Pneumonectomy: calculable or non-tolerable risk factor in trimodal therapy for Stage III non-small-cell lung cancer?

Steger, Volker; Spengler, Werner; Hetzel, Juergen; Veit, Stefanie; Walker, Tobias; Mustafi, Migdat; Friedel, Godehard; Walles, Thorsten

doi:10.1093/ejcts/ezr160

Cited by 17 publications

(8 citation statements)

References 21 publications

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“…The role of pneumonectomy likely is dependent on T and N stage in heterogeneous IIIA patients. The perioperative morbidity of 58% and mortality of 9% in this study are notable but similar to previously published rates [14,17-20]. Our study did not find a significant difference in survival based on N2 lymph node involvement, but was likely underpowered to detect any such differences, particularly considering that the majority of patients with N2 disease in this study had microscopic disease determined after resection despite negative pre-treatment PET scans and/or mediastinoscopy.…”

Section: Commentsupporting

confidence: 87%

Does Pneumonectomy Have a Role in the Treatment of Stage IIIA Non-Small Cell Lung Cancer?

Shah

Worni

Kelsey

et al. 2013

The Annals of Thoracic Surgery

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Background The role of surgical resection for stage IIIA non-small cell lung cancer (NSCLC) is unclear. We sought to examine outcomes after pneumonectomy for patients with stage IIIA disease. Methods All patients with stage IIIA NSCLC who had pneumonectomy at a single institution between 1999 and 2010 were reviewed. The Kaplan-Meier method was used to estimate long-term survival, and multivariable Cox proportional hazards regression was used to identify clinical characteristics associated with survival. Results During the study period, 324 patients had surgical resection of stage IIIA NSCLC. Pneumonectomy was performed in 55 patients, 23 (42%) of whom had N2 disease. Induction treatment was used in 17 patients (31%) overall and in 11 of the patients (48%) with N2 disease. Perioperative mortality was 9% (n=5) overall and 18% (n=3) in patients that had received induction therapy (p=0.17). Complications occurred in 32 patients (58%). Three-year survival was 36% and five-year survival was 29% for all patients. Three-year survival was 40% for N0-1 patients and 29% for N2 patients (p=0.59). In multivariable analysis, age over 60 (HR 3.65, p=0.001), renal insufficiency (HR 5.80, p=0.007), and induction therapy (HR 2.17, p=0.05) predicted worse survival; and adjuvant therapy (HR 0.35, p=0.007) predicted improved survival. Conclusions Long-term survival after pneumonectomy for stage IIIA NSCLC is within an acceptable range, but pneumonectomy may not be appropriate after induction therapy or in patients with renal insufficiency. Patient selection and operative technique that limit perioperative morbidity and facilitates the use of adjuvant chemotherapy are critical to optimizing outcomes.

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Section: Commentsupporting

confidence: 87%

Does Pneumonectomy Have a Role in the Treatment of Stage IIIA Non-Small Cell Lung Cancer?

Shah

Worni

Kelsey

et al. 2013

The Annals of Thoracic Surgery

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“…Therefore, further investigation is necessary in order to generate safe conclusions. However, when lobectomy/bi-lobectomy was compared to pneumonectomy there was no significant difference (p = 0.3), a result which is in concert with further recent studies, indicating that pneumonectomy can be done safe and may not be a risk factor for survival in trimodal therapy of stage III NSCLC [35]. …”

