening was nodular in 131 (69.7%) cases. Inter-lobar fissure was thickened in 29.4%. Mediastinal Pleura was affected in 37.1%. Nearly, half of our cases had effusion. Ossification & calcification were detected in 8 (4.1%) cases. Contraction of hemithorax was identified in 77 (39.7%) cases. Chest wall invasion (CWI) was present in 18 (9.3%) cases. Pulmonary nodules were detected in one-fifth of the cohort. Metastases were detected in 9 (4.6%) cases (Figure). By comparing both groups, we found that more lymph node involvement(N+), less metastasis(M+),older median age, more females, more epithelial subtype, less pleural effusion presentation, more pleural thickening were detected in group 2(new cases) reflecting better staging ( mediastinoscopy& PET-CT),early detection, more incidence in females and better treatment modalities.

Role of Adjuvant Therapy for Node-Negative Lung Cancer Invading the Chest Wall

IntroductionThe present study investigated the effect of adjuvant chemotherapy and radiation on survival among patients undergoing chest wall resection for T3N0 non–small cell lung cancer (NSCLC). Materials and MethodsPatients with T3N0 NSCLC who underwent chest wall resection were identified in the National Cancer Data Base in 2004 to 2012. The cohort was divided into patients who had received adjuvant chemotherapy, radiation therapy, chemoradiation therapy, or no adjuvant treatment. Kaplan-Meier and log-rank tests were used to compare overall survival, and a bootstrapped Cox proportional hazards model was used to determine the significant contributors to survival. A subset analysis was performed with stratification by margin status and tumor size. ResultsOf 759 patients identified, 42.0% underwent surgery alone, 23.3% underwent surgery followed by chemotherapy, 22.3% underwent surgery followed by chemoradiation therapy, and 12.3% underwent surgery followed by radiotherapy alone. Tumors > 4 cm benefited from adjuvant chemotherapy and radiation therapy in the multivariable analysis, and those ≤ 4 cm benefited only from adjuvant chemotherapy. The subgroup analysis by margin status identified that margin-positive patients with tumors > 4 cm benefited significantly from either adjuvant chemoradiation therapy or radiation therapy alone. ConclusionT3N0 NSCLC with chest wall invasion requires unique management compared with other stage IIB tumors. An important determinant of management is tumor size, with tumors ≤ 4 cm benefiting from adjuvant chemotherapy and tumors > 4 cm benefiting from adjuvant chemotherapy if margin negative and adjuvant chemoradiation therapy or radiotherapy if margin positive.

Imaging Evaluation of Malignant Chest Wall Neoplasms.

Neoplasms of the chest wall are uncommon lesions that represent approximately 5% of all thoracic malignancies. These tumors comprise a heterogeneous group of neoplasms that may arise from osseous structures or soft tissues, and they may be malignant or benign. More than 50% of chest wall neoplasms are malignancies and include tumors that may arise as primary malignancies or secondarily involve the chest wall by way of direct invasion or metastasis from intrathoracic or extrathoracic neoplasms. Although 20% of chest wall tumors may be detected at chest radiography, chest wall malignancies are best evaluated with cross-sectional imaging, principally multidetector computed tomography (CT) and magnetic resonance (MR) imaging, each of which has distinct strengths and limitations. Multidetector CT is optimal for depicting bone, muscle, and vascular structures, whereas MR imaging renders superior soft-tissue contrast and spatial resolution and is better for delineating the full extent of disease. Fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT is not routinely performed to evaluate chest wall malignancies. The primary functions of PET/CT in this setting include staging of disease, evaluation of treatment response, and detection of recurrent disease. Ultrasonography has a limited role in the evaluation and characterization of superficial chest wall lesions; however, it can be used to guide biopsy and has been shown to depict chest wall invasion by lung cancer more accurately than CT. It is important that radiologists be able to identify the key multidetector CT and MR imaging features that can be used to differentiate malignant from benign chest lesions, suggest specific histologic tumor types, and ultimately guide patient treatment. (©)RSNA, 2016.

