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Ribcage procedure after neoadjuvant chemoradiotherapy for non-small cell lung cancer involving the chest wall

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Abstract

Purpose

Non-small cell lung cancer (NSCLC) involving the chest wall is usually treated with en bloc rib resection or parietal pleurectomy; however, the former causes chest wall deformity and the latter is associated with local recurrence. To prevent both these sequalae, we performed the “ribcage” procedure for tumors involving the chest wall after induction chemoradiotherapy.

Methods

This was a single center retrospective study conducted from 2012 to 2018. The “ribcage” procedure is designed to preserve the ribs of patients with lung tumors involving chest wall and involves peeling the intercostal muscles and periosteum from the ribs, resulting in a birdcage-like appearance. Seventeen patients with NSCLC clearly involving the chest wall, but not destroying the ribs, were treated with induction chemoradiotherapy, followed by the ribcage procedure. A negative margin at the ribs was confirmed by intraoperative frozen sections in 16 of these patients, who then underwent the ribcage procedure.

Results

Complete resection was achieved in all 16 patients, none of whom experienced major postoperative complications. After a median follow-up period of 37 months, there was no evidence of local recurrence in any of the patients.

Conclusion

Our findings suggest that the ribcage procedure is the preferable surgical option as it can prevent chest wall deformities as well as local recurrence.

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References

  1. Lardinois D, Müller M, Furrer M, Banic A, Gugger M, Krueger T, et al. Functional assessment of chest wall integrity after methylmethacrylate reconstruction. Ann Thorac Surg. 2000;69:919–23.

    Article  CAS  Google Scholar 

  2. Leuzzi G, Nachira D, Cesario A, Novellis P, Petracca Ciavarella L, et al. Chest wall tumors and prosthetic reconstruction: a comparative analysis on functional outcome. Thorac Cancer. 2015;6:247–54.

    Article  Google Scholar 

  3. Rusch VW, Giroux DJ, Kraut MJ, Crowley J, Hazuka M, Winton T, 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). J Clin Oncol. 2007;25:313–8.

    Article  Google Scholar 

  4. Kunitoh H, Kato H, Tsuboi M, Shibata T, Asamura H, Ichinose Y, Japan Clinical Oncology Group, 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. J Clin Oncol. 2008;26:644–9.

    Article  CAS  Google Scholar 

  5. Iioka S, Sawamura K, Nagaoka Y, Chikamori J, Mori T, Nanjo S, et al. A new surgical method for chronic empyema–application of the extraperiosteal “air-plombage” procedure. Kekkaku. 1977;52:627–33.

    CAS  PubMed  Google Scholar 

  6. Ribeiro Netto A (1988) The extramusculoperiosteal resection ‘in cage of bird’ (Ribeiro Netto procedure) of invasive malignant lung neoplasms of thoracic wall side costal, of primary or secondary neoplasms of thoracic wall, of pathologic lung and of chronic empyemas. Ph.D. thesis. Rio de Janeiro: Faculty of Medical Sciences

  7. Kawaguchi K, Yokoi K, Niwa H, Ohde Y, Mori S, Okumura S, et al. Trimodality therapy for lung cancer with chest wall invasion: initial results of a phase II study. Ann Thorac Surg. 2014;98:1184–91.

    Article  Google Scholar 

  8. Downey RJ, Martini N, Rusch VW, Bains MS, Korst RJ, Ginsberg RJ. Extent of chest wall invasion and survival in patients with lung cancer. Ann Thorac Surg. 1999;68:188–93.

    Article  CAS  Google Scholar 

  9. Nomori H, Shiraishi A, O'uchi T, Honma K, Shoji K, Misawa M, et al. Positron emission tomography in T3/T4 non-small cell lung cancer after induction chemoradiotherapy. Ann Thorac Surg. 2019;109:255–61.

    Article  Google Scholar 

  10. Vandenvbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology. 2007;18:805–35.

    Article  Google Scholar 

  11. Guidelines for diagnosis and treatment of lung cancer. The Japan lung cancer society. Tokyo: Kanehara Inc.; 2014.

    Google Scholar 

  12. Chansky K, Detterbeck FC, Nicholson AG, Rusch VW, Vallières E, Groome P, IASLC Staging, and Prognostic Factors Committee, Advisory Boards, and Participating Institutions, et al. The IASLC lung cancer staging project: external validation of the revision of the TNM stage groupings in the eighth edition of the TNM classification of lung cancer. J Thorac Oncol. 2017;12:1109–21.

