Surgical treatment of primary sarcoma of the lung

Objective: To study the results of surgical treatment of primary lung sarco ma. Methods: Between 1982 and 1998, we performed 18 macroscopically complet e resections for primary sarcomas of the lung. The records of all patients were reviewed, as were pathological slides. Presence of symptoms, tumour si ze (more or less than 5 cm), complete resection, TNM stage and histology gr ade were analyzed for predictors of survival. Results: Patients comprised 1 1 women and seven men whose age ranged from 19 to 73 years (mean 50 years). Mean tumour diameter was 8.05 cm (range 2.5-15 cm) There were one grade 1, eight grade 2 and nine grade 3 tumours. Tumours in two patients were unres ectable at first presentation, and another was of doubtful resectability ac cording to computed tomography scan. These three patients received pre-oper ative chemotherapy, with a partial response in the two unresectable patient s allowing macroscopically complete resection in both cases. We performed 1 2 lobectomies (extended to the chest wall in two cases and to the diaphragm in two cases) and six pneumonectomies (extended to the chest wall in one c ase and the superior vena cava in one case). Operative and 30 days postoper ative mortality were nil. Resection margins were invaded in two cases. Six patients received post-operative chemo- or radiotherapy and three others un derwent repeat resections for pulmonary sarcoma recurrence. No patients wer e lost to follow-up. Pulmonary sarcomas recurred in eight patients (44%) le ading to death in five cases after a mean period of 17 months. Overall medi an survival was 48 months, and actuarial 5-year survival 43%. Only TNM stag e correlated with significantly increased survival. Conclusion: As complete resection is the best therapeutic option for obtaining an acceptable survi val rate in primary pulmonary sarcoma, pre-operative chemotherapy can be a useful adjunct in increasing the resectability of these tumours. (C) 2000 E lsevier Science B.V. All rights reserved.