Abstract:Background:The effectiveness of preoperative chemotherapy in the treatment of non-small cell lung cancer has remained unclear despite the conduct of several randomized controlled trials (RCTs). Methods: A systematic review and meta-analysis was carried out to assess the effectiveness of preoperative chemotherapy in non-small cell lung cancer. This involved identifying eligible RCTs and extracting aggregate data from the abstracts or reports of these RCTs. Hazard ratios were calculated from these published summ… Show more
“…9 Despite such serious adverse effects, survival is improved with preoperative neoadjuvant chemotherapy (NAC) followed by surgery, compared with surgery alone. [10][11][12] By reducing the tumor burden and downgrading the tumor stage, NAC facilitates surgical resection and may improve long-term outcome by eradicating micrometastases. But NAC may be a double-edged sword.…”
BACKGROUND:In non-small-cell lung cancer patients, high peak oxygen uptake (peak V O 2 ) predicts lower rates of postoperative complications and better long-term survival. Neoadjuvant chemotherapy (NAC) may negatively impact peak V O 2 . METHODS: Cardiopulmonary exercise testing (CPET) was performed in 34 consecutive stage IIIA/IIIB non-small-cell lung cancer subjects scheduled for elective lung surgery. Using multivariate linear regression adjusted for potential confounders, we compared CPET results in subjects receiving or not receiving NAC (NAC؉, n ؍ 19; NAC؊, n ؍ 15). RESULTS: Adjusted peak V O 2 was lower in NAC ؉ compared with NAC؊ subjects (؊5.3 mL/min/kg [95% CI ؊8.3 to ؊2.2], P ؍ .01). Likewise, oxygen pulse, maximal work load, and ventilatory threshold were also lower in NAC؉ subjects, whereas peak heart rate and breathing reserve were similar. NAC؉ subjects presented lower values of diffusion capacity for carbon monoxide (D LCO ) (P ؍ .035) and hemoglobin concentrations (P < .001). D LCO was strongly correlated with peak V O 2 (r 2 ؍ 0.56). Adjustment for D LCO reduced the effect of NAC on peak V O 2 without suppressing it. CONCLUSIONS: NAC was associated with lower preoperative peak V O 2 in subjects with non-small-cell lung cancer. This lower aerobic fitness may result from NAC-induced reduction in pulmonary gas exchange or heart toxicity. Since lower fitness is linked to poorer outcome, the decision for NAC may have to be balanced with its possible toxicity.
“…9 Despite such serious adverse effects, survival is improved with preoperative neoadjuvant chemotherapy (NAC) followed by surgery, compared with surgery alone. [10][11][12] By reducing the tumor burden and downgrading the tumor stage, NAC facilitates surgical resection and may improve long-term outcome by eradicating micrometastases. But NAC may be a double-edged sword.…”
BACKGROUND:In non-small-cell lung cancer patients, high peak oxygen uptake (peak V O 2 ) predicts lower rates of postoperative complications and better long-term survival. Neoadjuvant chemotherapy (NAC) may negatively impact peak V O 2 . METHODS: Cardiopulmonary exercise testing (CPET) was performed in 34 consecutive stage IIIA/IIIB non-small-cell lung cancer subjects scheduled for elective lung surgery. Using multivariate linear regression adjusted for potential confounders, we compared CPET results in subjects receiving or not receiving NAC (NAC؉, n ؍ 19; NAC؊, n ؍ 15). RESULTS: Adjusted peak V O 2 was lower in NAC ؉ compared with NAC؊ subjects (؊5.3 mL/min/kg [95% CI ؊8.3 to ؊2.2], P ؍ .01). Likewise, oxygen pulse, maximal work load, and ventilatory threshold were also lower in NAC؉ subjects, whereas peak heart rate and breathing reserve were similar. NAC؉ subjects presented lower values of diffusion capacity for carbon monoxide (D LCO ) (P ؍ .035) and hemoglobin concentrations (P < .001). D LCO was strongly correlated with peak V O 2 (r 2 ؍ 0.56). Adjustment for D LCO reduced the effect of NAC on peak V O 2 without suppressing it. CONCLUSIONS: NAC was associated with lower preoperative peak V O 2 in subjects with non-small-cell lung cancer. This lower aerobic fitness may result from NAC-induced reduction in pulmonary gas exchange or heart toxicity. Since lower fitness is linked to poorer outcome, the decision for NAC may have to be balanced with its possible toxicity.
“…В 2006 году Бардет и др. [6] включили 7 из 12 приемлемых рандомизированных исследо-ваний (пять других исследований были исключены из анализа в связи с недостаточностью данных). В общей сложности было включено 988 пациентов, и авторы обнаружили, что предоперационная ХТ улучшила выживаемость с коэффициентом в 0,82 (95% ДИ: 0.69-0.97, р=0,02).…”
“…Несколько исследований, а также мета-анализ, основанный на литературе, действи-тельно описал эффективность с точки зрения выживаемо-сти в пользу предоперационной химиотерапии [37][38][39][40][41]. Было показано, что снижение «медиастинальной стадии» является важным прогностическим фактором [38] и [40].…”
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