Superior sulcus non–small cell lung cancers (Pancoast tumors): Current outcomes after multidisciplinary management Journal Article


Authors: McLaughlin, K.; Tan, K. S.; Dycoco, J.; Chen, M. F.; Chaft, J. E.; Mankuzhy, N. P.; Rimner, A.; Aly, R. G.; Fanaroff, R. E.; Travis, W. D.; Bilsky, M.; Bains, M.; Downey, R.; Huang, J.; Isbell, J. M.; Molena, D.; Park, B. J.; Jones, D. R.; Rusch, V. W.
Article Title: Superior sulcus non–small cell lung cancers (Pancoast tumors): Current outcomes after multidisciplinary management
Title Series: Journal of Thoracic and Cardiovascular Surgery
Abstract: Objective: Despite neoadjuvant chemoradiotherapy, Pancoast tumors still present surgical and oncologic challenges. To optimize outcomes, we used a multidisciplinary care paradigm with medical and radiation oncology, and involvement of spine neurosurgery for most T3 and all T4 tumors. Spine neurosurgery permitted resection of transverse process for T3 and vertebral body resection for T4 tumors. Methods: Retrospective analysis of single institution, prospective database of patients undergoing resection for cT3 4M0 Pancoast tumors. Patients were grouped as cT3 with combined resection with spine neurosurgery (T3 Neuro), cT3 without spine neurosurgery (T3 NoNeuro), and cT4. Overall survival, progression-free survival were analyzed by Kaplan-Meier and compared between groups using log-rank test. Cumulative incidence of local-regional and distant recurrence were compared using Gray test. P value <.05 was considered significant. Results: From 2000 to 2021, 155 patients underwent surgery: median age was 58 years, and 81 were (52%) men. Most patients received neoadjuvant platinum-based neoadjuvant chemoradiotherapy (n = 127 [82%]). Operations were 48 cT3 Neuro, 41 cT3 NoNeuro, 66 cT4. R0 resection was achieved in 49 (94%) cT3 NoNeuro, 35 (85%) cT3 Neuro, and 57 (86%) cT4 patients (P = .4). Complete or major pathologic response occurred in 71 (55%) patients. Lower local-regional cumulative incidence was seen in cT3 Neuro versus cT3 NoNeuro (P = .05) and after major pathologic response. Overall survival and progression-free survival were associated with complete response, pathologic stage, and nodal status but not cT category. Conclusions: This treatment paradigm was associated with a high frequency of R0 resection, complete response, and major pathologic response. cT3 and cT4 tumors had similar outcomes. Novel therapies are needed to improve complete response. © 2023
Keywords: middle aged; retrospective studies; neoadjuvant therapy; chemotherapy; cancer staging; neoplasm staging; neoplasm recurrence, local; radiation; carcinoma, non-small-cell lung; lung neoplasms; pathology; retrospective study; lung tumor; tumor recurrence; surgery; non small cell lung cancer; humans; human; male; female; pancoast tumors
Journal Title: Journal of Thoracic and Cardiovascular Surgery
Volume: 166
ISSN: 0022-5223
Publisher: Mosby Elsevier  
Date Published: 2023-12-01
Start Page: 1477
End Page: 1487.e8
Language: English
DOI: 10.1016/j.jtcvs.2023.08.023
PROVIDER: scopus
PUBMED: 37611845
PMCID: PMC11229055
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is Valerie W. Rusch -- Kaitlin Mcloughlin's last name is misspelled in the publication -- Source: Scopus
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MSK Authors
  1. Valerie W Rusch
    869 Rusch
  2. Mark H Bilsky
    320 Bilsky
  3. James Huang
    215 Huang
  4. Jamie Erin Chaft
    290 Chaft
  5. William D Travis
    749 Travis
  6. Bernard J Park
    266 Park
  7. Andreas Rimner
    527 Rimner
  8. Robert J Downey
    254 Downey
  9. Joseph Dycoco
    46 Dycoco
  10. Manjit S Bains
    338 Bains
  11. David Randolph Jones
    419 Jones
  12. Daniela   Molena
    277 Molena
  13. Kay See   Tan
    244 Tan
  14. James Michael Isbell
    128 Isbell
  15. Rania Gaber Aly
    31 Aly
  16. Monica Chen
    32 Chen