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Preoperative concurrent chemoradiotherapy for invading apical lung cancer
Surgery~Chest Wall 6 of the cases (in 2 cases blue and hot, in 4 cases blue alone). The sensitivity was good (75%). Metastases were present in 2, but 2 out of 3 patients with negative SLN were found to be pN0. Conclusion: The SLN mapping in NSCLC with blue dye and radioisotopc technique is feasible but one has to improve the detection rate. If SLN biopsy is shown to be sucessfull, the SLN, if uninvolved, should thus adequately predict the nodal status of the disease and therefore avoid useless lymphadenectomy.
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Identification of the sentinel lymph node by staining in lung cancer patients
K. Sogi, Y. Kaneda 1, K. Esato ~. Department of Clinical Research,
Sanyo National Hospital; 1First Depatment of Surgery, Yamaguchi University School of Medicine, Yamaguchi, Japan Lymph node metastasis is the most important prognostic factor for lung cancer. Identification of the sentinel node, i.e., the first lymph node invaded by the cancer, should be useful for assessing the status of lymph node metastasis in lung cancer patients. Objective: To determine whether it is possible to identify the sentinel lymph node (SLN) in lung cancer patients during surgery, and to investigate whether this is useful for understanding the status of lymph node metastasis and whether dissection of the mediastinal lymph nodes can be avoided. Subjects and Methods: The subjects were 8 patients who underwent pulmonary Iobectomy with ND2 dissection at our department. CN0-N2 were studied. An injection of 3 to 4 mL of indigo-carmine or Lymphazurin (isosulfan blue) was given near the tumor and the first lymph node to be stained was defined as the SLN. Metastasis to the SLN and to other lymph nodes was studied histopathologically. Results: The SLN could be identified in 7 out of 8 patients (87.5%), but identification was not possible in one patient with fight middle lobe cancer. The SLN was found to be #10 or#4 in the fight upper lobe, #10 in the fight middle lobe, #10, #12, or #7 in the fight lower lobe, #5 in the left upper lobe, and #10 or #12 in the left lower lobe. Since all patients were pN0, all SLN metastasis-negative patients were pN0. Conclusion: Identification of a lymph node considered to be the SLN was possible by staining in 87.5% of the lung cancer patients we studied. However, the correct SLN diagnosis rate requires further investigation.
139
left lobe. The resection of one costalis segment was performed in 14 cases (11%), of two in 36 (29%), of three in 61 (51%), of four in 9 (8%) and of five in 1 (1%). The mean of resected ribs was of 2.56 ± 0.83, median of 3, in a range from 1 to 5. In 57 cases, when rib's resection was lateral or anterior, we utilize a mesh to reduce chest wall defect while in other cases, when defect was posterior and subscapular, no reconstruction was needed anyway. One patient died in per±operative period (1%). Histology showed 69 adenocaminomas (57%), 43 squamous carcinomas (35%), 6 large cells carcinomas (5%), 1 mucoepidermoidal carcinoma (1%), 1 neuroendocrine tumor (1%) and 1 microcitoma (1%). According to pTNM classing 80 patients (71%) belonged at stage liB (T3NoMo), 35 at stage IliA (29 T3N1M0 6 T3N2M0), 4 at stage IIIB (3 T4NoM 0 - 1 T4N1Mo) and 2 at stage IV (1 T3NoM 1 - 1 T3N1M1). The last six patients had a synchronous lung tumor Radiotherapy (local and mediastinal) and/or chemotherapy were effected in indicated cases. Actuarial 5 year-survival rate for patients at stage lib was of 40.8% versus 13.9% of subjects at stage IliA. Our results are confirming the usefulness of a surgical therapy when the primitive lung cancer is involving the chest wall; the resection "en bloc" offers a potential curative therapy especially when lymphonodal metastasis are absent. In these cases survival at 5 years can reach and exceed 40%.