Computed tomography findings of focal lung lesion and their pathological correlations

Background: Focal lung masses are common radiological fi ndings which need to be characterized to plan management. Suspicious lesions require invasive investigations and aggressive treatment. However, likely benign lesions require no invasive investigations.Objectives: We aimed to correlate the computerized tomography fi ndings of focal lung lesions with pathological diagnoses.Methods: A total of 56 patients were enrolled in the study. Plain and contrast enhanced computerized tomography scan of chest was done in spiral computerized tomography. Radiologist’s computerized tomography reports were obtained. Pathological diagnosis were followed in all cases and recorded. Computerized tomography reports were compared with pathological reports and validity of computerized tomography in predicting the nature of lung lesion was assessed.Results: Overall, squalors cell carcinoma was the most common histological cell type (46.34%) followed by adenocarcinoma (41.46%). In 95.12% of total cases, size of the malignant lesion was more than 3cm. Squalors cell Carcinoma was the most common tumor located centrally (71.42%) and adenocarcinoma peripherally (55.55%). Spiculated margin was most commonly associated in malignant lesions. Among morphological characters, chest wall invasion and meditational invasion were statistically significant for malignancy. Contrast enhancement more than 20 hounsfield unit had more than 80% sensitivity and specificity for malignant lesions. Sensitivity of computerized tomography combining all morphological characteristics for depicting malignancy was 97.6% and specificity was 46.7%.Conclusion: The present study showed that contrast enhanced computerized tomography provides more precise tumor localization, characterization and intrathoracic extension to differentiate benign from malignant lung lesion. Enhancement of the lesion is more specific for malignancy than other morphological characteristic.Journal of Kathmandu Medical College, Vol. 4, No. 2, Issue 12, Apr.-Jun., 2015, page: 59-64

Pleomorphic Carcinoma of the Lung: Relationship Between CT Findings and Prognosis.

The objective of our study was to assess the radiologic and clinical findings of pleomorphic carcinoma (PC) of the lung and to evaluate whether there are any characteristic features that can be used to predict prognosis. Forty-four consecutive patients whose diagnosis of PC was histologically confirmed through resection of the lung tumor were included in this study. The clinical and CT findings of these patients were retrospectively reviewed. Two thoracic radiologists evaluated the CT findings including the size, location, internal characteristics, and margin characteristics of the tumors and the presence of chest wall invasion, mediastinal invasion, and surrounding lung abnormalities. A multivariate analysis by the Cox proportional hazards regression model was used to identify variables that can be used to predict overall survival and disease-free survival. In the patients with PC, a central low-attenuation area or cavity (40/44, 91%), chest wall invasion (19/44, 43%), and pulmonary emphysema (30/44, 68%) were frequently observed on CT. On multivariate analysis, a massive central low-attenuation area or cavity (> 25% of the lesion) on CT indicating necrosis was the only significant independent factor for overall survival and disease-free survival (p < 0.05). Clinical findings, the presence of lymph node metastasis at surgery, and postoperative pathologic stage were not significant predictors of overall survival and disease-free survival. A massive central low-attenuation area or cavity on CT was the only predictor of overall survival and disease-free survival in patients with lung PC.

High Expression of Urokinase-Type Plasminogen Activator Is Associated with Lymph Node Metastasis of Invasive Ductal Carcinoma of the Breast.

PurposeIn the present study, we evaluated the levels of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor 1 (PAI-1) by performing immunohistochemical staining to determine whether they were reliable prognostic markers in patients with breast cancer.MethodsDemographic and clinicopathological parameters of 214 patients with invasive ductal carcinoma (IDC) and 80 patients with ductal carcinoma in situ (DCIS) who were diagnosed and treated from 2006 to 2010 were analyzed. Tissue microarray was constructed and immunohistochemical staining was performed for each specimen.ResultsUnivariate analyses showed that age at diagnosis, history of hormone replacement therapy, radiation therapy, skin and chest wall invasion, Paget disease, lymphovascular invasion, estrogen receptor positivity, and triple-negative subtype were significantly associated with patient prognosis (p<0.005). Patients with DCIS showed higher PAI-1 expression than patients with IDC (82.5% and 36.2%, respectively; p=0.012). Lymph node metastasis was more frequent in patients with high uPA levels than in patients with low uPA levels (p=0.001).ConclusionOur results suggested that PAI-1 was involved in tumor progression in the early stages of breast cancer, such as DCIS. In addition, our results suggested that high uPA levels were associated with the lymph node metastasis of IDC.

