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J Thorac Cardiovasc Surg 2005;129:1250-1257
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

High-dose radiotherapy in trimodality treatment of Pancoast tumors results in high pathologic complete response rates and excellent long-term survival

^a Division of Thoracic Surgery, University of Maryland School of Medicine and Greenebaum Cancer Center, Baltimore, Md
^b Division of Medical Oncology, University of Maryland School of Medicine and Greenebaum Cancer Center, Baltimore, Md
^c Department of Radiation Oncology, University of Maryland School of Medicine and Greenebaum Cancer Center, Baltimore, Md

Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25–28, 2004.

Received for publication May 13, 2004; revisions received December 7, 2004; accepted for publication December 17, 2004.

^_* Address for reprints: Mark J. Krasna, MD, Division of Thoracic Surgery, University of Maryland School of Medicine, 22 S. Greene St, Room N4E35, Baltimore, MD 21201 (Email: mkrasna{at}smail.umaryland.edu).

OBJECTIVE: We sought to study the clinical characteristics and outcomes of patients treated with a surgery-inclusive multimodality approach for Pancoast tumors.

METHODS: Clinical records of patients with Pancoast lung cancer who were enrolled for multimodality treatment between 1993 and 2003 at our institution were reviewed retrospectively.

RESULTS: Thirty-six patients completed neodjuvant chemoradiation followed by en bloc surgical resection, whereas one patient received high-dose radiation alone followed by surgical intervention. There were 22 men and 15 women. Thirty-four lobectomies and 3 pneumonectomies were performed. Pretreatment non-small cell lung cancer stages were IIB, IIIA, IIIB, and IV (presenting with solitary brain metastasis) in 18, 8, 6, and 5 cases, respectively. R0 resection was achieved in 36 (97.3%) patients. Operative mortality was 2.7% (n = 1). High-dose radiotherapy was successfully tolerated in all but 1 patient. Mean total radiation dose was 56.9 Gy. Pathologic complete response was found in 40.5% (n = 15) of patients. Recurrences were found in 50% (n = 18) of patients. Brain metastasis was the most common recurrence (n = 9), followed by other distant recurrences (n = 4) and local recurrences (n = 5). Median survival time for the group is 2.6 years, and median survival time (pathologic complete response) is 7.8 years. It is noteworthy that median survival time of patients with positive pretreatment lymph nodes (12 patients) was not reached.

CONCLUSIONS: Surgical resection of Pancoast tumors after neoadjuvant high-dose radiation and chemotherapy can be safely performed. High-dose radiation in trimodality treatment is well tolerated and might be beneficial. Similar to other studies, late central nervous system relapse is problematic and indicates a need for assessing the role of prophylactic cranial irradiation in this disease.

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