Current management of chest-wall tumors

Abstract

Chest-wall resection can be performed with low morbidity and mortality rates and remains the primary treatment for most chest-wall tumors. However, some lesions are best treated with a multimodality approach including preoperative chemotherapy. Therefore, pretreatment tissue diagnosis is essential in planning. The biopsy should be done at the medical center where the definitive treatment will be undertaken, and frequently, a needle biopsy will be sufficient. Osteosarcoma, rhabdomyosarcoma, Ewing's sarcoma, and other small-cell sarcomas are sensitive to chemotherapy, which should be given preoperatively, continued postoperatively, and modified according to the tumor response. Chondrosarcomas and most adult soft-tissue sarcomas are well controlled by primary excision and selective use of adjuvant irradiation. Better systemic and local therapy is needed for the recurrent soft-tissue sarcomas and the aggressive unclassified sarcomas. Chest-wall resection continues to play a primary role in the management of locally and regionally recurrent breast cancer but is best combined with systemic chemotherapy. Chest-wall resection can provide a long disease-free survival in patients with isolated metastases from sarcomas or carcinomas. In addition, significant palliation can be afforded patients with symptomatic chest-wall metastases and a shortened life expectancy.