Annals of Surgical Oncology

, Volume 3, Issue 3, pp 261–269 | Cite as

Chest wall invasive non-small cell lung cancer: Patterns of failure and implications for a revised staging system

  • David H. HarpoleJr.
  • Elizabeth A. Healey
  • Malcolm M. DeCampJr.
  • Steven J. Mentzer
  • Gary M. Strauss
  • David J. Sugarbaker
Original Articles


Background: To assess outcomes and patterns of failure for chest wall invasive non-small cell lung cancer (T3 or IIIA NSCLC), data were acquired prospectively on 47 consecutive patients at a single institution over 6 years.

Methods: Preresectional stagings included bone scan, head and chest/abdominal computed tomography, and mediastinoscopy. There were 25 superior sulcus tumors (radiation and/or chemotherapy followed by resection) and 22 other chest wall invasive NSCLCs (resection alone).

Results: There were no perioperative deaths. Seventeen patients (36%) had an operative complication (median length of stay increased from 7 to 12 days; p<0.05). A complete pathologic resection was achieved for 44 of 47 patients (94%). The median survival was 38 months (actuarial 2- and 5-year survival rates of 62% and 50%, respectively). Median lengths of survival for superior sulcus and other chest wall tumors were 36 and >60 months, respectively. Significant univariate predictors of decreased overall and cancer-free survival were poor performance status, positive margins, and positive lymph nodes. Recurrence was observed in 22 of 47 patients (46%) at a median of 8 months (range 2–24); patterns of failure were in the ipsilateral chest (n=2; 4%) and at a distant site (n=15; 32%) or both (n=5; 11%).

Conclusions: The operative risk for chest wall invasive NSCLC is acceptable, even after neoadjuvant therapy, allowing for a 94% complete resection rate. The survival of this subset of stage IIIA patients may warrant a reappraisal of the international staging system.

Key Words

Chest wall resection Non-small cell lung cancer Superior sulcus tumors Pancoast tumors 


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Copyright information

© The Society of Surgical Oncology, Inc 1996

Authors and Affiliations

  • David H. HarpoleJr.
    • 1
  • Elizabeth A. Healey
    • 3
  • Malcolm M. DeCampJr.
    • 1
  • Steven J. Mentzer
    • 1
  • Gary M. Strauss
    • 2
  • David J. Sugarbaker
    • 1
  1. 1.From the Division of Thoracic Surgery, Department of SurgeryHarvard Medical SchoolBostonUSA
  2. 2.Division of Hematology-Oncology, Department of MedicineHarvard Medical SchoolBostonUSA
  3. 3.Brigham and Women's Hospital, and The Harvard Joint Center for Radiation TherapyHarvard Medical SchoolBostonUSA

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