Ann Thorac Surg 2005;80:2040
© 2005 The Society of Thoracic Surgeons
Original article: General thoracic
Invited commentary
Walter J. Scott, MD
Thoracic Surgical Oncology, Fox Chase Cancer Center, Suite C312, 333 Cottman Avenue, Philadelphia, PA19111
(Email: w_scott{at}fccc.edu).
Doddoli and colleagues [1] have reported the largest series of patients with completely resected nonsmall cell lung cancer invading the chest wall. Their series is a retrospective analysis and it confirms the results of other large series in most respects.
Because all of the patients in this series underwent complete (R0) resection, the main influence on overall survival was the presence or absence of lymph node metastases. T3N0M0 (stage IIB) patients had a median and 5-year survival of 19 months and 40%, respectively. Patients staged IIIA (T3N1M0 or T3N2M0) had a 12% 5-year survival (p < 104). T3N0 patients did not benefit from adjuvant radiotherapy to the chest wall.
Novel findings included the fact that based on their multivariate analysis stage IIIA patients seemed to benefit in terms of survival from adjuvant radiotherapy to the chest wall and mediastinum. The authors also noted that in the stage IIB subgroup of patients with tumor invasion limited to the parietal pleura, the survival rate of those patients undergoing en bloc chest wall resection was greater than that of patients undergoing extrapleural resection. This is a controversial finding not consistently supported in the literature. Certainly if there is any question of tumor invasion beyond the parietal pleura, en bloc resection of the chest wall should be performed.
An unusual aspect of this series is the inclusion of patients with superior sulcus tumors. Superior sulcus tumors are usually not included in series of lung cancers invading the chest wall because they may have higher local recurrence rates, require a unique operative approach, and so forth. The authors justify the inclusion of these patients by saying that none of those included had Pancoast syndrome. Surely some of these patients had pain because all had T3 tumors, although they may not have had Horner's syndrome and muscle wasting. The best approach would have been for the authors to analyze these patients separately within the report or to at least tell us how many patients with superior sulcus tumors were included in their series.
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References
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- Doddoli C, D'Journo B, Le Pimpec-Barthes F, et al. Lung cancer invading the chest walla plea for en-bloc resection but the need for new treatment strategies. Ann Thorac Surg 2005;80:2032-2040.[Abstract/Free Full Text]
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