Advanced non-small cell lung cancer: induction chemotherapy and chemoradiation before operation

Cyjon, Arnold; Nili, M; Fink, Gershon; Kramer, Mordechai R.; Fenig, Eyal; Sandbank, Judith; Sulkes, Aarón; Rakowsky, Erica

doi:10.1016/s0003-4975(02)03719-0

Cited by 25 publications

(15 citation statements)

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“…[27][28][29][30][31] In particular, distant recurrences are a serious problem in the postoperative period in patients with complete or near complete response after oncological treatments. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] In the current study, recurrence developed in one patient in the pT 0 tumor group, which was a distant recurrence. Four of the eight recurrences in the pT 1 tumor group were distant and one was both local and distant.…”

Section: Discussionmentioning

confidence: 42%

“…[5][6][7][8][9][18][19][20][21][22][23][24][25][26] Pathologically complete or near complete response is reported to be a prognostic factor by some authors. [10][11][12][13][14] Although prognosis is preferably good in this group of patients, distant recurrences in particular may reduce success rates. [3,8,25] However, in cases when local control cannot be achieved completely, the survival expectancy of R 0 resections or R 1 -R 2 resections to diminish the tumor burden relying on the adjuvant treatment regimens may not be met.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8][9] Various studies have demonstrated that a pathologically complete or near complete response is also one of the important prognostic factors. [10][11][12][13][14] There is no certainty about the evaluation of complete response after treatment. When compared with other conventional methods, positron emission tomography/ computed tomography (PET/CT), which is more likely to produce metabolic information than anatomical information, has been considered to be the most appropriate imaging method; however, its efficacy is limited due to the inadequacy of detecting the small amount of living tumor cells.…”

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confidence: 99%

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Long-term survival results of non-small cell lung cancer patients with complete pathological response after neoadjuvant therapy

Gürsoy¹

2016

Turk Gogus Kalp Dama

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Section: Discussionmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Long-term survival results of non-small cell lung cancer patients with complete pathological response after neoadjuvant therapy

Gürsoy¹

2016

Turk Gogus Kalp Dama

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“…Early case series evaluating pneumonectomy following induction chemoradiation reviewed small study populations and reported mortality rates as high as 45% (10). Subsequent data, from a randomized study evaluating surgery for lung cancer following chemoradiation, continued to question the safety of performing pneumonectomy in that setting (2).…”

Section: Discussionmentioning

confidence: 99%

Pneumonectomy is safe and effective for non-small cell lung cancer following induction therapy

et al. 2017

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Background: Uncertainty surrounds the safety and efficacy of pneumonectomy in the setting of induction chemoradiation for non-small cell lung cancer (NSCLC). We sought to evaluate fifteen years of experience with pneumonectomy with and without induction therapy.Methods: Over a 15-year period [1999][2000][2001][2002][2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014], data were extracted from medical records of patients undergoing pneumonectomy for NSCLC. Primary outcomes were 5-year overall survival and mortality at 30, 60 and 90 days following operation. Morbidity data was also reviewed. Statistical comparisons were performed using the Chi-Square test. Kaplan-Meier curves were compared using the log rank test.Significance was defined as a P value less than 0.05. Patients with a prior cancer history, bilateral lung nodules and oligometastatic disease at presentation were excluded.Results: After exclusion criteria were applied, 240 patients were analyzed and 137 (57%) underwent induction therapy prior to pneumonectomy. Five-year overall survival was 38.5%. Mortality at 90 days was 7.94%. There was no statistically significant difference in perioperative mortality with the addition of induction therapy. In fact, in the subset of patients with N2 disease (n=65), induction therapy was associated with improved 5-year overall survival (10.7% vs. 32.7%, P=0.014). Thirty-five percent of patients with N2 disease exhibited a complete response in the nodal basin following induction therapy; however, this did not confer a statistically significant overall or disease-free survival benefit.Conclusions: Pneumonectomy can safely be performed in the setting of induction chemoradiation. In patients with N2 disease, induction therapy may confer a survival benefit when the surgery can be done with limited morbidity and mortality.

