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Significance of Multimodality Therapy in Patients with a Superior Sulcus Tumor of the Lung: A Review Article

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DOI: 10.4236/jct.2014.51014    2,574 Downloads   3,681 Views   Citations

ABSTRACT

Despite the aggressive pursuit of diagnostic and treatment modalities for lung cancer, the treatment outcomes are still not satisfactory, and even patients with surgically resectable non-small cell lung cancer (NSCLC) are often at considerable risk of suffering recurrence and/or death from lung cancer. Regarding the treatment of patients with locally advanced, resectable NSCLC, several retrospective and prospective studies have shown the significance of multimodality treatments with preoperative chemoradiotherapy and surgical treatment. However, no definitive treatment strategies for locally advanced NSCLC patients have yet been established. One of the reasons for the lack of established treatment strategies for patients with locally advanced NSCLC is considered to be the heterogeneity of the population, i.e., cT4N0, cT3-4N1 and cT1a-3N2 tumors are included in stage IIIA disease, and superior sulcus tumors (SSTs) are also included in this classification. With regard to SST, two representative prospective phase II trials indicated the efficacy of surgical treatment following concurrent radiation and chemotherapy. In a study conducted by the Southwest Oncology Group, 110 patients with superior sulcus NSCLC were treated with two cycles of cisplatin and etoposide concurrently with 45 gray (Gy) of radiation, followed by surgical treatment and two additional cycles of chemotherapy postoperatively. The response rate (RR) to the preoperative chemoradiotherapy was 86%, and 83 patients (76%) were able to undergo complete resection. A pathological complete response (CR) was observed in 61 patients (56%), and the five-year survival of all patients and those undergoing complete resection was 44% and 54%, respectively. A phase II study conducted by the Japan Clinical Oncology Group examined the safety and efficacy of preoperative concurrent chemoradiotherapy using mitomycin, vinblastin and cisplatin followed by surgical treatment. Seventy-six patients with SST were enrolled in this study, and all received chemotherapy using two cycles of MVP concurrently with 45 Gy of radiation, followed by surgery. Neoadjuvant chemoradiotherapy resulted in a 61% RR, and pathological complete resection was successfully achieved in 51 patients (68%). A pathological CR was observed in 12 patients (16%), and the disease-free and overall survival rates at five years were 45% and 56%, respectively. Both studies showed the efficacy and tolerability of the multimodality treatment for SST, thus suggesting that multimodality treatment with preoperative chemoradiotherapy followed by surgery may therefore be an effective treatment for resectable SST. We herein review the results of retrospective and prospective studies while assessing the treatment outcomes of NSCLC patients with SST.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

G. Toyokawa, M. Takenoyama and Y. Ichinose, "Significance of Multimodality Therapy in Patients with a Superior Sulcus Tumor of the Lung: A Review Article," Journal of Cancer Therapy, Vol. 5 No. 1, 2014, pp. 115-123. doi: 10.4236/jct.2014.51014.

