Pneumonectomy after induction chemoradiotherapy for locally advanced non-small cell lung cancer: should curative intent pulmonary resection be avoided?
- 26 Downloads
We conducted a retrospective analysis to assess the practicality of pneumonectomy, especially after concurrent induction chemoradiotherapy (i-CRT), for locally advanced non-small cell lung cancer (LA-NSCLC). The operative risks vs. the survival benefit of this procedure for such patients is a subject of controversy.
The subjects of this retrospective study were 71 consecutive LA-NSCLC patients with cStage IIIA-C NSCLC, who underwent i-CRT followed by curative intent pulmonary resection between February, 2001 and March, 2013.
Thirty-two patients underwent pneumonectomy (group P) and 39 patients underwent lobectomy (group L). In group P, 17 (54.8%) patients underwent right pneumonectomy. There was no 30-day postoperative mortality in either group and no significant difference in 90-day postoperative mortality between the groups (3.1% vs. 2.6% in groups P and L, respectively). The 5-year overall survival (OS) rate was 58.7% (95% CI: 41.5–75.9%) in group P and 57.3% (95% CI 41.2–73.4%) in group L, without a significant difference between the groups.
Our findings suggest that i-CRT followed by pneumonectomy is feasible, with a similar survival benefit to lobectomy. Thus, pneumonectomy after i-CRT should not be avoided as it is a potentially curative intent strategy for carefully selected patients.
KeywordsLocally advanced non-small cell lung cancer Induction chemoradiotherapy Pneumonectomy
This study received no funding.
Compliance with ethical standards
Conflict of interest
Masafumi Yamaguchi: No conflict of interest. Shinichiro Shimamatsu: No conflict of interest. Makoto Edagawa: No conflict of interest. Fumihiko Hirai: No conflict of interest. Ryo Toyozawa: No conflict of interest. Kaname Nosaki: No conflict of interest. Takashi Seto: Received honoraria (lecture fees) from AstraZeneca, Eli Lilly Japan and Ono Pharmaceutical. Received research grants from Astellas Pharma, AstraZeneca, Chugai Pharmaceutical, Daiichi Sankyo, Eli Lilly Japan, Merck Serono, Nippon Boehringer Ingelheim, Novartis Pharma and Pfizer Japan. Mitsuhiro Takenoyama: Received research grants from Eli Lilly Japan and Ono Pharmaceutical. Yukito Ichinose: No conflict of interest.
- 2.network NCC. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Non-small cell lung cancer version 2.2013. 2013. http://www.nccn.com.
- 4.Ramnath N, Dilling TJ, Harris LJ, Kim AW, Michaud GC, Balekian AA, et al. Treatment of stage III non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143:e314S–40S.CrossRefGoogle Scholar
- 16.Travis WD, Corrin B, Shimosato Y, Brambilla E. and Collaborators from 14 Countries. Histological typing of lung and pleural tumors. In: World Health Organization. International histological classification of tumors, 3th edn. Berlin:Springer; 1999.Google Scholar
- 17.Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11:39–51.CrossRefGoogle Scholar
- 25.Eberhardt WE, Pottgen C, Gauler TC, Friedel G, Veit S, Heinrich V, et al. Phase III study of surgery versus definitive concurrent chemoradiotherapy boost in patients with resectable stage IIIA(N2) and selected IIIB non-small-cell lung cancer after induction chemotherapy and concurrent chemoradiotherapy (ESPATUE). J Clin Oncol. 2015;33:4194–201.CrossRefGoogle Scholar
- 31.Ichinose Y, Seto T, Sasaki T, Yamanaka T, Okamoto I, Takeda K, et al. S-1 plus cisplatin with concurrent radiotherapy for locally advanced non-small cell lung cancer: a multi-institutional phase II trial (West Japan Thoracic Oncology Group 3706). J Thorac Oncol. 2011;6:2069–75.CrossRefGoogle Scholar