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Preoperative concurrent chemoradiotherapy for invading apical lung cancer
S. Miyoshi, K. luchi, K. Nakamura, K. Nakagawa, H. Maeda, K. Nakahara, K. Ohno, N. Nakano, H. Matsuda. Thoracic Surgery
Study Group of Osaka University, Osaka, Japan
Surgery/Chest Wall
We retrospectively reviewed 30 patients with an invading apical lung cancer (IALC) who underwent surgery from 1987 to 1996 at our institute and the affiliated hospitals in terms of effect of induction therapy. IALC was defined as primary lung cancer which invades a chest wall beyond the first rib and was associated with a pain in the shoulder or the arm. There were 10 patients with no induction therapy (NT), 9 with radiation therapy (RT) and 11 with concurrent chemoradiotherapy (CCRT). There were no significant differences in age (57 ± 8, 55 ± 13, 51 ± 9 years), sex, histological diagnosis, pstage. The follow up time was 6.7 ± 3.0 years in NT, 6.4 ± 3.1 years in RT, and 4.6 ± 1.5 years in CRT, respectively. RT patients received a mean of 42 (30-52.5) Gy and CCRT patients a mean of 48 (40-56) Gy. Regimens of CCRT patients consisted of CDDP + MMC + Vindesine in 5, CDDP + Vindesine in 3 and CDDP (or CBDCA) + Etoposide in 3. The operative mortality was 1/30. The one, three and five year survival rates were 70, 20, 20% in NT patients, 33, 11, 11% in RT patients, and 82, 64, 53% in CCRT patients, respectively. The survival rate of CCRT patients was significantly higher than that of NT and RT patients. We conclude that CCRT may be superior to RT alone as induction therapy for IALC.
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Surgery for primary and metastatic [46-• tumors
Friday, 15 September 2000
10:30-12:00
ORAL SESSION
4
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]
En bloc chest wall resection for peripheral lung cancer
P.P. Brega Massone, C. Lequaglie, B. Conti, B. Magnani 1 , I. Cataldo.
Oncologic Thoracic Surgery, Istituto Nazionale Tumor±, Milano; I Statistica/ Unit, /1. AA.RR., Pavia, Italy In our the Department of Oncology Thoracic Surgery of National Cancer Institute of Milan, from 1988 to 1996, 121 patients with lung cancer involving chest wall underwent surgical treatment. One hundred five were males (87%) and 16 females (13%), with a mean age of 61.21 ± 8.61 years, a median of 62.5 years in a range 36-77. We performed in every patients an en-bioc chest wall and pulmonary resection to achieve a complete tumor clearance. In 70 subjects tumor was located on the rigth (58%) while in 51 on the left (42%). The intervention was a Iobectomy in 64 cases (53%), 33 upper right, 24 upper left, 2 media, 3 lower right and 2 lower left; a superior bilobectomy in 4 (3%); a typical segmentectomy in 3 (2%); a pneumonectomy in 8 (7%), 6 left and 2 right; a wedge resection in 42 (35%), 20 of upper right lobe, 15 of upper left lobe, 4 of lower right lobe and 3 of lower
malignant chest wall
I.S. Poliakov, V.A. Porhanov, V.B. Kononenko, S.S. Semendiaev, MU. Mamelov, V.N. Bodnia. Thoracic Surgery Department,
Krasnodar, Russia Objective: Presence of pain syndrome caused by chest wall tumor invasion necessitates its resection as improving life quality, even with palliative effect only. Materials and Methods: Between 1989 and 1998 61 patients were treated for chest wall tumor invasion. Primary tumor: chondrosarcoma in 8, solitary plasmacytoma in 4, osteoblastoclastoma in 4, malignant fibrogistiocytoma 3, desmoid 2. Metastatic invasion was caused by melanoma in 2, osteosarcoma in 1, cotorectal cancer in 1, mesotheliorna in 2. Chest wall invasion was observed in 34 cases. Three patients underwent resection of sternum alone, 32 had resection of ribs and lung, 2-ribs, lung and vertebrae, 2-vertebrae and ribs, 22 had rib resection. Defect closure was performed by musculo-cutaneous flap, bone autograft, Marlex mesh.
