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Good Long-Term Survival Seen With Stage T4 Lung Cancer Surgery: Presented at STS

By Ed Susman

FORT LAUDERDALE, FL -- February 4, 2008 -- Select patients diagnosed with stage T4 non-small-cell lung cancer (NSCLC) can be successful candidates for surgery, even when the cancer affects structures outside the lungs.

"In highly qualified centres, radical surgery of T4 N0-N1 [NSCLC] can be performed with a 4% mortality rate and may yield a 43% 5-year survival rate," said Philippe G. Dartevelle, MD, Professor of Surgery, Marie Lannelongue Hospital, Paris, France.

"These results seem to indicate primary surgery as the treatment of choice for T4 [NSCLC], whenever a complete resection is thought to be technically feasible and the patient's condition is compatible with the extent of the planned surgery," Dr. Dartevelle said in an oral presentation here on January 29 at the Society of Thoracic Surgeons 44th Annual Meeting (STS).

"The benefit is worth the risk," he said.

Dr. Dartevelle and colleagues reviewed the outcomes of 271 patients who underwent surgery for stage T4 NSCLC at his institution over the past 25 years.

The 271 patients included 126 patients with superior sulcus tumours, 92 with carinal involvement, 39 with superior vena cava replacement that were repaired with prosthetic grafts, and 14 with tumours invading other mediastinal structures. In some cases, the tumour invaded the spine, requiring surgeons to enter the spinal cord and ligate specific nerves before removing the tumour en bloc. Metal rods are used to stabilise the spine.

Dr. Dartevelle said that the overall survival rate for patients with sulcus involvement was 37%. For patients requiring spinal surgery, nine of 28 patients have survived for at least 5 years.

He said 81 of the 92 carinal tumors were resected by performing a right pneumonectomy; six patients underwent a left pneumonectomy; three patients required mediastinectomy; two underwent right pleuronectomy. "There was an overall 5-year survival rate of 42.5% in these patients," Dr. Dartevelle said.

Among the 39 patients whose tumours invaded the vena cava, 17 also required a carinalectomy.

The 5-year survival for this group of 92 patients was 29.7%. About 59% of the patients whose tumours involved the mediastinum survived for 5 years or longer.

The need to perform a right pneumonectomy appeared to be the only significant risk factor leading to perioperative mortality (P <.05), Dr. Dartevelle said. "Induction chemotherapy, preoperative radiation, and use of coronary-pulmonary bypass -- primarily in cases of aortic involvement and repair -- are not significant mortality factors," he said.

He said that induction chemotherapy and especially blood transfusion contributed to patient morbidity and longer stays in the intensive care unit.

"The overall 5-year survival for these patients is 38.4%," he said. "Seventy-three patients have survived for 5 years."

Those patients with pathological N0-N1 disease had a 43% overall survival which was significantly higher than patients with N2-N3 disease, who had a 5-year survival of 17.7% (P =.003).

Complete resection of the tumour resulted in a 40.3% 5-year survival, while 15.9% of patients with incomplete resection survived at 5 years later.


[Presentation title: Results of Primary Surgery in 271 Patients With T4 Non-Small Cell Lung Cancer Over a 25 Year Period in a Single Center: The Benefit Is Worth the Risk. Abstract 44]

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