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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 373-378, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
TR DeMeester, M Albertucci, PJ Dawson and SM Montner
Twelve patients with non-small cell lung cancer had tumors that were
adherent to the vertebral column and clinically suspected of invading the
bone. All were free of mediastinal node involvement as assessed by
pretreatment mediastinoscopy. All received 3000 rads of preoperative
radiation followed by en bloc resection of the lung and a tangential
portion of the involved vertebral bodies. A complete mediastinal
lymphadenectomy was also performed. Three patients had true Pancoast's
syndrome and in the remaining nine the tumor was located above T6 with the
majority in the apex of the chest. Resectability was based on the absence
of tumor extension into the costotransverse foramen and the extent of
vertebral body involvement. Detailed studies of the decalcified surgical
specimen show that the tumor extended into the cortex in two patients,
periosteum in six, parietal in three, and up to the visceral pleura in one.
Six patients are alive after 1 to 11 years (four beyond 5 years) without
evidence of recurrent tumor and arthritic pain. The overall 5- and 10-year
survival rate (Kaplan-Meier method) was 42%. In patients with tumors
adherent to the vertebral body and no evidence of roentgenographic erosion,
the en bloc removal of the lung and the involved portion of the vertebral
body is required for complete excision and is associated with long-term
survival without sequelae.
ARTICLES
Management of tumor adherent to the vertebral column
Creighton University School of Medicine, Department of Surgery, Omaha, Neb 68131.
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