I•-•
Identification of the sentinel lymph node by staining in lung cancer patients
K. Sogi, Y. Kaneda 1, K. Esato ~. Department of Clinical Research,
Sanyo National Hospital; 1First Depatment of Surgery, Yamaguchi University School of Medicine, Yamaguchi, Japan Lymph node metastasis is the most important prognostic factor for lung cancer. Identification of the sentinel node, i.e., the first lymph node invaded by the cancer, should be useful for assessing the status of lymph node metastasis in lung cancer patients. Objective: To determine whether it is possible to identify the sentinel lymph node (SLN) in lung cancer patients during surgery, and to investigate whether this is useful for understanding the status of lymph node metastasis and whether dissection of the mediastinal lymph nodes can be avoided. Subjects and Methods: The subjects were 8 patients who underwent pulmonary Iobectomy with ND2 dissection at our department. CN0-N2 were studied. An injection of 3 to 4 mL of indigo-carmine or Lymphazurin (isosulfan blue) was given near the tumor and the first lymph node to be stained was defined as the SLN. Metastasis to the SLN and to other lymph nodes was studied histopathologically. Results: The SLN could be identified in 7 out of 8 patients (87.5%), but identification was not possible in one patient with fight middle lobe cancer. The SLN was found to be #10 or#4 in the fight upper lobe, #10 in the fight middle lobe, #10, #12, or #7 in the fight lower lobe, #5 in the left upper lobe, and #10 or #12 in the left lower lobe. Since all patients were pN0, all SLN metastasis-negative patients were pN0. Conclusion: Identification of a lymph node considered to be the SLN was possible by staining in 87.5% of the lung cancer patients we studied. However, the correct SLN diagnosis rate requires further investigation.
139
left lobe. The resection of one costalis segment was performed in 14 cases (11%), of two in 36 (29%), of three in 61 (51%), of four in 9 (8%) and of five in 1 (1%). The mean of resected ribs was of 2.56 ± 0.83, median of 3, in a range from 1 to 5. In 57 cases, when rib's resection was lateral or anterior, we utilize a mesh to reduce chest wall defect while in other cases, when defect was posterior and subscapular, no reconstruction was needed anyway. One patient died in per±operative period (1%). Histology showed 69 adenocaminomas (57%), 43 squamous carcinomas (35%), 6 large cells carcinomas (5%), 1 mucoepidermoidal carcinoma (1%), 1 neuroendocrine tumor (1%) and 1 microcitoma (1%). According to pTNM classing 80 patients (71%) belonged at stage liB (T3NoMo), 35 at stage IliA (29 T3N1M0 6 T3N2M0), 4 at stage IIIB (3 T4NoM 0 - 1 T4N1Mo) and 2 at stage IV (1 T3NoM 1 - 1 T3N1M1). The last six patients had a synchronous lung tumor Radiotherapy (local and mediastinal) and/or chemotherapy were effected in indicated cases. Actuarial 5 year-survival rate for patients at stage lib was of 40.8% versus 13.9% of subjects at stage IliA. Our results are confirming the usefulness of a surgical therapy when the primitive lung cancer is involving the chest wall; the resection "en bloc" offers a potential curative therapy especially when lymphonodal metastasis are absent. In these cases survival at 5 years can reach and exceed 40%.
