ABSTRACT
BACKGROUND: Superior sulcus tumors, or Pancoast tumors, are challenging thoracic malignancies to treat due to their anatomical location posing difficult surgical access and potential involvement of adjacent vital structures. The current standard of care is trimodality treatment, which consists of induction chemoradiotherapy followed by radical surgical resection. This study aims to report the clinical outcomes of trimodality approach in British Columbia, Canada. METHODS: Patients with Pancoast tumors who underwent trimodality treatment between 2000-2015 were included in this provincial multi-center retrospective study. Patient-, disease-, and treatment-related data were collected, and treatment outcomes were recorded. RESULTS: We identified 32 patients who underwent induction chemoradiotherapy and subsequent surgical resection. Mean age was 59 (43-75 years) with median follow-up of 43 months (5-216 months). Complete resection was achieved in 31 patients (97%). Fourteen patients (44%) had pathological complete response after induction chemoradiotherapy. Thirteen (41%) showed minimal microscopic (>90% tumor necrosis) and 5 (16%) macroscopic residual disease (<90% tumor necrosis). Fourteen patients (44%) developed recurrence, which was distant in 9 cases. The 2-, 5-, and 10-year overall survival rates were 67.9%, 50.1%, 31.8% and the 2-, 5-, and 10-year disease-free survival rates were 65.1%, 47.1% and 28.2% respectively. There were no statistically significant differences in overall survival or disease-free survival rates with or without pathological complete response. CONCLUSIONS: Complete surgical resection with negative margins can be achieved after induction chemoradiotherapy, and curative-intent trimodality treatment can lead to long-term survival in some patients. This study did not demonstrate any prognostic value of pathological complete response, likely due to small sample size.
ABSTRACT
Music and surgery have a long and shared history, and the existence of musician-surgeons has been well documented. Best known for his 2 gastric reconstruction operations, Theodor Billroth was also a skilled musician and made valuable contributions to the field of music theory and composition. While he was a prolific composer during his lifetime, most of his works have unfortunately been lost. His 1 surviving composition Todessehnsucht offers insight into his composition process and serves as a testament to the amalgamation of his personal life, his career as a surgeon, and his lifelong love of music. This article seeks to analyze Billroth's only musical composition from a historical, musical, and sociopolitical perspective and to illustrate the close interplay between science and art in one of the most quintessential musician-surgeons in history.