    Article  Google Scholar 

  13. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumors: revised RECIST guideline. Eur J Cancer. 2009;45:228–47.

    Article  CAS  Google Scholar 

  14. The Japan Lung Cancer Society—Tokyo. General rule for clinical and pathological record of lung cancer. 7th ed. Tokyo: Kanehara Inc.; 2010.

    Google Scholar 

  15. Kaplan EL, Meier P. Non-parametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–84.

    Article  Google Scholar 

  16. Nakahashi H, Yasumoto K, Ishida T, Nagashima A, Nishino T, Oka T, et al. Results of surgical treatment of patients with T3 non-small cell lung cancer. Ann Thorac Surg. 1988;46:178–81.

    Article  CAS  Google Scholar 

  17. Nomori H, Horio H, Hasegawa T. Chest wall reconstruction using a titanium hollow screw reconstruction plate. Thorac Cardiovasc Surg. 1997;45:35–7.

    Article  CAS  Google Scholar 

  18. Horio H, Ohtsuka T, Kubota Y, Hasegawa T, Nomori H, Naruke T, et al. Large chest wall reconstruction using titanium micromesh and a pedicled latissimus dorsi musculocutaneous flap: report of a case. Surg Today. 2005;35:73–5.

    Article  Google Scholar 

  19. Jordan BF, Sonveaux P, Feron O, Grégoire V, Beghein N, Dessy C, et al. Nitric oxide as a radiosensitizer: evidence for an intrinsic role in addition to its effect on oxygen delivery and consumption. Int J Cancer. 2004;109:768–73.

    Article  CAS  Google Scholar 

  20. Saleem W, Suzuki Y, Mobaraki A, Yoshida Y, Noda S, Saitoh JI, et al. Reduction of nitric oxide level enhances the radiosensitivity of hypoxic non-small cell lung cancer. Cancer Sci. 2011;102:2150–6.

    Article  CAS  Google Scholar 

  21. Aoki M, Sato M, Hirose K, Akimoto H, Kawaguchi H, Hatayama Y, et al. Radiation-induced rib fracture after stereotactic body radiotherapy with a total dose of 54–56 Gy given in 9–7 fractions for patients with peripheral lung tumor: impact of maximum dose and fraction size. Radiat Oncol. 2015;22(10):99. https://doi.org/10.1186/s13014-015-0406-8.

    Article  Google Scholar 

  22. Nomori H, Shiraishi A, Cong Y, Shoji K, Misawa M, Sugimura H, et al. Impact of induction chemoradiotherapy on pulmonary function after lobectomy for lung cancer. J Thorac Cardiovasc Surg. 2018;155:2129–37.

    Article  Google Scholar 

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Funding

No funding was received for the present study.

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, Kashiwa Kousei General Hospital, 617 Shikoda, Kashiwa city, Chiba, 277-8661, Japan

    Hiroaki Nomori

  2. Department of Pathology, Kameda Medical Center, Chiba, Japan

    Koichi Honma

  3. Department of Radiology, Kameda Medical Center, Chiba, Japan

    Kazufusa Shoji

  4. Department of Thoracic Pulmonary Medicine, Kameda Medical Center, Chiba, Japan

    Ayumu Otsuki

  5. Department of Thoracic Surgery, Kameda Medical Center, Chiba, Japan

    Yue Cong & Hiroshi Sugimura

  6. Department of Medical Oncology, Kameda Medical Center, Chiba, Japan

    Yu Oyama

Authors
  1. Hiroaki Nomori
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  2. Koichi Honma
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  3. Kazufusa Shoji
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  4. Ayumu Otsuki
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  5. Yue Cong
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  6. Hiroshi Sugimura
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  7. Yu Oyama
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Correspondence to Hiroaki Nomori.

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We have no conflict of interest or financial ties to declare. There has been no prior or related publication or prior abstract/poster session in relation to this study.

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Date and number of IRB approval: January 25th in 2014, 14-005.

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Nomori, H., Honma, K., Shoji, K. et al. Ribcage procedure after neoadjuvant chemoradiotherapy for non-small cell lung cancer involving the chest wall. Surg Today 50, 1262–1271 (2020). https://doi.org/10.1007/s00595-020-02015-5

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  • DOI: https://doi.org/10.1007/s00595-020-02015-5

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