The Effects of Neoadjuvant Chemotherapy on Pulmonary Structures: A Quantitative Analysis

Ceylan, K.; Kaya, Sadi; Samancılar, Özgür; Gürsoy, Soner; Üçvet, Ahmet

doi:10.1055/s-0030-1270836

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…By analyzing the surgical approach, we observed a high rate of thoracotomy in two treatment groups, and the rate in immunotherapy patients was higher than that in chemotherapy patients (75% vs. 62.5%, P = 0.496). According to recent studies, a low tensile strength of the pulmonary vessels and bronchi was found in patients receiving neoadjuvant chemotherapy ( 18 ), and more severe destruction of elastic fibers of the blood vessels, pulmonary interstitial exudation, vascular wall degeneration, fibrinoid necrosis, and fibrosis was found in patients receiving neoadjuvant immunotherapy ( 19 ). Such histological changes could explain the high rate of thoracotomy in two treatment groups.…”

Section: Discussionmentioning

confidence: 99%

Real-world outcomes of immunotherapy-based neoadjuvant therapy in resectable non-small cell lung cancer

Shen,

Gu,

et al. 2023

Front. Immunol.

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ObjectivesRecent clinical studies have demonstrated that immunotherapy-based neoadjuvant therapy have promising effectiveness for patients with resectable non-small cell lung cancer (NSCLC) in terms of pathologic response. Therefore, we performed this study to investigate whether immunotherapy-based neoadjuvant therapy is effective and safe for patients with resectable NSCLC.Materials and methodsThis open-label observational two-arm clinical study was performed at Shanghai Chest Hospital in China with patients who had resectable NSCLC and received two to three cycles of immunotherapy-based neoadjuvant therapy or neoadjuvant chemotherapy alone, followed by surgical resection. The primary endpoint was a major pathologic response (MPR). The secondary endpoints include a complete pathological response (pCR), a radiologic response to neoadjuvant therapy (TRR), event-free survival (EFS), and overall survival (OS).ResultsA total of 51 patients was included in this clinical study, of which 31 patients received immunotherapy-based neoadjuvant therapy and 20 patients received neoadjuvant chemotherapy alone. The percentage of patients achieving a major pathologic response was 41.9% with immunotherapy-based neoadjuvant therapy and 15.0% (95% CI, 0.008 to 0.468; P = 0.043) with neoadjuvant chemotherapy alone. The percentage of patients with pathologic complete response was 19.4% in the immunotherapy-based group and 5% (95% CI, -0.069 to 0.318; P = 0.223) in the chemotherapy group. The radiographic response rate was 71% after immunotherapy-based neoadjuvant therapy and 60% (95% CI, -0.143 to 0.359; P = 0.417) after neoadjuvant chemotherapy. At a median follow-up of 28 months, the median EFS and OS endpoints were not reached.ConclusionsNeoadjuvant immunotherapy offers a considerable advantage over chemotherapy alone for resectable NSCLC in terms of the major pathologic response. Moreover, it did not enhance the risk of adverse events or hinder surgical resection.

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Section: Discussionmentioning

confidence: 99%

Real-world outcomes of immunotherapy-based neoadjuvant therapy in resectable non-small cell lung cancer

Shen,

Gu,

et al. 2023

Front. Immunol.

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“…Kim [ 22 ] also reported a 20% 90-day mortality after right-sided pneumonectomy. On the other hand, there are also some recent studies published showing that this high-risk procedure can be performed with acceptable mortality rates from 3 to 10% [ 2 , 3 , 5 – 8 , 10 , 23 ]. More recently Kim et al .…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemotherapy is a risk factor for bronchopleural fistula after pneumonectomy for non-small cell lung cancer

Samancılar¹,

Kaya²,

Usluer³

et al. 2014

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IntroductionPerforming pneumonectomy after neoadjuvant chemotherapy is still controversial. Bronchopleural fistula is a major complication after pneumonectomy. In this study the effect of neoadjuvant chemotherapy on postpneumonectomy bronchopleural fistula was investigated.Material and methodsA retrospective review of patients who underwent pneumonectomy for non-small cell lung cancer from January 2005 to December 2011 was undertaken. The major complications and operative mortality were analyzed and compared between the patients having neoadjuvant chemotherapy and patients having surgery only.ResultsOne hundred and seventy-seven pneumonectomies (77 right and 100 left) were performed during the study period and 49 of these patients (27.7%) received neoadjuvant chemotherapy. Median age was 60 years (range, 32 to 80). The bronchopleural fistula rate was 26.5% (13/49) in the neoadjuvant group versus 3.1% (4/128) in the surgery alone group (p = 0.029). The bronchopleural fistula rate was 16.9% (13/77) in the right pneumonectomy group vs. 4% (4/100) in the left pneumonectomy group (p = 0.004). Overall operative mortality was 5.6%. Mortality in the neoadjuvant group was 8.2% vs. 4.7% in the surgery only group (p = 0.37).ConclusionsNeoadjuvant chemotherapy and right pneumonectomy is a major risk factor for bronchopleural fistula. Especially right pneumonectomy should be avoided after induction therapy.

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“…Resulta muy difícil medir o cuantificar un parámetro como complejidad técnica, porque dependerá de muchos factores, especialmente de la experiencia o destreza del cirujano. Sin embargo, como ya proponían Ceylan y col. hace más de una década, parece importante intentar cuantificar de alguna manera las peculiaridades que detectamos en el campo quirúrgico e intentemos recogerlas utilizando un lenguaje común (34). Esto cobra especial importancia en una era en la que el tratamiento neoadyuvante parece que va a ser cada vez más frecuente en pacientes potencialmente quirúrgicos (35).…”

Section: D) Neumonectomíaunclassified

Surgical treatment in lung cancer

Jarabo,

Fernández,

Fraile

et al. 2023

Rev Cancer

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ResumenEl escenario de cáncer de pulmón de célula no pequeña ha cambiado, con nuevos retos como la detección precoz de tumores a través de programas de cribado, abordajes multidisciplinares con nuevos fármacos, una precisa tipificación biomolecular tumoral, el creciente número de pacientes en situación funcional límite que son rescatables para cirugía, y la consecución de resecciones oncológicas completas con abordajes mínimamente invasivos. Los cirujanos torácicos se enfrentan a nódulos pulmonares pequeños sin confirmación citohistológica difíciles de localizar intraoperatoriamente, nuevas peculiaridades técnicas tras tratamientos neoadyuvantes nuevos, pacientes añosos con múltiples comorbilidades y tumores localmente avanzados o metastásicos que se hacen potencialmente resecables tras tratamientos sistémicos. Para ello contamos con nuevas tecnologías como sistemas de asistencia robótica, programas de reconstrucción de imágenes, herramientas para detección y marcaje de nódulos y, especialmente, el entusiasmo de profesionales trabajando para lograr altas tasas de curación y largas supervivencias con máximos niveles de calidad de vida.

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The Effects of Neoadjuvant Chemotherapy on Pulmonary Structures: A Quantitative Analysis

Abstract: Neoadjuvant chemotherapy did not increase postoperative morbidity or mortality. The decreased tensile strength of pulmonary vessels and bronchi after neoadjuvant therapy should alert thoracic surgeons to possible surgical complications.

Cited by 5 publications

References 12 publications

Real-world outcomes of immunotherapy-based neoadjuvant therapy in resectable non-small cell lung cancer

Real-world outcomes of immunotherapy-based neoadjuvant therapy in resectable non-small cell lung cancer

Neoadjuvant chemotherapy is a risk factor for bronchopleural fistula after pneumonectomy for non-small cell lung cancer

Surgical treatment in lung cancer

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