Section: Discussionsupporting

confidence: 55%

Trimodal therapy for stage III-N2 non-small-cell lung carcinoma: a single center retrospective analysis

et al. 2014

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BackgroundTreatment of locally advanced non-small-cell lung cancer is based on a combined approach. To study the impact of trimodal therapy for stage III-N2 NSCLC a single centre retrospective evaluation focusing on survival and therapy-related toxicity was performed.Methods71 patients diagnosed between March 2001 and August 2008 with pathologically confirmed stage III-N2 non-small-cell lung cancer at the University Clinic of Heidelberg were retrospectively analyzed. All patients were treated within trimodal therapy strategies including surgery, induction or adjuvant chemotherapy and postoperative radiotherapy. Overall survival (OS) and disease free survival (DFS) rates were calculated using the Kaplan-Meier method. The log-rank test and Fishers Exact test were applied for univariate analysis and Cox proportional regression model for multivariate analysis.ResultsMedian survival was 32 months. 1-, 3- and 5-year overall survival (OS) rates were 84.5%, 49.6% and 35.5% respectively. Disease free survival rates at 1, 3 and 5 years were 70.4%, 41.8% and 27.4% respectively. 9 patients (12.6%) were diagnosed with a local recurrence. Multivariate analysis did not reveal any independent prognostic factors for OS, but indicated a trend for pT stage and type of surgery. In regard to toxicity 8.4% of the patients developed a clinically relevant ≥ grade 2 pneumonitis. Evaluation of the forced expiratory volume in 1 second per unit of vital capacity (FEV1/VC) before and 1-3 years post radiotherapy revealed a median decrease of 2.1%.ConclusionsOur descriptive data indicate that trimodal therapy represents an effective and safe treatment approach for patients with stage III-N2 non-small-cell lung cancer. Further prospective clinical trials are necessary in order to clearly define the impact of multimodal strategies and optimize NSCLC treatment.

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“…The 30-day mortality rate after pneumonectomy following induction chemoradiation in our study was 8.5%, which is line with the 3–8% operative mortality in several prior reports. (28–30) Finally, in the European Organization for Research and Treatment of Cancer-Lung Cancer Group study patients with stage IIIA-N2 NSCLC were given three cycles of induction chemotherapy. Responding patients were randomized to surgical resection or radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

National Patterns of Care and Outcomes After Combined Modality Therapy for Stage IIIA Non–Small-Cell Lung Cancer

Patel

Crabtree

Bell

et al. 2014

Journal of Thoracic Oncology

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Introduction The role of surgery in addition to chemotherapy and radiation for stage IIIA non-small cell lung cancer (NSCLC) remains controversial. Since there is limited data on the benefit from surgery in this setting, we evaluated the use of combined modality therapy nationally, and explored the outcomes with and without the addition of surgery. Methods Patient variables and treatment-related outcomes were abstracted for patients with clinical stage IIIA NSCLC from the National Cancer Database. Patients receiving chemotherapy and radiation (CR) were compared to those undergoing chemotherapy, radiation, and surgery in any sequence (CRS). Results Between 1998 and 2010, 61339 patients underwent combined modality treatment for clinical stage IIIA NSCLC. Of these, 51979 (84.7%) received CR while 9360 (15.3%) underwent CRS. Patients in the CRS group were younger, more likely females and Caucasians, had smaller tumors and lower Charlson comorbidity scores. The 30-day surgical mortality was 200/8993 (2.2%). The median overall survival favored the CRS group in both unmatched (32.4 months vs. 15.7 months, p<.001) and matched analysis based on patient characteristics (34.3 months vs. 18.4months, p<.001). Conclusion There is significant heterogeneity in the treatment of stage IIIA NSCLC in the United States. Patients selected for surgery in addition to chemoradiation therapy appear to have better long-term survival.

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Pneumonectomy: calculable or non-tolerable risk factor in trimodal therapy for Stage III non-small-cell lung cancer?

Cited by 17 publications

References 21 publications

Does Pneumonectomy Have a Role in the Treatment of Stage IIIA Non-Small Cell Lung Cancer?

Does Pneumonectomy Have a Role in the Treatment of Stage IIIA Non-Small Cell Lung Cancer?

Trimodal therapy for stage III-N2 non-small-cell lung carcinoma: a single center retrospective analysis

National Patterns of Care and Outcomes After Combined Modality Therapy for Stage IIIA Non–Small-Cell Lung Cancer

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