Radical en bloc resection advised for NSCLC with chest wall invasion

Based on a retrospective analysis, a group of Italian surgeons recommends radical en bloc resection for the treatment of chest wall invasive non-small cell lung cancer (NSCLC).

“The treatment of patients with NSCLC that is invading the chest wall is still debated,” Dr. Giancarlo Rovario and colleagues from the University of Milan, note in the May issue of Chest. They report their experience to document the improvements in outcomes seen over the last 10 years. The researchers operated on 146 patients with chest wall invasion, among the 2738 patients seen with NSCLC between 1970 and 1999. They excluded any cases with superior sulcus tumor and tumors invading the diaphragm or mediastinum. One hospital death (0.69%) was reported as a result of respiratory inefficiency. Five major complications (3.4%) were reported. Between 1970 and 1979, 32 patients underwent surgery. Of these, 10 underwent an exploratory thoracotomy (ET) and 22 underwent a radical resection. The 5-year survival rate was 22.73%.From 1980 to 1989, 67 patients underwent surgery. Of these, 11 had ET and 56 had a radical resection. “The survival rate following radical resection was 14.1%,” Dr. Rovario and colleagues explain.Between 1990 and 1999, 47 patients underwent surgery. Of these, 2 underwent ET, 2 underwent exploratory thoracoscopy, and 43 underwent a radical resection. The 5-year survival rate in this group was 42.7%. The group comments that adjuvant chemotherapy does not appear to influence the survival rate. Hence they conclude that, given the improved survival noted in their series over the past decade, “en bloc surgical resection of the chest wall still represents the mainstay of treatment.”(Source: Chest 2003;123:1341-1347: Reuters Health: 9th June 2003: Oncolink)