En bloc resection of non-small-cell lung cancer invading the spine

To describe our surgical en bloc approach and to assess the outcome and survival of non-small-cell lung cancer (NSCLC) invading the spine.

We retrospectively reviewed our prospective database of all patients, who underwent lung resection with en bloc hemivertebrectomy or total vertebrectomy for NSCLC between January 2003 and December 2008 in an individualized multimodality treatment concept. Survival was estimated by the Kaplan-Meier method. Log-rank analyses were used to compare groups.

Twenty-eight patients (age 58.9 ± 12.9 years) were diagnosed with NSCLC invading the spine at a single center. Eight of those patients were inoperable. Twenty patients proceeded to surgery with en bloc hemivertebrectomy (n = 16) or total vertebrectomy (n = 4). Six patients had induction chemotherapy (30%). Complete resection could be achieved in 16 patients (80%). Morbidity was observed in eight patients (40%); no mortality occurred. Adjuvant radiation (n = 14) or chemoradiation (n = 6) was administered with 66 Gy. The mean survival and 5-year survival for patients, who underwent surgery (n=20), were 46.0 months and 47%, respectively. Inoperable patients had poorer survival (14.0 months; p = 0.004). Sublobar resections (p = 0.002) and incomplete resections (p = 0.02) were associated with inferior survival. Adjuvant chemoradiation (p = 0.088), hemivertebrectomy (p = 0.062), and age < 70 years (p = 0.076) trended toward prolonged survival.

Multimodality treatment including en bloc lung resections with hemivertebrectomy or total vertebrectomy offer promising long-term survival in highly selected patients with NSCLC invading the spine. These extended resections can be performed with acceptable morbidity and mortality in specialized centers. Patients aged ≥ 70 years should be selected very carefully for radical resection. Sublobar resections should be avoided.