Anterior transclavicular approach for lung cancer invading the superior sulcus.
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ABSTRACT:
SUBMITTER: Hashimoto K
PROVIDER: S-EPMC8691735 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectivesLocally advanced non-small-cell lung cancer (NSCLC) with chest wall invasion carries a high risk of recurrence and portends poor survival (30-40% and 20-50%, respectively). No studies have identified prognostic factors in patients who underwent R0 resection for non-superior sulcus NSCLC.MethodsA retrospective review was conducted for all chest wall resections for NSCLC from 2004 to 2018. Patients with superior sulcus tumours, partial (<1 rib) or incomplete (R1/R2) resection or distant metastasis were excluded. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Cox proportional hazards modelling was used to determine factors associated with DFS and OS.ResultsA total of 100 patients met inclusion criteria. Seventy-three (73%) patients underwent induction therapy, and all but 12 (16%) patients experienced a partial radiological response. A median of 3 ribs was resected (range 1-7), and 67 (67%) patients underwent chest wall reconstruction. The 5-year DFS and OS were 36% and 45%, respectively. Pathological N2 status [hazard ratio (HR) 3.12, confidence interval (CI) 1.56-6.25; P = 0.001], intraoperative blood transfusion (HR 2.24, CI 1.28-3.92; P = 0.005) and preoperative forced vital capacity (per % forced vital capacity, HR 0.97, CI 0.96-0.99; P = 0.013) were associated with DFS. Increasing pathological stage, lack of radiological response to induction therapy (HR 7.35, CI 2.35-22.99; P = 0.001) and cardiovascular comorbidity (HR 2.43, CI 1.36-4.36; P = 0.003) were associated with OS.ConclusionsWe demonstrate that blood transfusion and forced vital capacity are associated with DFS after R0 resection for non-superior sulcus NSCLC, while radiological response to induction therapy greatly influences OS. We confirm that pathological nodal status and pathological stage are reproducible determinants of DFS and OS, respectively.
| S-EPMC7305839 | biostudies-literature
Project description:IntroductionCurative-intent treatment of superior sulcus tumors (SSTs) of the lung invading the spine presents considerable challenges. We retrospectively studied outcomes in a single center, uniformly staged patient cohort treated with induction concurrent chemoradiotherapy followed by surgical resection (trimodality therapy).MethodsAn institutional surgical database from the period between 2002 and 2021 was accessed to identify SSTs in which the resection included removal of at least part of the vertebral body. All patients were staged using fluorodeoxyglucose positron emission tomography (/computed tomography), computed tomography scan of the chest/upper abdomen, and brain imaging. Surgical morbidity was assessed using the Clavien-Dindo classification. Overall and disease-free survival were calculated using the Kaplan-Meier method.ResultsA total of 18 patients were included: 8 complete and 10 partial vertebrectomies were performed, with six of the eight complete vertebrectomies involving two vertebral levels, resulting in Complete surgical resection (R0) in 94%. Nine patients had a 1-day procedure, and nine were staged over 2 days. The median follow-up was 30 months (interquartile range 11-57). The 90-day postoperative morbidity was 44% (grade III/IV), with no 90-day surgery-related mortality. There were 83% who had a major pathologic response, associated with improved survival (p = 0.044). The 5-year overall and disease-free survival were 55% and 40%, respectively. Disease progression occurred in 10 patients, comprising locoregional recurrences in two and distant metastases in eight patients.ConclusionsMultimodality treatment in selected patients with a superior sulcus tumor invading the spine is safe and results in good survival. Such patients should be referred to expert centers. Future research should focus on improving distant control (e.g. [neo]adjuvant immunotherapy).
| S-EPMC10689281 | biostudies-literature
Project description:Humans show a remarkable ability to discriminate others' gaze direction, even though a given direction can be conveyed by many physically dissimilar configurations of different eye positions and head views. For example, eye contact can be signaled by a rightward glance in a left-turned head or by direct gaze in a front-facing head. Such acute gaze discrimination implies considerable perceptual invariance. Previous human research found that superior temporal sulcus (STS) responds preferentially to gaze shifts [1], but the underlying representation that supports such general responsiveness remains poorly understood. Using multivariate pattern analysis (MVPA) of human functional magnetic resonance imaging (fMRI) data, we tested whether STS contains a higher-order, head view-invariant code for gaze direction. The results revealed a finely graded gaze direction code in right anterior STS that was invariant to head view and physical image features. Further analyses revealed similar gaze effects in left anterior STS and precuneus. Our results suggest that anterior STS codes the direction of another's attention regardless of how this information is conveyed and demonstrate how high-level face areas carry out fine-grained, perceptually relevant discrimination through invariance to other face features.
