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OBJECT - Traditionally, superior sulcus tumors of the lung that involve the chest wall and spinal column have been considered to be unresectable, and historically, patients harboring these tumors have been treated with local radiation therapy with, at best, modest results. The value of gross-total resection remains unclear in this patient population; however, with the recent advances in surgical technique and spinal instrumentation, procedures involving more radical removal of such tumors are now possible. At The University of Texas M. D. Anderson Cancer Center, the authors have developed a new technique for resecting superior sulcus tumors that invade the chest wall and spinal column. They present a technical description of this procedure and results in nine patients in whom stage IIIb superior sulcus tumors extensively invaded the vertebral column.
METHODS - These patients underwent gross-total tumor resection via a combined approach that included posterolateral thoracotomy, apical lobectomy, chest wall resection, laminectomy, vertebrectomy, anterior spinal column reconstruction with methylmethacrylate, and placement of spinal instrumentation. There were six men and three women, with a mean age of 55 years (range 36-72 years). Histological examination revealed squamous cell carcinoma (three patients), adenocarcinoma (four patients), and large cell carcinoma (two patients). The mean postoperative follow-up period was 16 months. All patients are currently ambulatory or remained ambulatory until they died. Pain related to tumor invasion improved in four patients and remained unchanged in five. In three patients instrumentation failed and required revision. There was one case of cerebrospinal fluid leakage that was treated with lumbar drainage and one case of wound breakdown that required revision. Two patients experienced local tumor recurrence, and one patient developed a second primary lung tumor.
CONCLUSIONS - The authors conclude that in selected patients, combined radical resection of superior sulcus tumors of the lung that involve the chest wall and spinal column may represent an acceptable treatment modality that can offer a potential cure while preserving neurological function and providing pain control.
Osteoblastomas of the cervical spine frequently occur with anterior vertebral body involvement despite the classical teaching, which suggests that involvement is usually confined to the posterior elements. A review of osteoblastomas that involved the cervical spine was conducted at a single institution over 20 years. Four patients were identified with osteoblastoma of the cervical spine from a total of 13 spinal osteoblastomas, and their conditions were assessed to determine the anatomic extent of neoplastic involvement, the surgical margins obtained at resection, methods of spinal stabilization, and local recurrence rate. A mean follow-up time of 11.4 years was obtained. Posterior surgical extirpation of the neoplasm can successfully be accomplished with good long-term results by achieving intralesional margins. Patients with cervical spine osteoblastomas represent a separate subset from patients with other spinal osteoblastomas because of their unique appearances.