Earlier reports of treatment of SST have only historical value because major improvements have been made in staging (CT scan, MRI, (video-) mediastinoscopy and, more recently, positron emission tomography and endoscopic ultrasonography), surgical skills (type of incision), and radiotherapy (treatment planning and delivery). Most surgical series reported in the recent literature show a 5-year survival rate of 10 to 40%, with a calculated median of 32 ± 12% (± SD).
There are indications that the prognosis of SST can be improved results when the combination of preoperative and/or postoperative radiotherapy and surgery is used Generic viagra pharmacy whether or not with concomitant chemotherapy. In this series of SST, a protocol has been used combining optimal radiotherapy including intraoperative brachytherapy and resection of the apex of the thoracic wall. In delivering external beam radiotherapy, concerns about the tolerance level of the plexus and spinal cord has to be taken into account. To avoid late radiation damage of these structures, it is often impossible to administer a curative dose of radiotherapy only with external fields. Brachytherapy is by nature the most conformational technique of radiotherapy.
Boosting the surgical bed, the area with the highest risk of microscopic residual disease gives a high extra dose to a thin layer of tissue, while due to the rapid fall-off of dose, the spinal cord is relatively spared. Therefore, brachytherapy by means of intraoperative high-dose rate afterloading irradiation is an option after approaching the tolerance level (50 Gy) of the spinal cord by external irradiation, a facility available in our institute; however, others could not find any advantage for the use of this technique Sildenafil Australia.
In experienced hands, the complex surgical procedure is feasible without increased morbidity, compared with a lung resection without removing a part of the chest wall even when preoperative radiotherapy has been administered. Only our patient who died after a bronchopleural fistula may be considered as a complication related to the radiotherapy; however, published data on additional complications of radiotherapy are scarce. The complication rate of 1 of 22 patients (4%) is similar to that reported in the literature of extended lung surgery. Operative mortality is only mentioned in 7 of the 13 reviewed articles with a median mortality of 3.5 ± 2.9%.
