Nscac Case Study

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Case 2
NSCLC superior sulcus tumour (Pancost tumour)
70 years old male, life long smoker, presented with shoulder pain and cough. CXR reviled shadowing at the right lung apex, staging CT scan reviled possible superior sulcus tumour, Ct guided biopsy confirmed NSCLC squamous T4 (invading vertebral body)N0M0 stage IIIB. Patient has performance status of 1. Subsequently Patient’s case discussed at the Lung MDT and deemed operable. Decision was for induction preoperative chemoradiotherapy (CRT)followed by surgery. I will discuss the evidence for preoperative CRT followed by surgery in superior sulcus
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Patients were treated with preoperative Cisplatin and Etoposide and concurrent radiation to 45Gy in 25 fractions. Subsequently, Patients with stable disease or response to treatment underwent thoracotomy. All patients received an additional two cycles of chemotherapy postoperatively. Overall five-year survival was 44% and for patient with complete pathological response, 5 years’ survival was 54% …show more content…
This trial yielded a disease-free survival and overall survival rates at five years 45 and 56 percent, respectively. Interestingly in this trial, patients who underwent surgery, 92% of them had complete resection. Patient with incomplete resection or residual disease post operatively had further radiotherapy boost with 21.6 Gy in 12 fractions 10.
Furthermore, A single institution from France treated 107 patient with superior sulcus tumours with preoperative CRT followed by surgery. Again demonstrated 2 years survival of 55% and 3 years survival of 40%. Strikingly 61% of patients with N2 disease down staged to PN0/N1. Median survival was 26.7 months11.
Surgery for superior sulcus tumor is generally undertaken five weeks following induction CRT, providing staging CT scan demonstrate operable disease . Surgery is generally complicated given the location of the superior sulcus tumour and the possible complications associated with this treatment for example; chylothorax, ulnar nerve paralysis secondary to resection of the C8 nerve root, Horner 's syndrome12. Its important to mention, that localised vertebral body metastasis isn’t a contraindication for surgery, providing the localised metastasis is less than 50 % of the vertebral body as in our patient’s

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