Survival After Pneumonectomy for Stage III Non-small Cell Lung Cancer

Abstract

Objectives: Stage III non-small cell lung cancer (NSCLC) has a poor prognosis. Reports suggest that five-year survival after current treatment is between 14 to 24 percent. The purpose of this retrospective study was to investigate the morbidity and mortality of patients diagnosed with stage III NSCLC and treated with pneumonectomy at the University of Kentucky Medical Center in Lexington, KY. Methods: We reviewed the medical record and tumor registry follow-up data on 100 consecutive patients who underwent pneumonectomy for lung cancer at the University of Kentucky. Results: We identified thirty-six patients in stage III who underwent pneumonectomy. Ten patients had surgery only, eight patients received adjuvant chemotherapy, and eighteen patients received neoadjuvant therapy. There was one surgical death in this series. Mean follow-up was 2.9 years. One-, three-, and five-year survival was 66%, 38%, and 38%, respectively. Five-year survival for the group with adjuvant therapy was 60%. Conclusion: Most lung cancer patients present with advanced disease and the prognosis remains poor. Our experience indicates resection offers an above average chance of long-term survival when supplemented with neoadjuvant and/or adjuvant therapy.

Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis

“…However, the benefits of neoadjuvant and/or adjuvant treatment in five-year survival after pneumonectomy for LC stage III patients are also reported in literature (40). Individualization of the adjuvant radiotherapy dose along with improvement of technological equipment both significantly reduced cardiotoxicity (39).…”

“…Issues investigated deal with the impact of: (I) age (1-4); (II) safety of choice for a combined or staged surgical procedure (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19); (III) on-or off-pump technique on postoperative complications occurrence (12,16,(20)(21)(22)(23)(24)(25)(26)(27); (IV) an extended surgery, due to LC infiltration in the left atrium and/or great vessels, on postoperative outcome (24,(28)(29)(30); (V) videoassisted thoracoscopic surgery (VATS) method on primary LC patients (31)(32)(33)(34)(35)(36); (VI) neo-adjuvant or adjuvant treatment (37)(38)(39)(40); and (VII) factors, other than the aforementioned ones, influencing postoperatively patients operated for primary LC and HD. These factors were: myocardial ischemia (41), arrhythmias (41,42), type of grafts selected (20), high preoperative serum level of lactate dehydrogenase (LDH) (43), low preoperative forced expiratory volume in one second ...…”

Examining the ınterval between radiation therapy and surgery in trimodality therapy: Try Tri Again

“…The 7 th edition of the TNM Staging Manual defined stage III NSCLC as tumors that invade into local structures and/or have mediastinal nodal involvement (2). For stage III patients with N2 involvement, the decision between treating with definitive chemoradiotherapy or neoadjuvant chemoradiotherapy followed by surgery has been extensively debated (3)(4)(5). Retrospective and phase II trials have suggested that the addition of surgery after chemoradiotherapy may lead to improved survival (6)(7)(8)(9).…”

“…Retrospective and phase II trials have suggested that the addition of surgery after chemoradiotherapy may lead to improved survival (6)(7)(8)(9). However, phase III trials have showed that while local control and progression free survival is improved with trimodality therapy, overall survival does not appear to be significantly prolonged compared to definitive chemoradiotherapy (2,5). Despite this gap in knowledge, it is important to note that the success of surgery after neoadjuvant chemoradiation therapy may heavily depend on a number of factors that were not adequately controlled for in previous studies, including the selection of appropriate patients, the surgical approach taken, and the details of the protocol for trimodality therapy.…”