Resection of T4 Non-Small Cell Lung Cancer Invading the Spine: Short- and Long-term Outcomes of a Single-Institution
Presented During:
Sunday, May 4, 2025: 9:00AM - 4:00PM
Seattle Convention Center | Summit
Posted Room Name:
Poster Area, Exhibit Hall
Abstract No:
P0191
Submission Type:
Abstract Submission
Authors:
Domenico Galetta (1), Lorenzo Spaggiari (2)
Institutions:
(1) Division of Thoracic Surgery, San Giovanni Bosco Hospital, Turin, Italy, (2) European Institute of Oncology, Milan, Lombardia
Submitting Author:
Domenico Galetta
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Division of Thoracic Surgery, San Giovanni Bosco Hospital
Division of Thoracic Surgery, San Giovanni Bosco Hospital
Co-Author:
Lorenzo Spaggiari
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European Institute of Oncology
European Institute of Oncology
Presenting Author:
Domenico Galetta
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European Institute of Oncology
European Institute of Oncology
Abstract:
Object
Surgical treatment of non-small cell lung cancer (NSCLC) invading the spine is controversial. We evaluated surgical results and long-term outcomes of patients with T4 NSCLC who underwent vertebral resection (VR) infiltrated by lung tumor.
Methods
Retrospective analysis of 18 consecutive patients undergoing VR for NSCLC invading the spine between 2003 and 2023 was performed. Eleven patients (61.1%) received induction therapy. Vertebral resection was divided into 5 types; type 1 (Figure 1, A): only transverse process; type 2A (Figure 1, B): transverse process with a portion of the vertebral body; type 2B (Figure 1, C) : a portion of vertebral body without transverse process; type 3 (Figure 1, D), hemivertebrectomy; type 4 (Figure 1, E): total vertebrectomy.
Results
There were 16 men with a median age of 62 years (range, 41-80). Ten patients (55.5%) had induction therapy. Vertebral resection included 4 type 1 resection, 7 type 2A, 4 type 2B, 2 type 3, and 1 type 4. Pneumonectomy was performed in 3 patients, lobectomy in 9, segmentectomy in 3 and wedge in 3. Complete resection was achieved in 16 patients (88.8%). Surgical nodal status was N0 in 11 patients, N1 in 4, and N2 in 3, each. There was no postoperative mortality. Morbidity was observed in 7 patients (38.9%), including 1 (5.5%) neurologic complication, 3 (16.7%) ARDS, and 3 (16.7%) cardiac. Eight patients (44.4%) are alive without disease after e mean follow up of 48.6 months. The 1- and 5-year predicted survivals were 79% and 40.4%, respectively. Patients without nodal involvement had the best prognosis (56.3% vs 0%; p=0.0009). Induction therapy did not influence survival and morbidity.
Conclusions
Resection of NSCLC with vertebrectomy is technically demanding and is associated with acceptable morbidity. However, an encouraging long-term survival observed in this series suggest that resection could be a valid option in selected patients with vertebral invasion by NSCLC.
Surgical treatment of non-small cell lung cancer (NSCLC) invading the spine is controversial. We evaluated surgical results and long-term outcomes of patients with T4 NSCLC who underwent vertebral resection (VR) infiltrated by lung tumor.
Methods
Retrospective analysis of 18 consecutive patients undergoing VR for NSCLC invading the spine between 2003 and 2023 was performed. Eleven patients (61.1%) received induction therapy. Vertebral resection was divided into 5 types; type 1 (Figure 1, A): only transverse process; type 2A (Figure 1, B): transverse process with a portion of the vertebral body; type 2B (Figure 1, C) : a portion of vertebral body without transverse process; type 3 (Figure 1, D), hemivertebrectomy; type 4 (Figure 1, E): total vertebrectomy.
Results
There were 16 men with a median age of 62 years (range, 41-80). Ten patients (55.5%) had induction therapy. Vertebral resection included 4 type 1 resection, 7 type 2A, 4 type 2B, 2 type 3, and 1 type 4. Pneumonectomy was performed in 3 patients, lobectomy in 9, segmentectomy in 3 and wedge in 3. Complete resection was achieved in 16 patients (88.8%). Surgical nodal status was N0 in 11 patients, N1 in 4, and N2 in 3, each. There was no postoperative mortality. Morbidity was observed in 7 patients (38.9%), including 1 (5.5%) neurologic complication, 3 (16.7%) ARDS, and 3 (16.7%) cardiac. Eight patients (44.4%) are alive without disease after e mean follow up of 48.6 months. The 1- and 5-year predicted survivals were 79% and 40.4%, respectively. Patients without nodal involvement had the best prognosis (56.3% vs 0%; p=0.0009). Induction therapy did not influence survival and morbidity.
Conclusions
Resection of NSCLC with vertebrectomy is technically demanding and is associated with acceptable morbidity. However, an encouraging long-term survival observed in this series suggest that resection could be a valid option in selected patients with vertebral invasion by NSCLC.
THORACIC:
Chest Wall, Pleural and Mediastinal Disease
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