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J Thorac Cardiovasc Surg 2009;137:441-447
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Induction chemoradiotherapy facilitates radical resection of T4 non–small cell lung cancer invading the spine

^a Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
^b Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
^c Department of Medical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
^d Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
^e Division of Applied Molecular Oncology, Ontario Cancer Institute, Toronto, Ontario, Canada

Received for publication November 8, 2007; revisions received August 27, 2008; accepted for publication September 14, 2008.

^_* Address for reprints: Shaf Keshavjee, MD, Professor and Chair, Division of Thoracic Surgery, University of Toronto, Toronto General Hospital 9N-947, 200 Elizabeth St, Toronto, Ontario M5G 2C4, Canada. (Email: shaf.keshavjee{at}uhn.on.ca).

Objective: We evaluated the outcome, long-term results, and factors affecting outcome of induction chemoradiotherapy followed by surgical resection for T4 non–small cell lung cancer invading the spine.

Methods: Retrospective analysis of 23 consecutive patients undergoing radical vertebral resection for non–small cell lung cancer invading the spine between 1996 and 2007 was performed. In most cases, induction chemoradiotherapy consisted of cisplatin and etoposide followed by 45 Gy of radiation. Surgical resection with vertebrectomy was performed en bloc in either a 1-stage or 2-stage operation. Survival was estimated by Kaplan–Meier techniques. The log–rank comparison was used to compare groups.

Results: There were 13 men and 10 women with a median age of 61 years (range 32–75). Twenty-two patients had induction chemoradiotherapy and 1 had induction chemotherapy alone. Vertebral resections included 6 total vertebrectomies, 15 hemivertebrectomies, and 2 partial vertebrectomies. Complete resection was achieved in 19 (83%) patients. Two (8.7%) patients died postoperatively. Pathologic complete response was observed in 10 (43%) patients. The 3-year survival was 58% (median follow-up, 34 months). Patients who achieved pathologic complete response or near complete response (viable tumor cells < 1%) demonstrated significantly better survival than those who did not (3-year survival, 92% vs 20%; P = .006).

Conclusion: Highly selected patients with lung cancer invading the spine can potentially be cured with induction chemoradiation therapy followed by radical en bloc resection of the tumor. A multidisciplinary operative strategy allows a significant chance of achieving complete resection in patients requiring multilevel hemivertebrectomy or total vertebrectomy and an appreciable cure rate.