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“…Plusieurs é tudes ré trospectives rapportant les ré sultats de la chimioradiothé rapie pré opé ratoire ont retrouvé des ré sultats similaires [11,21,32,39], avec des taux de ré section compris entre 50 et 90 %, et une survie mé diane et à cinq ans respectivement de 20-25 mois et de 20 %. Dans toutes ces é tudes, outre le stade IIIA ou IIIB, les principaux facteurs pronostiques mis en é vidence é taient d'une part, le downstaging ganglionnaire mé diastinal aprè s traitement d'induction, et d'autre part, la né gativité des marges de résection.…”

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Chimioradiothérapie néoadjuvante des cancers bronchopulmonaires non à petites cellules

2007

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Ré sumé : Les associations de la chirurgie avec la radiothé rapie, devenues une pratique courante en cancé rologie pour de multiples localisations tumorales, restent en cours d'é valuation dans les cancers bronchiques non à petites cellules, du fait du potentiel mé tastatique é levé de ces tumeurs, atté nuant l'impact sur la survie des traitements locoré gionaux. Dans les cancers bronchiques de stade IIIAN2, les essais ré cents de phase III comparant chirurgie et radiothé rapie aprè s traitement né oadjuvant ont montré d'une part, que la ré section n'est à proposer qu'en cas de ré ponse ganglionnaire mé diastinale majeure et de possibilité de ré section curative par lobectomie, et d'autre part, que la chimioradiothé rapie exclusive reste le standard thé rapeutique dans tous les autres cas. Ces dé veloppements font du traitement des cancers bronchiques localement avancé s de stade IIIA un modèle de ré flexion sur les straté gies multimodales en oncologie, combinant chimiothé rapie, radiothé rapie et chirurgie.Mots clé s : Cancer bronchique non à petites cellules -ChirurgieChimioradiothé rapie -Radiothé rapie -Traitement né oadjuvant Neoadjuvant chemoradiation in non-small cell lung cancer Abstract: Combined surgery and radiotherapy has become a standard treatment regimen for patients with multiple cancers. For nonsmall cell lung cancer, however, this strategy is currently used only in clinical trial settings because of its high metastatic potential, which reduces the effectiveness of local and systemic treatments. Recent results from phase III studies comparing surgery and radiotherapy in stage IIIAN2 locally advanced non-small cell lung cancer after induction treatment showed that surgery should only be performed in patients presenting with a major mediastinal downstaging and the possibility of curative resection by lobectomy. In all other cases, exclusive chemoradiation remains the therapeutic standard at this time. These developments make treatment of locally advanced nonsmall cell lung cancer a model for multimodal strategies in oncology, combining chemotherapy, radiotherapy and surgery.La prise en charge thé rapeutique des patients atteints de cancer bronchique non à petites cellules de stade III est trè s discuté e actuellement. Alors qu'il s'agit d'une problé matique fré quente, qui concerne plus d'un tiers des patients avec un cancer bronchique, les modalité s et la sé quence optimale de la straté gie de traitement ne sont en effet actuellement pas dé terminé es [18]. Les cancers bronchiques non à petites cellules de stade III correspondent en fait à un groupe trè s hé té rogè ne de patients tant en termes d'extension tumorale (T) que ganglionnaire (N) [24]. Ainsi, le stade IIIA regroupe à la fois des patients ayant une atteinte ganglionnaire mé diastinale minime et d'autres ayant un envahissement majeur de plusieurs relais ganglionnaires : le N2 peut ê tre scannographique ou histologique (diagnostiqué par mé diastinoscopie ou dé couvert lors du curage ganglionnaire mé diastinal) [17], et les survies à cin...

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Advanced non-small cell lung cancer: induction chemotherapy and chemoradiation before operation

Cited by 25 publications

References 29 publications

Long-term survival results of non-small cell lung cancer patients with complete pathological response after neoadjuvant therapy

Long-term survival results of non-small cell lung cancer patients with complete pathological response after neoadjuvant therapy

Pneumonectomy is safe and effective for non-small cell lung cancer following induction therapy

Chimioradiothérapie néoadjuvante des cancers bronchopulmonaires non à petites cellules

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