Radiological evaluation of various types of primary bronchogenic carcinoma: a study of 65 cases

Background: Orderly approach to diagnosis and staging based on the knowledge of lung cancer requires selection of treatment for either potential cure or optional palliation of individual patient. A radiological imaging is extremely valuable and indispensable when it comes to diagnosis and staging of primary bronchogenic carcinoma. Objective: To study the imaging features on various radiological and imaging techniques in various types of primary bronchogenic carcinoma and to differentiate bronchogenic carcinoma from other lung masses. Materials and Methods: This was a prospective observational study. Ethical committee permission was taken before enrollment of the patients in the study. Data of participants regarding demographics, history of smoking habit, clinical presentation, histopathological type, radiographic findings on chest radiograph, ultrasonography, computed tomography (CT) scan, and, if required, magnetic resonance imaging were recorded in detail. The method of diagnosis and clinical stage of the disease were obtained. Statistical analysis was performed using descriptive statistics of the collected data. Result: The maximum prevalence of bronchogenic carcinoma was seen between 60–69 years of age (50.76%) with male predominance (90.76%). About 92.31% patients showed positive smoking history. Thirty-three patients (50.76%) showed primary tumor size in lung, which was > 4 cm size. All masses (100%) showed heterogeneous contrast enhancement. Other common findings by CT scan were loss of patency of bronchus (41.53%), hilar enlargement (38.46%), enlarged mediastinal lymph nodes (35.38%), mediastinal invasion (24.61%), rib, chest wall, and plural invasion (20%), pleural effusion (15.38%), calcification (13.84%), necrosis (10.76%), cavitation (12.3%), and superior vena cava compression (10.76%). Conclusion: The evaluation of a patient with known or suspected bronchogenic carcinoma requires the detection and characterization of the lesions involving the lungs, hila, mediastinum, pleura, chest wall, and upper abdomen. Various radiological imaging techniques play a dominant role in diagnosis and proper staging of the primary bronchogenic carcinoma.

A multicenter phase II study of concurrent chemoradiotherapy with cisplatin and oral S-1, followed by surgery for locally advanced non-small-cell lung cancer

Abstract Purpose This study was designed to evaluate the feasibility of concurrent induction chemoradiotherapy (CRT) using S-1, an oral fluoropyrimidine derivative, plus cisplatin followed by surgery in locally advanced non-small cell lung cancer (NSCLC). Patients and methods We defined locally advanced NSCLC as pathologically proven chest wall invasion or hilar and/or mediastinal lymph node metastases by endobronchial ultrasound-guided transbronchial needle aspiration. Twenty-three patients were enrolled in this study from May 2011 to April 2014. The patients received S-1 40mg/m 2 orally twice daily on days 1 through 14 and 29 through 42, and cisplatin 60mg/m 2 was injected intravenously on days 8 and 36. The patients also underwent radiotherapy and received a total dose of 40Gy in 20 fractions beginning on day 1. Surgical resection was performed from 4 to 6 weeks after completion of the induction treatment. Results Of the 23 eligible patients, 18 had stage IIIA and 5 had stage IIB NSCLC. Twenty patients (87.0%) completed induction CRT and underwent surgical resection. Representative grade 3 adverse reactions were neutropenia (21.7%) and leukocytopenia (8.7%); no grade 4 adverse reactions were observed. Radiologically, 7 (30.4%) of the 23 patients achieved partial response and were therefore radiologically downstaged. Twenty patients were curatively resected. Six (26.1%) complete responses were identified and 12 cases (52.2%) were histopathologically downstaged by induction CRT. Conclusion Concurrent induction CRT using S-1 plus cisplatin is a feasible and promising new treatment modality for locally advanced NSCLC. Evaluation of histopathological downstaging revealed sufficient anti-cancer effects for preoperative treatment. MicroAbstract Because chemoradiotherapy (CRT) using cisplatin and S-1, an oral fluoropyrimidine, is effective for unresectable non-small cell lung cancer, the feasibility of this therapy in a neoadjuvant setting was evaluated in a multicenter phase II study. Toxicities were very mild and 87.0% of the 23 patients completed induction CRT. This protocol seems feasible and is considered an option among preoperative therapies.

