1 / 7

NSCLC Pancoast tumor

NSCLC Pancoast tumor. Swiss tumor board Bern – 26.3.2009. Dr. Christian Monnerat Département Pluridisciplaire d’Oncologie – Hôpital Neuchâtelois Service de génétique médicale – CHUV - Lausanne. NSCLC stage IIIB (treated in 2004) Summary of the case presented by Dr. Zappa.

jaxon
Download Presentation

NSCLC Pancoast tumor

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. NSCLCPancoast tumor Swiss tumor board Bern – 26.3.2009 Dr. Christian Monnerat Département Pluridisciplaire d’Oncologie – Hôpital Neuchâtelois Service de génétique médicale – CHUV - Lausanne

  2. NSCLC stage IIIB(treated in 2004)Summary of the case presented by Dr. Zappa 82 y. woman, severe comorbidities (diarrhes, diverticulitis,hypecalcemia,…) Biopsies : G3 NSCLC (squamoid) obtained by bronchoscopy CT + PET-CT : upper left « huge » Pancoast NSCLC Palliative RT (or RT + CT) Curative RT-CT (ev surgery ?) Palliative or curative option ?

  3. Pancoast tumorcurative intent ? metaanalyses or large prospective studies of patients are not available Sulcus tumors or Pancoast tumors: Lung cancers in the apex of the chest, with ANY invasion of apical chest wall structures . Brachial plexus invasion not more required for definition Staging work-up like other resectable lung cancers Strong recommandation to perform a mediastinoscopy Shen - CHEST 2007; 132:290S–305S

  4. Pancoast tumorcurative intent Chemoradiation followed by surgery if possible Chemoradiation alone Baltimore retrospective serie of 37 patients induction chemotherapy high-dose three-dimensional radiation (60 Gy) followed by surgery In 37 patients : complete resection rate of 97.3% complete response rate of 40.5% Overall median survival time was 2.6 years (7.8 years in the group with a pathologic CR) Kwong K, J Thorac Cardiovasc Surg 2005;129:1250–1257 Staging work-up like other resectable lung cancers Shen - CHEST 2007; 132:290S–305S

  5. Pancoast tumorpalliative intent radiation alone achieved good palliation of pain in approximately 75% of patients (Van Houtte P. Cancer 1984; 54:223–227) No long term survival if radiation alone (<5%) (Detterbeck FC, Pancoast tumors. Saunders, 2001; 233–243) Palliative radiotherapy recommended in this case (age, comorbidities) Shen - CHEST 2007; 132:290S–305S

  6. NSCLC stage IIIBChemoradiation Standard : Concomittant chemoradiation Slight OS advantage : HR 0.87 The optimal chemotherapy regimen to combine with RT is uncertain Jett - CHEST 2007; 132:266S–276S

  7. NSCLC stage IIIBChemoradiation (oral vinorelbine) • 2 induction cycles : • oral vinorelbine 60 mg/m day 1,8 cycle 1 and 80 mg/m day 1,8 cycle 2 • cisplatin 80 mg/m day 1 every 3 weeks for 2 cycles as induction • Radiotherapy 66 Gy (6,5 weeks) with 2 cycles of • oral vinorelbine 40 mg/m day 1, 8 • cisplatin 80 mg/m day 1 every 3 weeks TOX : G3 dysphagia/radiation in 4% ORR 54% Med DFS = 12.5 mo Med OS = 23.4 mo Krzakowski M – J Thorac Oncol. 2008 Sep;3(9):994-1002.

More Related