En bloc resection of non-small-cell lung cancer invading the spine

Joachim Schirren; Tina Dönges; Michael Melzer; Robert Schönmayr; Michael Eberlein; Servet Bölükbas

doi:10.1016/j.ejcts.2010.12.046

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En bloc resection of non-small-cell lung cancer invading the spine

Journal article

Open access

Peer reviewed

En bloc resection of non-small-cell lung cancer invading the spine

Joachim Schirren, Tina Dönges, Michael Melzer, Robert Schönmayr, Michael Eberlein and Servet Bölükbas

European journal of cardio-thoracic surgery, Vol.40(3), pp.647-655

09/2011

DOI: 10.1016/j.ejcts.2010.12.046

PMID: 21334220

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Abstract

Abstract Objective: To describe our surgical en bloc approach and to assess the outcome and survival of non-small-cell lung cancer (NSCLC) invading the spine. Methods: We retrospectively reviewed our prospective database of all patients, who underwent lung resection with en bloc hemivertebrectomy or total vertebrectomy for NSCLC between January 2003 and December 2008 in an individualized multimodality treatment concept. Survival was estimated by the Kaplan-Meier method. Log-rank analyses were used to compare groups. Results: Twenty-eight patients (age 58.9 ± 12.9 years) were diagnosed with NSCLC invading the spine at a single center. Eight of those patients were inoperable. Twenty patients proceeded to surgery with en bloc hemivertebrectomy (n = 16) or total vertebrectomy (n = 4). Six patients had induction chemotherapy (30%). Complete resection could be achieved in 16 patients (80%). Morbidity was observed in eight patients (40%); no mortality occurred. Adjuvant radiation (n = 14) or chemoradiation (n = 6) was administered with 66 Gy. The mean survival and 5-year survival for patients, who underwent surgery (n = 20), were 46.0 months and 47%, respectively. Inoperable patients had poorer survival (14.0 months; p = 0.004). Sublobar resections (p = 0.002) and incomplete resections (p = 0.02) were associated with inferior survival. Adjuvant chemoradiation (p = 0.088), hemivertebrectomy (p = 0.062), and age ≪ 70 years (p = 0.076) trended toward prolonged survival. Conclusions: Multimodality treatment including en bloc lung resections with hemivertebrectomy or total vertebrectomy offer promising long-term survival in highly selected patients with NSCLC invading the spine. These extended resections can be performed with acceptable morbidity and mortality in specialized centers. Patients aged ≥ 70 years should be selected very carefully for radical resection. Sublobar resections should be avoided.

Multimodality Treatment

NSCLC

Vertebrectomy

Spine

Surgery

Details

Title: Subtitle: En bloc resection of non-small-cell lung cancer invading the spine
Creators: Joachim Schirren - aDepartment of Thoracic Surgery, Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany
Tina Dönges - aDepartment of Thoracic Surgery, Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany
Michael Melzer - aDepartment of Thoracic Surgery, Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany
Robert Schönmayr - aDepartment of Thoracic Surgery, Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany
Michael Eberlein - aDepartment of Thoracic Surgery, Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany
Servet Bölükbas - aDepartment of Thoracic Surgery, Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany
Resource Type: Journal article
Publication Details: European journal of cardio-thoracic surgery, Vol.40(3), pp.647-655
Publisher: Elsevier Science B.V
DOI: 10.1016/j.ejcts.2010.12.046
PMID: 21334220
ISSN: 1010-7940
eISSN: 1873-734X
Language: English
Date published: 09/2011
Academic Unit: Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
Record Identifier: 9984094771102771

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