En bloc spondylectomy combined with chest wall excision for spinal tumor via a modified posterior approach: a retrospective study on 21 patients

ObjectiveThis study was to investigate the feasibility and efficacy of total en bloc spondylectomy (TES) combined with chest wall excision through a modified posterior approach in treating the patients with thoracic spinal tumor and posterior chest wall invasion. MethodsClinical data of 21 consecutive patients (7 males, 14 females; average age: 41.5, range: 20–69) who underwent the combined TES and chest wall excision through a modified posterior approach from 08/2005 to 01/2014 were retrospectively analyzed. Reconstruction of the spinal defect following TES was accomplished by dorsal stabilization and carbon cage interposition. All resected specimens were examined histologically. Radiotherapy and chemotherapy were performed according to the results of the surgery and histological examination. All patients were followed up on a regular basis. ResultsThe surgery was successfully performed in all patients. Histological analysis revealed primary malignant tumors in 16 patients and solitary vertebral metastases in 5 patients. Three patients with preoperative neurologic deficits of Frankel D recovered to Frankel E 1–3 weeks postoperatively. After the mean follow-up of 31 months (9–70), the 16 patients (16/21, 76.2%) with primary bone tumors were free of recurrence and present no evidence of disease. Four cases (4/21, 19%) with metastatic tumor developed recurrence or distant metastases. Three patients presented with cerebrospinal fluid leakage and one patient suffered pneumonia; they were soon recovered after treatment. No other complications were observed. ConclusionThe results suggest that the combined TES with chest wall excision via a modified posterior approach seems feasible and effective for treating patients with thoracic spinal tumor and posterior chest wall invasion.

Surgical Outcomes of Patients With Stage III Thymoma in the Japanese Nationwide Database

To investigate the clinical characteristics and therapeutic outcomes of patients who underwent surgery for stage III thymoma in Japan. Using the Japanese nationwide database, which contains the records of 2,835 patients with thymic epithelial tumors who underwent treatment between 1991 and 2010, we extracted and analyzed the records of those who underwent surgery for stage III thymoma. A total of 310 patients (170 males, 140 females; median age, 58 years) were analyzed. Involved sites were the lung in 194 (62.6%), the pericardium in 151 (48.7%), the great vessels in 126 (40.6%), the phrenic nerve in 84 (27.1%), and the chest wall in 7 (2.3%). Complete resection (R0) was achieved in 247 (79.7%) cases. Induction therapies were administered to 42 (13.5%) patients, and postoperative therapies were administered to 147 (47.4%). In R0 cases, 68 (27.5%) experienced recurrence. The pleural space was the most frequent site of recurrence (46; 18.6%). The 10-year overall and disease-free (in R0) survival rates were 80.2% and 51.6%, respectively. Multivariate analyses revealed that age (p= 0.002), male sex (p= 0.017), induction therapy (p < 0.001), and type B histology (p= 0.037) were independent adverse predictors for overall survival. Chest wall invasion was the only independent adverse predictor for disease-free survival, although the factor analysis was marginal for overall survival. The outcomes of surgery for patients with stage III thymoma were favorable unless chest wall invasion was present; however, the role of complete resection and appropriate multimodal treatment plan require further investigation.

Douleurs thoraciques par envahissement pariétal néoplasique : stratégies thérapeutiques

Thoracic chest wall invasion can cause pain sometimes refractory to analgesic. There is no specific general agreement concerning its treatment, and specialized symptomatic treatments can be envisaged. We offer, from a review of literature and our clinical experience, an algorithm for taking care of this condition worked out within a working party as part of the “Societe francaise d’etude et de traitement de la douleur” and by “l’Association francophone pour les soins oncologiques de support.”