References

[1] A. J. Alberg, et al., “American College of Chest Physicians. Epidemiology of Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition),” Chest, Vol. 132, No. 3, 2007, pp. 29S-55S.
[2] R. J. Ginsberg, et al., “Randomized Trial of Lobectomy versus Limited Resection for T1 N0 Non-Small Cell Lung Cancer. Lung Cancer Study Group,” Annals of Thoracic Surgery, Vol. 60, No. 3, 1995, pp. 615-622. http://dx.doi.org/10.1016/0003-4975(95)00537-U
[3] H. Asamura, et al., “A Japanese Lung Cancer Registry Study: Prognosis of 13,010 Resected Lung Cancers,” Journal of Thoracic Oncology, Vol. 3, No. 1, 2008, pp. 46-52. http://dx.doi.org/10.1097/JTO. 0b013e31815e8577
[4] T. Goya, et al., “Prognosis of 6644 Resected Non-Small Cell Lung Cancers in Japan: A Japanese Lung Cancer Registry Study,” Lung Cancer, Vol. 50, No. 2, 2005, pp. 227-234. http://dx.doi.org/10.1016/j. lungcan.2005.05.021
[5] N. Sawabata, et al., “Japanese Lung Cancer Registry Study of 11,663 Surgical Cases in 2004: Demographic and Prognosis Changes over Decade,” Journal of Thoracic Oncology, Vol. 6, No. 7, 2011, pp. 1229-1235. http://dx.doi.org/10.1097/JTO.0b013e318219aae2
[6] H. Kato, et al., “A Randomized Trial of Adjuvant Chemotherapy with Uracil-Tegafur for Adenocarcinoma of the Lung,” New England Journal of Medicine, Vol. 350, No. 17, 2004, pp. 1713-1721. http://dx.doi.org/10.1056/NEJMoa032792
[7] J. P. Pignon, et al., “Lung Adjuvant Cisplatin Evaluation: A Pooled Analysis by the LACE Collaborative Group,” Journal of Clinical Oncology, Vol. 26, No. 21, 2008, pp. 3552-3559. http://dx.doi.org/10.1200/ JCO.2007.13.9030
[8] S. Heon, et al., “Adjuvant Chemotherapy for Surgically Resected Non-Small Cell Lung Cancer,” Journal of Thoracic Cardiovascular Surgery, Vol. 144, No. 3, 2012, pp. S39-S42. http://dx.doi.org/10.1016/j. jtcvs.2012.03.039
[9] Non-Small Cell Lung Cancer Collaborative Group, “Chemotherapy and Supportive Care versus Supportive Care Alone for Advanced Non-Small Cell Lung Cancer,” Cochrane Database of Systematic Reviews, Vol. 12, No. 5, 2010, Article ID: CD007309.
[10] T. Mitsudomi, et al., “Gefitinib versus Cisplatin plus Docetaxel in Patients with Non-Small-Cell Lung Cancer Harbouring Mutations of the Epidermal Growth Factor Receptor (WJTOG3405): An Open Label, Randomised Phase 3 Trial,” Lancet Oncology, Vol. 11, No. 2, 2010, pp. 121-128.
http://dx.doi.org/10.1016/S1470-2045(09)70364-X
[11] A. T. Shaw, et al., “Crizotinib versus Chemotherapy in Advanced ALK-Positive Lung Cancer,” New England Journal of Medicine, Vol. 368, No. 25, 2013, pp. 2385-2394. http://dx.doi.org/10.1056/ NEJMoa1214886
[12] T. Seto, et al., “CH5424802 (RO5424802) for Patients with ALK-Rearranged Advanced Non-Small-Cell Lung Cancer (AF-001JP Study): A Single-Arm, Open-Label, Phase 1-2 Study,” Lancet Oncology, Vol. 14, No. 7, 2013, pp. 590-598. http://dx.doi.org/10.1016/S1470-2045(13)70142-6
[13] F. G. Pearson, et al., “Significance of Positive Superior Mediastinal Nodes Identified at Mediastinoscopy in Patients with Resectable Cancer of the Lung,” Journal of Thoracic and Cardiovascular Surgery, Vol. 83, No. 1, 1982, pp. 1-11.
[14] N. Martini, et al., “The Role of Surgery in N2 Lung Cancer,” Surgical Clinics of North America, Vol. 67, No. 5, 1987, pp. 1037-1049.
[15] Y. Watanabe, et al., “Aggressive Surgical Intervention in N2 Non-Small Cell Cancer of the Lung,” Annals of Thoracic Surgery, Vol. 51, No. 2, 1991, pp. 253-261. http://dx.doi.org/10.1016/0003-4975(91)90797-T
[16] T. Funatsu, et al., “The Role of Mediastinoscopic Biopsy in Preoperative Assessment of Lung Cancer,” Journal of Thoracic and Cardiovascular Surgery, Vol. 104, No. 6, 1992, pp. 1688-1695.
[17] R. R. Shaw, et al., “Treatment of Superior Sulcus Tumor by Irradiation Followed by Resection,” Annals of Surgery, Vol. 154, No. 1, 1961, pp. 29-40. http://dx.doi.org/10.1097/00000658-196107000-00003
