The following is a summary of “Superior sulcus non–small cell lung cancers (Pancoast tumors): Current outcomes after multidisciplinary management,” published in the December 2023 issue of Thoracic and Cardiovascular Surgery by McLaughlin, et al.

Pancoast tumors continue to provide complications in terms of both surgery and oncology, even though neoadjuvant chemotherapy and radiation treatment are being administered. For a study, researchers used a multidisciplinary care paradigm that included medical and radiation oncology, as well as the participation of spine neurosurgery, to achieve the best possible results for the majority of T3 tumors and all T4 tumors. Spinal neurosurgery made it possible to remove the vertebral body and the transverse process from tumors of the third and fourth levels, respectively. They sought to conduct a retrospective analysis of a prospective database of patients who were having resection for cT3 4M0 Pancoast tumors.

A retrospective analysis was conducted using a single institution’s prospective database, focusing on patients undergoing resection for cT3 4M0 Pancoast tumors. The patients were categorized into three groups: cT3 with combined resection with spine neurosurgery (T3 Neuro), cT3 without spine neurosurgery (T3 NoNeuro), and cT4. The study aimed to analyze overall survival and progression-free survival using Kaplan-Meier methods, with group comparisons done through the log-rank test. The cumulative incidence of local-regional and distant recurrence was assessed using the Gray test. A significance level of P < 0.05 was applied for statistical significance.

The median age of the 155 patients who had surgery was 58 years, and 81 were male, 52% of the total. Neoadjuvant platinum-based neoadjuvant chemotherapy and radiation treatment were administered to most patients (n = 127, or 82%). 48 cT3 Neuro, 41 cT3 NoNeuro, and 66 cT4 were the results of the operations.  A total of 49 (94%) cT3 NoNeuro patients, 35 (85%) cT3 Neuro patients, and 57 (86%) cT4 patients were successful in achieving R0 resection (P =.4). Seventy-one patients, or fifty-five percent, had a complete or significant pathologic response. There was a significant difference in the local-regional cumulative incidence between cT3 Neuro and cT3 NoNeuro (P =.05), seen after severe pathologic response. It was shown that full response, pathologic stage, and nodal status were linked with overall survival and progression-free survival, although cT category was not connected with these factors.

The treatment paradigm was shown to be linked with a high likelihood of R0 resection, full response, and substantial pathologic response. In terms of results, cT3 and cT4 tumors were comparable. There is a need for innovative therapy to enhance total response.

Source: sciencedirect.com/science/article/abs/pii/S0022522323007341