Sarcomatoid Lung Carcinoma Case and Clinicopathologic Review

Lung cancer remains the leading cause of cancer deaths in both men and women in the United States. Lung cancers are broadly divided into non–small cell lung carcinomas and small cell carcinomas for treatment purposes; non–small cell carcinoma is by far the most common type of bronchogenic malignancy. Rare primary pulmonary malignancies include adenosquamous carcinoma, carcinoid tumors, minor salivary gland tumors, and poorly differentiated lung malignancies with sarcomatoid differentiation; the latter are referred to under the umbrella term “sarcomatoid carcinomas.” Sarcomatoid lung carcinomas account for 0.1% to 0.3% of all lung cancer diagnoses. These malignancies often present at imaging as nonspecific peripherally located masses that may be associated with chest wall invasion. Sarcomatoid carcinomas are aggressive cancers associated with a poor prognosis. Although they may present with clinical features resembling other non–small cell lung malignancies, the pathologic features, response to treatment, and prognosis of sarcomatoid carcinomas often differ from other non–small cell lung malignancies.

Current Concepts on Preoperative Breast MRI

It is well established that contrast-enhanced breast MRI is the most sensitive and accurate imaging modality for the local-regional staging of breast cancer. Contrast-enhanced breast MRI is superior to clinical examination, mammography, and ultrasonography, alone or combined, in delineation of the size and extent of the tumor, additional sites of disease, pectoralis muscle and chest wall invasion, nipple and skin involvement, and lymph node metastases.1

Multi-institutional analysis of T3 subtypes and adjuvant radiotherapy effects in resected T3N0 non-small cell lung cancer patients.

PurposeWe evaluated the prognostic significance of T3 subtypes and the role of adjuvant radiotherapy in patients with resected the American Joint Committee on Cancer stage IIB T3N0M0 non-small cell lung cancer (NSCLC).Materials and MethodsT3N0 NSCLC patients who underwent resection from January 1990 to October 2009 (n = 102) were enrolled and categorized into 6 subgroups according to the extent of invasion: parietal pleura chest wall invasion, mediastinal pleural invasion, diaphragm invasion, separated tumor nodules in the same lobe, endobronchial tumor <2 cm distal to the carina, and tumor-associated collapse.ResultsThe median overall survival (OS) and disease-free survival (DFS) were 55.3 months and 51.2 months, respectively. In postoperative T3N0M0 patients, the tumor size was a significant prognostic factor for survival (OS, p = 0.035 and DFS, p = 0.035, respectively). Patients with endobronchial tumors within 2 cm of the carina also showed better OS and DFS than those in the other T3 subtypes (p = 0.018 and p = 0.016, respectively). However, adjuvant radiotherapy did not cause any improvement in survival (OS, p = 0.518 and DFS, p = 0.463, respectively). Only patients with mediastinal pleural invasion (n = 25) demonstrated improved OS and DFS after adjuvant radiotherapy (n = 18) (p = 0.012 and p = 0.040, respectively).ConclusionThe T3N0 NSCLC subtype that showed the most favorable prognosis is the one with endobronchial tumors within 2 cm of the carina. Adjuvant radiotherapy is not effective in improving survival outcome in resected T3N0 NSCLC.

Largest recorded non-invasive true intrathoracic desmoid tumour

Intrathoracic desmoid tumours are rare soft-tissue neoplasms arising from fascial or musculo-aponeurotic structures, accounting for less than 0.03% of all neoplasms. Most cases in fact represent intrathoracic extension of chest wall tumours. This case report describes the largest recorded true intrathoracic desmoid tumour without mediastinal or chest wall invasion. The tumour was completely excised through a left thoracotomy with negative tumour margins. Management of the patient will involve radiological surveillance. Desmoids are benign tumours that do not metastasise but have a high rate of recurrence, especially if tumour margins are positive after surgical resection. Complete surgical resection is the treatment of choice. Other treatment options include radiotherapy; non-steroidal inflammatory drugs or antioestrogen therapy (tamoxifen) or a combination thereof; and chemotherapy or targeted drug therapy.