A multidisciplinary treatment approach can produce favorable outcomes in patients with superior sulcus non-small cell lung cancer (NSCLC), according to researchers.
The approach is associated with a high incidence of R0 resection and no difference in outcomes between patients with T3 tumors and those with T4 tumors, according to results presented at the American Association for Thoracic Surgery (AATS) Annual Meeting.
The treatment approach includes the option of chemotherapy and radiotherapy before and/or after surgery, as well as spine neurosurgery (SNS) for most T3 tumors and all T4 tumors.
The approach was used in 155 patients with superior sulcus NSCLC treated at a single center. The patients’ median age was 59 years, and 52% were men. Adenocarcinoma was the most common histology (45%). Sixty-six patients had T4 tumors. Patients with T3 tumors were divided into 2 groups — T3 with SNS (n=48) and T3 without SNS (n=41).
Lobectomy and chest wall resection via posterolateral thoracotomy were performed in more than 70% of patients. Most patients (n=138) received neoadjuvant therapy.
Overall, the R0 resection rate was 88.3% (n=137), and 18% of patients went on to receive adjuvant therapy (n=28). There were no deaths within 30 days of surgery and 4 deaths within 90 days. Two deaths were related to surgery.
Of the 125 patients who received concurrent chemotherapy and radiation as neoadjuvant therapy, 111 had R0 resection, 11 had R1, and 3 had R2 resection. Most patients (n=102) received no adjuvant therapy, but 13 received chemotherapy, 8 received radiation, and 2 received chemotherapy and radiation.
Of the 10 patients who received neoadjuvant chemotherapy alone, 8 had R0 resection, 1 had R1 resection, and 1 had R2 resection. One patient received adjuvant chemotherapy, 1 received adjuvant radiation, and the rest received no adjuvant therapy.
The 2 patients who received sequential chemotherapy and radiation as neoadjuvant therapy both had R0 resection and received no adjuvant therapy. The 1 patient who received radiation alone as neoadjuvant therapy had R0 resection and received no adjuvant therapy.
Of the 17 patients who did not receive neoadjuvant therapy, 15 had R0 resection, and 2 had R2 resection. Thirteen patients received no adjuvant therapy. One received chemotherapy, 1 had radiation, and 1 had both. The remaining patient’s treatment was unknown.
At 5 years, there were no significant differences between the T3 and T4 groups with regard to overall survival (P =.591) or progression-free survival (P =.45). Likewise, there were no significant differences in overall or progression-free survival between the T4, T3-SNS, and T3 without SNS groups.
Patients with pathologic N0 tumors had significantly longer 5-year overall survival (P =.007) and progression-free survival (P =.015) than those with N1/2 tumors.
Disclosures: The study presenter disclosed a relationship with Genentech. No other disclosures were provided.
McLoughlin K, Tan KS, Bilsky M, et al. Superior sulcus non-small cell lung cancers (Pancoast tumors): The importance of multidisciplinary management. AATS 2023. May 6-9, 2023. Abstract 52.