[18] A. Masaoka, et al., “Anterior Approach for Tumor of the Superior Sulcus,” Journal of Thoracic and Cardiovascular Surgery, Vol. 78, No. 3, 1979, pp. 413-415.
[19] H. Niwa, et al., “Surgical Therapy for Apical Invasive Lung Cancer: Different Approaches According to Tumor Location,” Lung Cancer, Vol. 10, No. 1-2, 1993, pp. 63-71. http://dx.doi.org/10.1016/0169-5002(93)90310-T
[20] P. G. Dartevelle, et al., “Anterior Transcervical-Thoracic Approach for Radical Resection of Lung Tumors Invading the Thoracic Inlet,” Journal of Thoracic and Cardiovascular Surgery, Vol. 105, No. 6, 1993, pp. 1025-1034.
[21] D. Grunenwald, et al., “Transmanubrial Osteomuscular Sparing Approach for Apical Chest Tumors,” Annals of Thoracic Surgery, Vol. 63, No. 2, 1997, pp. 563-566. http://dx.doi.org/10.1016/S0003-4975(96)01023-5
[22] D. L. Paulson, “Carcinomas in the Superior Pulmonary Sulcus,” Journal of Thoracic and Cardiovascular Surgery, Vol. 70, No. 6, 1975, pp. 1095-1104.
[23] V. W. Rusch, et al., “Factors Determining Outcome after Surgical Resection of T3 and T4 Lung Cancers of the Superior Sulcus,” Journal of Thoracic and Cardiovascular Surgery, Vol. 119, No. 6, 2000, pp. 1147-1153. http://dx.doi.org/10.1067/mtc.2000.106089
[24] R. Martínez-Monge, et al., “Combined Treatment in Superior Sulcus Tumors,” American Journal of Clinical Oncology, Vol. 17, No. 4, 1994, pp. 317-322. http://dx.doi.org/10.1097/00000421-199408000-00007
[25] M. P. Hagan, et al., “Superior Sulcus Lung Tumors: Impact of Local Control on Survival,” Journal of Thoracic and Cardiovascular Surgery, Vol. 117, No. 6, 1999, pp. 1086-1094. http://dx.doi.org/10. 1016/S0022-5223(99)70244-8
[26] S. Gandhi, et al., “A Multidisciplinary Surgical Approach to Superior Sulcus Tumors with Vertebral Invasion,” Annals of Thoracic Surgery, Vol. 68, No. 5, 1999, pp. 1778-1784. http://dx.doi.org/10. 1016/S0003-4975(99)01068-1
[27] R. Komaki, et al., “Outcome Predictors for 143 Patients with Superior Sulcus Tumors Treated by Multidisciplinary Approach at the University of Texas M.D. Anderson Cancer Center,” International Journal of Radiation Oncology, Biology, Physics, Vol. 48, No. 2, 2000, pp. 347-354.
http://dx.doi.org/10.1016/S0360-3016(00)00736-7
[28] E. Martinod, et al., “Management of Superior Sulcus Tumors: Experience with 139 Cases Treated by Surgical Resection,” Annals of Thoracic Surgery, Vol. 73, No. 5, 2002, pp. 1534-1540.
http://dx.doi.org/10.1016/S0003-4975(02)03447-1
[29] M. Alifano, et al., “Surgical Treatment of Superior Sulcus Tumors: Results and Prognostic Factors,” Chest, Vol. 124, No. 3, 2003, pp. 996-1003. http://dx.doi.org/10.1378/chest.124.3.996
[30] N. Pourel, et al., “Concurrent Cisplatin/Etoposide plus 3D-Conformal Radiotherapy Followed by Surgery for IIB (Superior Sulcus T3N0)/III Non-Small Cell Lung Cancer Yields a High Rate of Pathological Complete Response,” European Journal of Cardiothoracic Surgery, Vol. 33, No. 5, 2008, pp. 829-836. http://dx.doi.org/10.1016/j.ejcts.2008.01.063
[31] I. Kappers, et al., “Results of Combined Modality Treatment in Patients with Non-Small-Cell Lung Cancer of the Superior Sulcus and the Rationale for Surgical Resection,” European Journal of Cardiothoracic Surgery, Vol. 36, No. 4, 2009, pp. 741-746. http://dx.doi.org/10.1016/j.ejcts.2009. 04.069
[32] T. Tagawa, et al., “Non-Small Cell Lung Carcinoma of the Superior Sulcus: The Evolution of Treatment Outcomes with Multimodality Treatment at a Single Institution,” Journal of Surgical Oncology, Vol. 101, No. 6, 2010, pp. 495-499.
[33] A. Marra, et al., “Induction Chemotherapy, Concurrent Chemoradiation and Surgery for Pancoast Tumour,” European Respiratory Journal, Vol. 29, No. 1, 2007, pp. 117-126. http://dx.doi.org/10. 1183/09031936.00108205
[34] V. W. Rusch, et al., “Induction Chemoradiation and Surgical Resection for Non-Small Cell Lung Carcinomas of the Superior Sulcus: Initial Results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160),” Journal of Thoracic and Cardiovascular Surgery, Vol. 121, No. 3, 2001, pp. 472-483. http://dx.doi.org/10.1067/mtc.2001.112465