| S-EPMC3267037 | biostudies-literature
Project description:BackgroundAlthough preoperative chemotherapy (cisplatin-etoposide) and radiotherapy, followed by surgical resection, is considered a standard of care for superior sulcus cancers, treatment is rigorous and relapse limits long-term survival. The Southwest Oncology Group-Intergroup Trial S0220 was designed to incorporate an active systemic agent, docetaxel, as consolidation therapy.MethodsPatients with histologically proven and radiologically defined T3 to 4, N0 to 1, M0 superior sulcus non-small cell lung cancer underwent induction therapy with cisplatin-etoposide, concurrently with thoracic radiotherapy at 45 Gy. Nonprogressing patients underwent surgical resection within 7 weeks. Consolidation consisted of docetaxel every 3 weeks for 3 doses. The accrual goal was 45 eligible patients. The primary objective was feasibility.ResultsOf 46 patients registered, 44 were eligible and assessable; 38 (86%) completed induction, 29 (66%) underwent surgical resection, and 20 (45% of eligible, 69% surgical, and 91% of those initiating consolidation therapy) completed consolidation docetaxel; 28 of 29 (97%) underwent a complete (R0) resection; 2 (7%) died of adult respiratory distress syndrome. In resected patients, 21 of 29 (72%) had a pathologic complete or nearly complete response. The known site of first recurrence was local in 2, local-systemic in 1, and systemic in 10, with 7 in the brain only. The 3-year progression-free survival was 56%, and 3-year overall survival was 61%.ConclusionsAlthough trimodality therapy provides excellent R0 and local control, only 66% of patients underwent surgical resection and only 45% completed the treatment regimen. Even in this subset, distant recurrence continues to be a major problem, particularly brain-only relapse. Future strategies to improve treatment outcomes in this patient population must increase the effectiveness of systemic therapy and reduce the incidence of brain-only metastases.
| S-EPMC4122593 | biostudies-literature
Project description:Facial motion plays a fundamental role in the recognition of facial expressions in primates, but the neural substrates underlying this special type of biological motion are not well understood. Here, we used fMRI to investigate the extent to which the specialization for facial motion is represented in the visual system and compared the neural mechanisms for the processing of non-rigid facial motion in macaque monkeys and humans. We defined the areas specialized for facial motion as those significantly more activated when subjects perceived the motion caused by dynamic faces (dynamic faces > static faces) than when they perceived the motion caused by dynamic non-face objects (dynamic objects > static objects). We found that, in monkeys, significant activations evoked by facial motion were in the fundus of anterior superior temporal sulcus (STS), which overlapped the anterior fundus face patch. In humans, facial motion activated three separate foci in the right STS: posterior, middle, and anterior STS, with the anterior STS location showing the most selectivity for facial motion compared with other facial motion areas. In both monkeys and humans, facial motion shows a gradient preference as one progresses anteriorly along the STS. Taken together, our results indicate that monkeys and humans share similar neural substrates within the anterior temporal lobe specialized for the processing of non-rigid facial motion.
| S-EPMC7478875 | biostudies-literature
Project description:Object perception and categorization can occur so rapidly that behavioral responses precede or co-occur with the firing rate changes in the object-selective neocortex. Phase coding could, in principle, support rapid representation of object categories, whereby the first spikes evoked by a stimulus would appear at different phases of an oscillation, depending on the object category. To determine whether object-selective regions of the neo-cortex demonstrate phase coding, we presented images of faces and objects to two monkeys while recording local field potentials (LFP) and single unit activity from object-selective regions in the upper bank superior temporal sulcus. Single units showed preferred phases of firing that depended on stimulus category, emerging with the initiation of spiking responses after stimulus onset. Differences in phase of firing were seen below 20 Hz and in the gamma and high-gamma frequency ranges. For all but the <20-Hz cluster, phase differences remained category-specific even when controlling for stimulus-locked activity, revealing that phase-specific firing is not a simple consequence of category-specific differences in the evoked responses of the LFP. In addition, we tested for firing rate-to-phase conversion. Category-specific differences in firing rates accounted for 30-40% of the explained variance in phase occurring at lower frequencies (<20 Hz) during the initial response, but was limited (<20% of the explained variance) in the 30- to 60-Hz frequency range, suggesting that gamma phase-of-firing effects reflect more than evoked LFP and firing rate responses. The present results are consistent with theoretical models of rapid object processing and extend previous observations of phase coding to include object-selective neocortex.
