Complete pathological response is predictive for clinical outcome after tri-modality therapy for carcinomas of the superior pulmonary sulcus

Johannes L. Blaauwgeers, Ingrid Kappers, Houke M. Klomp, José S. Belderbos, Lea M. Dijksman, Egbert F. Smit, Pieter E. Postmus, Marinus A. Paul, Jan W. Oosterhuis, Koen J. Hartemink, Cornelis G. Vos, Jacobus A. Burgers, Max Dahele, Erik C. Phernambucq, Birgit I. Witte, Erik Thunnissen

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19 Citations (Scopus)

Abstract

The objective was to define the relationship between histopathological changes after pre-operative chemo-radiotherapy (CRT) and clinical outcome following tri-modality therapy in patients with superior sulcus tumours. A retrospective analysis of tumour material was performed in a series of 46 patients who received tri-modality therapy between 1997 and 2007. Median follow-up was 34 months (5-154). Pathological complete response (pCR) was present in 20/46 tumours (43 %). The most common RECIST score after CRT in patients with pCR was a partial response (PR; 10/17, three unknown), whereas in patients without a pCR, stable disease was the most common (22/26) (p = 0.002). In 26 specimens with residual tumour, this was mainly located in the periphery of the lesion rather than the centre (Spearman's correlation = 0.67, p < 0.001). Prognosis was significantly better after a pCR compared to residual tumour (70 % 5-year overall survival vs. 20 %; p = 0.001) and in patients with fewer than 10 % vital tumour cells as compared to those with >10 % (65 % 5-year overall survival vs. 18 %; p < 0.001). A low mitotic count was associated with a longer disease-free survival (p = 0.02). Complete pathological response and the presence of fewer than 10 % vital tumour cells after pre-operative CRT are both associated with a more favourable prognosis. A modification of the pathological staging system after radiotherapy, incorporating the percentage of vital tumour cells, is proposed.

Original languageEnglish
Pages (from-to)547-556
Number of pages10
JournalVirchows Archiv
Volume462
Issue number5
DOIs
Publication statusPublished - May 2013
Externally publishedYes

Keywords

  • Chemoradiation
  • Histopathology
  • Lung cancer
  • Pancoast
  • Prognosis

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