[35] V. W. Rusch, et al., “Induction Chemoradiation and Surgical Resection for Superior Sulcus Non-Small-Cell Lung Carcinomas: Long-Term Results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160),” Journal of Clinical Oncology, Vol. 25, No. 3, 2007, pp. 313-318. http://dx.doi.org/10.1200/ JCO.2006.08.2826
[36] H. Kunitoh, et al., “Phase II Trial of Preoperative Chemoradiotherapy Followed by Surgical Resection in Patients with Superior Sulcus Non-Small-Cell Lung Cancers: Report of Japan Clinical Oncology Group Trial 9806,” Journal of Clinical Oncology, Vol. 26, No. 4, 2008, pp. 644-649.
http://dx.doi.org/10.1200/JCO.2007.14.1911
[37] V. W. Rusch, “Management of Pancoast Tumours,” Lancet Oncology, Vol. 7, No. 12, 2006, pp. 997-1005. http://dx.doi.org/10.1016/S1470-2045(06)70974-3
[38] H. Kunitoh, et al., “A Pilot Trial of Preoperative MVP-Combined Chemoradiotherapy: Mitomycin C (MMC), Vindesine (VDS), and Cisplatin (CDDP), Concurrently Given with Thoracic Radiotherapy (TRT) in N2 Non-Small Cell Lung Cancer (NSCLC),” Proceedings of American Society of Clinical Oncology, Vol. 19, 2000, p. 530a.
[39] K. G. Tournoy, et al., “Mediastinal Staging of Lung Cancer: Novel Concepts,” Lancet Oncology, Vol. 13, No. 5, 2012, pp. e221-e229. http://dx.doi.org/10.1016/S1470-2045(11)70407-7
[40] D. R. Gomez, et al., “A Prospective Phase 2 Study of Surgery Followed by Chemotherapy and Radiation for Superior Sulcus Tumors,” Cancer, Vol. 118, No. 2, 2012, pp. 444-451.
http://dx.doi.org/10.1002/cncr.26277
[41] N. Yamamoto, et al., “Phase III Study Comparing Secondand Third-Generation Regimens with Concurrent Thoracic Radiotherapy in Patients with Unresectable Stage III Non-Small-Cell Lung Cancer: West Japan Thoracic Oncology Group WJTOG0105,” Journal of Clinical Oncology, Vol. 28, No. 23, 2007, pp. 3739-3745. http://dx.doi.org/10.1200/JCO.2009.24.5050
[42] Y. Ichinose, et al., “S-1 plus Cisplatin with Concurrent Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer: A Multi-Institutional Phase II Trial (West Japan Thoracic Oncology Group 3706),” Journal of Thoracic Oncology, Vol. 6, No. 12, 2011, pp. 2069-2075. http://dx.doi.org/10.1097/JTO. 0b013e3182307e5a
[43] M. Yamaguchi, et al., “Preoperative Concurrent Chemoradiotherapy of S-1/Cisplatin for Stage III Non-Small Cell Lung Cancer,” Annals of Thoracic Surgery, Vol. 96, No. 5, 2013, pp. 1783-1789.
http://dx.doi.org/10.1016/j.athoracsur.2013.06.036
[44] R. J. Cerfolio, et al., “Pulmonary Resection after High-Dose and Low-Dose Chest Irradiation,” Annals of Thoracic Surgery, Vol. 80, No. 4, 2005, pp. 1224-1230. http://dx.doi.org/10.1016/j.athoracsur. 2005.02.091
[45] M. J. Edelman, et al., “Phase I/II Trial of Hyperfractionated Radiation and Chemotherapy Followed by Surgery in Stage III Lung Cancer,” Annals of Thoracic Surgery, Vol. 86, No. 3, 2008, pp. 903-910. http://dx.doi.org/10.1016/j.athoracsur.2008.06.022
[46] J. D. Bradley, et al., “A Randomized Phase III Comparison of Standard-Dose (60 Gy) versus High-Dose (74 Gy) Conformal Chemoradiotherapy with or without Cetuximab for Stage III Non-Small Cell Lung Cancer: Results on Radiation Dose in RTOG0617,” Journal of Clinical Oncology, Vol. 31, 2013, Abstract 7501.
[47] E. M. Gore, et al., “Phase III Comparison of Prophylactic Cranial Irradiation versus Observation in Patients with Locally Advanced Non-Small-Cell Lung Cancer: Primary Analysis of Radiation Therapy Oncology Study RTOG 0214,” Journal of Clinical Oncology, Vol. 29, No. 3, 2011, pp. 272-278. http://dx.doi.org/10.1200/JCO.2010.29.1609
[48] I. Okamoto, et al., “Single-Agent Gefitinib with Concurrent Radiotherapy for Locally Advanced Mutations of the Epidermal Growth Factor Receptor,” Lung Cancer, Vol. 72, No. 2, 2011, pp. 199-204. http://dx.doi.org/10.1016/j.lungcan.2010.08.016

  
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