| S-EPMC3511080 | biostudies-literature
Project description:Primates are highly attuned not just to social characteristics of individual agents, but also to social interactions between multiple agents. Here we report a neural correlate of the representation of social interactions in the human brain. Specifically, we observe a strong univariate response in the posterior superior temporal sulcus (pSTS) to stimuli depicting social interactions between two agents, compared with (i) pairs of agents not interacting with each other, (ii) physical interactions between inanimate objects, and (iii) individual animate agents pursuing goals and interacting with inanimate objects. We further show that this region contains information about the nature of the social interaction-specifically, whether one agent is helping or hindering the other. This sensitivity to social interactions is strongest in a specific subregion of the pSTS but extends to a lesser extent into nearby regions previously implicated in theory of mind and dynamic face perception. This sensitivity to the presence and nature of social interactions is not easily explainable in terms of low-level visual features, attention, or the animacy, actions, or goals of individual agents. This region may underlie our ability to understand the structure of our social world and navigate within it.
| S-EPMC5664556 | biostudies-literature
Project description:The superior temporal sulcus (STS) is a critical region for multiple neural processes in the human brain Hein and Knight (J Cogn Neurosci 20(12): 2125-2136, 2008). To better understand the multiple functions of the STS it would be useful to know more about its consistent functional coactivations with other brain regions. We used the meta-analytic connectivity modeling technique to determine consistent functional coactivation patterns across experiments and behaviors associated with bilateral anterior, middle, and posterior anatomical STS subregions. Based on prevailing models for the cortical organization of audition and language, we broadly hypothesized that across various behaviors the posterior STS (pSTS) would coactivate with dorsal-stream regions, whereas the anterior STS (aSTS) would coactivate with ventral-stream regions. The results revealed distinct coactivation patterns for each STS subregion, with some overlap in the frontal and temporal areas, and generally similar coactivation patterns for the left and right STS. Quantitative comparison of STS subregion coactivation maps demonstrated that the pSTS coactivated more strongly than other STS subregions in the same hemisphere with dorsal-stream regions, such as the inferior parietal lobule (only left pSTS), homotopic pSTS, precentral gyrus and supplementary motor area. In contrast, the aSTS showed more coactivation with some ventral-stream regions, such as the homotopic anterior temporal cortex and left inferior frontal gyrus, pars orbitalis (only right aSTS). These findings demonstrate consistent coactivation maps across experiments and behaviors for different anatomical STS subregions, which may help future studies consider various STS functions in the broader context of generalized coactivations for individuals with and without neurological disorders.
| S-EPMC6040641 | biostudies-literature
Project description:The superior temporal sulcus (STS) is a crucial hub for speech perception and can be studied with high spatiotemporal resolution using electrodes targeting mesial temporal structures in epilepsy patients. Goals of the current study were to clarify functional distinctions between the upper (STSU) and the lower (STSL) bank, hemispheric asymmetries, and activity during self-initiated speech. Electrophysiologic properties were characterized using semantic categorization and dialog-based tasks. Gamma-band activity and alpha-band suppression were used as complementary measures of STS activation. Gamma responses to auditory stimuli were weaker in STSL compared with STSU and had longer onset latencies. Activity in anterior STS was larger during speaking than listening; the opposite pattern was observed more posteriorly. Opposite hemispheric asymmetries were found for alpha suppression in STSU and STSL. Alpha suppression in the STS emerged earlier than in core auditory cortex, suggesting feedback signaling within the auditory cortical hierarchy. STSL was the only region where gamma responses to words presented in the semantic categorization tasks were larger in subjects with superior task performance. More pronounced alpha suppression was associated with better task performance in Heschl's gyrus, superior temporal gyrus, and STS. Functional differences between STSU and STSL warrant their separate assessment in future studies.
| S-EPMC7786351 | biostudies-literature
Project description:The affinity and temporal course of functional fields in middle and posterior superior temporal cortex for the categorization of complex sounds was examined using functional magnetic resonance imaging (fMRI) and event-related potentials (ERPs) recorded simultaneously. Data were compared before and after subjects were trained to categorize a continuum of unfamiliar nonphonemic auditory patterns with speech-like properties (NP) and a continuum of familiar phonemic patterns (P). fMRI activation for NP increased after training in left posterior superior temporal sulcus (pSTS). The ERP P2 response to NP also increased with training, and its scalp topography was consistent with left posterior superior temporal generators. In contrast, the left middle superior temporal sulcus (mSTS) showed fMRI activation only for P, and this response was not affected by training. The P2 response to P was also independent of training, and its estimated source was more anterior in left superior temporal cortex. Results are consistent with a role for left pSTS in short-term representation of relevant sound features that provide the basis for identifying newly acquired sound categories. Categorization of highly familiar phonemic patterns is mediated by long-term representations in left mSTS. Results provide new insight regarding the function of ventral and dorsal auditory streams.
| S-EPMC2978244 | biostudies-literature