From the Guidelines
Surgical resection by a board-certified thoracic surgeon is the recommended treatment for spindle cell tumors in the thoracic region, with the goal of complete gross cytoreduction of the tumor. The treatment approach for spindle cell tumors, including those in the thoracic region, depends on various factors such as the specific type of tumor, stage, and patient's overall health.
Key Considerations
- Diagnosis requires a thorough evaluation including imaging (CT scan with contrast, MRI) and tissue biopsy with immunohistochemical staining to determine the specific tumor type 1.
- For patients being considered for surgery, a single-port thoracoscopy on the line of the potential incision is recommended to assess the tumor's extent and feasibility of resection 1.
- The surgical choices include pleurectomy/decortication (P/D) with mediastinal lymph node sampling and extrapleural pneumonectomy (EPP), with the selection based on the patient's risk profile, disease extent, and tumor histology 1.
Treatment Approach
- Pleurectomy/decortication may be a better choice for patients with advanced disease, mixed histology, and/or high-risk, while extrapleural pneumonectomy may be considered for good-risk patients with early disease and favorable histology 1.
- Adjuvant therapy, including chemotherapy and radiation therapy, may be necessary after surgery, depending on the pathologic analysis of the surgical specimen and whether any preoperative therapy was used 1.
Prognosis and Follow-Up
- The prognosis varies significantly based on the specific tumor type, grade, stage, and completeness of resection.
- Follow-up typically includes regular imaging every 3-6 months initially, then annually for at least 5 years.
Multidisciplinary Management
- These tumors require multidisciplinary management involving thoracic surgeons, oncologists, radiologists, and pathologists to optimize outcomes due to their complex nature and variable biological behavior.
From the Research
Spindle Cell Tumors of the Thoracic Region
- Spindle cell tumors can occur in the thoracic region, including the lung, pleura, and chest wall 2, 3, 4, 5, 6
- These tumors can be benign or malignant, and their diagnosis can be challenging due to overlapping morphologic features 4, 6
Types of Spindle Cell Tumors
- Solitary fibrous tumor, inflammatory myofibroblastic tumor, desmoid fibromatosis, synovial sarcoma, sarcomatoid carcinoma, spindle cell melanoma, dedifferentiated liposarcoma, epithelioid hemangioendothelioma, and sarcomatoid mesothelioma are some of the spindle cell tumors that can involve the pleura or peritoneum 4
- Spindle cell sarcoma of the chest wall is a rare tumor that can occur in pediatric patients 5
Diagnosis and Treatment
- The diagnosis of spindle cell tumors requires a combination of histologic assessment, immunohistochemical and molecular tools 4, 6
- Surgical resection is a common treatment option for spindle cell tumors, and may be performed using robot-assisted thoracoscopic surgery (RATS) or other minimally invasive techniques 3, 5
- Adjuvant chemoradiotherapy may also be used to treat spindle cell tumors, particularly in cases where the tumor is malignant or has a high risk of recurrence 5