Surgery after induction chemotherapy in stage IIIA-N2 non-small cell lung cancer: Why pneumonectomy should be avoided

Kappers, Ingrid; Sandick, Johanna W. van; Burgers, Sjaak A.; Belderbos, J.; Zandwijk, Nico van; Klomp, Houke M.

doi:10.1016/j.lungcan.2009.07.001

Cited by 24 publications

(18 citation statements)

References 28 publications

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“…These authors demonstrated 11% mortality after right pneumonectomy. d'Amato et al [12] in their article also concluded that pneumonectomy increases the risk of mortality after induction chemotherapy and Kappers et al [13] recommended avoiding pneumonectomy after induction treatment. A recent article by Refai et al [14], who studied 81 patients that underwent pneumonectomy after neoadjuvant chemotherapy, concluded that induction therapy does not seem to increase the risk of morbidity, early or late mortality after pneumonecomy in properly selected patients.…”

Section: Discussionmentioning

confidence: 99%

Morbidity and Mortality after Major Pulmonary Resections in Patients with Locally Advanced Stage IIIA Non-small Cell Lung Carcinoma Who Underwent Induction Therapy

Peer

Stav

Cyjon

et al. 2015

Heart, Lung and Circulation

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Section: Discussionmentioning

confidence: 99%

Morbidity and Mortality after Major Pulmonary Resections in Patients with Locally Advanced Stage IIIA Non-small Cell Lung Carcinoma Who Underwent Induction Therapy

Peer

Stav

Cyjon

et al. 2015

Heart, Lung and Circulation

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“…Pneumonectomy remains associated with high and possibly unacceptable rates of perioperative morbidity and mortality, especially after induction therapy [16][17][18][19]. The recommendation of the American College of Chest Physicians (ACCP) is to avoid performing pneumonectomy after neoadjuvant chemoradiotherapy [20].…”

Section: Discussionmentioning

confidence: 99%

Major Pulmonary Resection After Neoadjuvant Therapy in Potentially Resectable Stage IIIA/B Non-Small Cell Lung Carcinoma: R0 or No R0

Peer

Azzam

Cyjon

et al. 2021

Preprint

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Objective The aim of this study was to identify predictors of postoperative outcome and survival of locally advanced non-small cell lung carcinoma (NSCLC) resections after neoadjuvant chemotherapy or chemoradiation.Methods Medical records of all patients with clinical stage III potentially resectable NSCLC initially treated by neoadjuvant chemotherapy or chemoradiation followed by major pulmonary resections between 1999 to 2019 were retrieved from the databases of four Israeli Medical Centers. Results: The 124 suitable patients included, 86 males (69.4%) and 38 females (30.6%), mean age of 64.2 years (range 37-82) and mean hospital stay of 12.6 days (range 5-123). Complete resection was achieved in 92.7% of the patients, while complete pathologic response was achieved in 35.5%. Overall readmission rate was 16.1%. The overall 5-year survival rate was 47.9%. One patient (0.8%) had local recurrence. Postoperative complications were reported in 49.2% of the patients, mainly atrial fibrillation (15.9%) and pneumonia (13.7%), empyema (10.3%), and early bronchopleural fistula (7.3%). Early in-hospital mortality rate was 6.5% and the six-month mortality rate was 5.6%. Pre-neoadjuvant bulky mediastinal disease (lymph nodes >20 mm) (p=0.034), persistent postoperative N2 disease (p=0.016), R1 resection (p=0.027) and postoperative stage IIIA (p=0.001), emerged as negative predictive factors for survival. Conclusions: Our findings demonstrate that neoadjuvant chemotherapy or chemoradiation in locally advanced potentially resectable NSCLC followed by major pulmonary resection is a beneficial approach in selected cases.

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“…Although a clinical trial designed to confirm this function of induction therapy would not be possible, we believe that induction chemotherapy facilitates and simplifies the surgery of patients with central disease as illustrated in Figures 4, 5, and 6. Many studies have reported that pneumonectomy was one of the major factors influencing outcome in patients with locally advanced NSCLC after induction chemotherapy [14,15,25]. Statistically significant differences were observed in postoperative mortality for pneumonectomies (11.3%) compared with lobectomies (2.4%), especially for right pneumonectomies [26].…”

Section: Discussionmentioning

confidence: 99%

“…Because the median OS time was not reached in our study, we focused on DFS time which is closely linked to surgery and perioperative therapy. In previous retrospective studies, it has been demonstrated that age, complete resection, pneumonectomy and pathological stage all had a significant impact on survival [7,15,16,25]. In addition to these factors, mediastinal downstaging is another important determinant of survival, particularly for stage IIIA disease [16,28].…”

Section: Discussionmentioning

confidence: 99%

A retrospective study: platinum-based induction chemotherapy combined with gemcitabine or paclitaxel for stage IIB-IIIA central non-small-cell lung cancer

et al. 2013

World J Surg Onc

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BackgroundSeveral encouraging phase III clinical trials have evaluated platinum-based induction chemotherapy against stage IIB-IIIA non-small-cell lung cancer (NSCLC). Chemotherapy efficacy was assessed using common regimens in this retrospective analysis.MethodsFrom 2007 to 2011, the clinical records of stage IIB-IIIA NSCLC patients undergoing surgery after neoadjuvant chemotherapy were reviewed. Gathered data were tested for significance and variables impacting survival were assessed by univariate and Cox regression analyses.ResultsOverall, 84% of patients were male and 93% had central disease. Platinum-based chemotherapy protocols with gemcitabine or paclitaxel gave an overall response rate of 55% (45/82) and 6.1% pathological complete response (5/82). Clinical response was unassociated with regimen or histology, while more pneumonectomies were performed in the stable compared to partial response disease group (P =0.040). Postoperative mortality was 1.2% (1/82), and complications, unassociated with regimen or histology, were atelectasis (26.8%) and supraventricular arrhythmias (13.4%). Right-sided procedures appeared to increase the incidence of bronchopleural fistula (P =0.073). The median disease-free survival time was 18 months and median overall survival time was not reached. Disease-free survival rates at one, two, and three years were 54%, 47%, and 33%, while the overall survival rate was 73%, 69%, and 59%, respectively. Disease-free survival predictors were radiographic response and mediastinal lymphadenopathy before chemotherapy (P =0.012 and 0.002, respectively).ConclusionsTwo cycles of platinum-based chemotherapy with gemcitabine or paclitaxel is efficacious for patients with stage IIB-IIIA central disease. Patients achieving clinical response had improved disease-free survival times, while those with mediastinal lymphadenopathy had a higher postoperative recurrence risk.

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Surgery after induction chemotherapy in stage IIIA-N2 non-small cell lung cancer: Why pneumonectomy should be avoided

Cited by 24 publications

References 28 publications

Morbidity and Mortality after Major Pulmonary Resections in Patients with Locally Advanced Stage IIIA Non-small Cell Lung Carcinoma Who Underwent Induction Therapy

Morbidity and Mortality after Major Pulmonary Resections in Patients with Locally Advanced Stage IIIA Non-small Cell Lung Carcinoma Who Underwent Induction Therapy

Major Pulmonary Resection After Neoadjuvant Therapy in Potentially Resectable Stage IIIA/B Non-Small Cell Lung Carcinoma: R0 or No R0

A retrospective study: platinum-based induction chemotherapy combined with gemcitabine or paclitaxel for stage IIB-IIIA central non-small-cell lung cancer

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