•6•
Preoperative concurrent chemoradiotherapy for invading apical lung cancer
S. Miyoshi, K. luchi, K. Nakamura, K. Nakagawa, H. Maeda, K. Nakahara, K. Ohno, N. Nakano, H. Matsuda. Thoracic Surgery
Study Group of Osaka University, Osaka, Japan
Surgery/Chest Wall
We retrospectively reviewed 30 patients with an invading apical lung cancer (IALC) who underwent surgery from 1987 to 1996 at our institute and the affiliated hospitals in terms of effect of induction therapy. IALC was defined as primary lung cancer which invades a chest wall beyond the first rib and was associated with a pain in the shoulder or the arm. There were 10 patients with no induction therapy (NT), 9 with radiation therapy (RT) and 11 with concurrent chemoradiotherapy (CCRT). There were no significant differences in age (57 ± 8, 55 ± 13, 51 ± 9 years), sex, histological diagnosis, pstage. The follow up time was 6.7 ± 3.0 years in NT, 6.4 ± 3.1 years in RT, and 4.6 ± 1.5 years in CRT, respectively. RT patients received a mean of 42 (30-52.5) Gy and CCRT patients a mean of 48 (40-56) Gy. Regimens of CCRT patients consisted of CDDP + MMC + Vindesine in 5, CDDP + Vindesine in 3 and CDDP (or CBDCA) + Etoposide in 3. The operative mortality was 1/30. The one, three and five year survival rates were 70, 20, 20% in NT patients, 33, 11, 11% in RT patients, and 82, 64, 53% in CCRT patients, respectively. The survival rate of CCRT patients was significantly higher than that of NT and RT patients. We conclude that CCRT may be superior to RT alone as induction therapy for IALC.
•
Surgery for primary and metastatic [46-• tumors
Friday, 15 September 2000
10:30-12:00
ORAL SESSION
4
•
]
En bloc chest wall resection for peripheral lung cancer
P.P. Brega Massone, C. Lequaglie, B. Conti, B. Magnani 1 , I. Cataldo.
Oncologic Thoracic Surgery, Istituto Nazionale Tumor±, Milano; I Statistica/ Unit, /1. AA.RR., Pavia, Italy In our the Department of Oncology Thoracic Surgery of National Cancer Institute of Milan, from 1988 to 1996, 121 patients with lung cancer involving chest wall underwent surgical treatment. One hundred five were males (87%) and 16 females (13%), with a mean age of 61.21 ± 8.61 years, a median of 62.5 years in a range 36-77. We performed in every patients an en-bioc chest wall and pulmonary resection to achieve a complete tumor clearance. In 70 subjects tumor was located on the rigth (58%) while in 51 on the left (42%). The intervention was a Iobectomy in 64 cases (53%), 33 upper right, 24 upper left, 2 media, 3 lower right and 2 lower left; a superior bilobectomy in 4 (3%); a typical segmentectomy in 3 (2%); a pneumonectomy in 8 (7%), 6 left and 2 right; a wedge resection in 42 (35%), 20 of upper right lobe, 15 of upper left lobe, 4 of lower right lobe and 3 of lower
malignant chest wall
I.S. Poliakov, V.A. Porhanov, V.B. Kononenko, S.S. Semendiaev, MU. Mamelov, V.N. Bodnia. Thoracic Surgery Department,
Krasnodar, Russia Objective: Presence of pain syndrome caused by chest wall tumor invasion necessitates its resection as improving life quality, even with palliative effect only. Materials and Methods: Between 1989 and 1998 61 patients were treated for chest wall tumor invasion. Primary tumor: chondrosarcoma in 8, solitary plasmacytoma in 4, osteoblastoclastoma in 4, malignant fibrogistiocytoma 3, desmoid 2. Metastatic invasion was caused by melanoma in 2, osteosarcoma in 1, cotorectal cancer in 1, mesotheliorna in 2. Chest wall invasion was observed in 34 cases. Three patients underwent resection of sternum alone, 32 had resection of ribs and lung, 2-ribs, lung and vertebrae, 2-vertebrae and ribs, 22 had rib resection. Defect closure was performed by musculo-cutaneous flap, bone autograft, Marlex mesh.