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The Annals of Thoracic Surgery, Vol 57, 198-202, Copyright © 1994 by The Society of Thoracic Surgeons
G Maggi, C Casadio, F Pischedda, R Giobbe, R Cianci, E Ruffini, M Molinatti and M Mancuso
Operative technique and long-term results of 60 consecutive patients with
Pancoast tumor treated with combined radiosurgical treatment were
evaluated. External radiation therapy was administered preoperatively in a
dose of 30 Gy in 50 patients. Operation was considered radical (R0) in 36
patients (60%). A microscopic invasion of the margin of resection (R1) was
observed in 5 patients (8.3%). In 19 patients (31.6%) the operation was
considered presumably not radical (R2). Three patients died in the
postoperative period (5%). Fourteen major postoperative complications
occurred in 13 patients (21%). Seven patients had recurrence of pain
postoperatively. Overall 3- and 5-year actuarial survival rates were 34%
and 17.4%, respectively. The corresponding figures for the R0 and combined
R1-R2 groups were 45.8% and 23.5% (R0), and 11.4% (R1-R2; no 5-year
survivors were observed in this group) (p < 0.025). Median survivals in
the R0 and combined R1-R2 patients were 19 and 7 months, respectively.
Different median survivals for the patients with residual tumor were as
follows: intervertebral foramina, 5 months; subclavian artery (isolated), 9
months; subclavian artery (in association), 7 months; brachial plexus, 4
months; and vertebral body, 7 months. We conclude that combined
radiosurgical treatment represents a valuable therapeutic option in the
treatment of Pancoast tumor. In case of residual tumor a poor outcome may
usually be anticipated, but in the majority of these patients the operation
permits good control of the pain.
ARTICLES
Combined radiosurgical treatment of Pancoast tumor
Department of Thoracic Surgery, University of Torino, Italy.
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