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Induction chemotherapy for T4 lung cancer

Induktionschemotherapie bei T4-Lungenkarzinomen

  • Main Topics: New Techniques In Thoracic Surgery
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Summary

Background: The prognosis of patients with T4 nonesmall cell lung cancer (NSCLC) involving the mediastinum is uniformly poor, and surgery alone does not represent a successfull solution.

Methods: In a 5-year period we entered 44 patients with histologically confirmed NSCLC in a prospective study intended to achieve the reconversion to surgery of unresectable T4 disease. Eligibility criteria for T4 where: Clinical (Superior Vena Cava syndrome [7 patients], vocal cord paralysis [6 patients]; Radiological [CT and MR evidence of infiltration — 8 patients]; Bronchoscopic [tracheal infiltration — 8 patients]; Thoracoscopic [histologically-proved mediastinal infiltration — 15 patients]). After 3 cycles of Cisplatin (120 mg/m2), Vinblastine (4 mg/m2) and Mitomycin (2 mg/m2) patients were reevaluated.

Results: 33 patients (75 %) (29 men, 4 women; age range 46 to 75 years; mean 57 years) responded to therapy and underwent thoracotomy, 8 did not respond and 3 had major toxicity. 28 patients (85%) had complete resection. We performed 3 exploratory thoracotomies, 4 pneumonectomies, 26 lobectomies (16 procedures were associated with reconstruction of hilar-mediastinal structures). Overall, 2 patients had no histological evidence of disease. We had 2 bronchopleural fistulas with 1 death, 5 other major complications and 8 cases of delayed lung reexpansion. Adjuvant chemo- and/or radiotherapy was administered to N2 and N1 patients. The follow up ranges between 12 and 60 months (mean 20 months). Survival at 1 and 3 years is 75 % and 39 %. Of the initial group of 44 patients, 33 (75 %) underwent exploration with a 3-year survival of 39 %, and 28 (64) % had complete resection.

Conclusions: Our data indicate that induction chemotherapy is effective for downstaging and surgical reconversion of centrally located, unresectable T4 NSCLC.

Zusammenfassung

Grundlagen: Die Prognose des T4-nichtkleinzelligen Bronchuskarzinoms (NSCLC)) ist allgemein schlecht. Die chirurgische Therapie allein bringt keine Verbesserung der Prognose.

Methodik: Innerhalb von 5 Jahren wurden 44 Patienten mit histologisch verifiziertem nicht-kleinzelligem Bronchuskarzinom in einer prospektiven Studie inkludiert. Ziel war es, eine Operabilität bei nicht resezierbaren T4-Karzinomen zu erreichen. Einschlußkriterien für T4 waren: Klinische — [V. Cava Superior Syndrom (7 Patienten), Reccurensparese (6 Patienten)]; Radiologische — [Nachweis einer Infiltration im CT und MIR (8 Patienten)]; Bronchoskopische — [Infiltration der Trachea (8 Patienten)]; Thorakoskopische — [histologisch verifizierte mediastinale Infiltration (15 Patienten)]. Die Patienten wurden nach 3 Zyklen Chemotherapie mit Cisplatin (120 mg/m2), Vinblastin (4 mg/m2) und Mitomycin (2 mg/m2) reevaluiert.

Ergebnisse: 33 Patienten [75 % (29 Männer, 4 Frauen; Alter Zwischen 46 und 75 Jahren; Mittelwert 57 Jahre)] sprachen auf die Chemotherapie an und wurden thorakotomiert. 8 sprachen nicht an, und bei 3 wurde eine schwere Toxizität beobachtet. Bei 28 Patienten (85 %) wurde anschließend eine komplette Resektion erreicht. Insgesamt wurden 3 explorative Thorakotomien, 4 Pneumonektomien, 26 Lobektomien (bei 16 Prozeduren wurde eine Rekonstruktion von hilären Strukturen durchgeführt) durchgeführt. 2 Patienten zeigten keine histologischen Zeichen der Erkrankung. Es wurden 2 bronchopleurale Fisteln (1 Todesfall), 5 andere schwere Komplikationen und 8 Fälle von verlängerter Lungenreexpansion beobachtet. Adjuvante Chemo- und/oder Strahlentherapie wurde bei N1- und N2-Patienten angewandt. Die Beobachtungszeit betrug zwischen 12 und 60 Monaten (Mittelwert 20). Das 1- und 3-Jahresüberleben war 73 % bzw. 39 %. Bei 33 (75 %) von den 44 initialen Patienten wurde eine Exploration mit einem 3-Jahresüberleben von 39 % durchgeführt. 28 (64 %) hatten eine komplette Resektion.

Schlußfolgerungen: Unsere Daten indizieren, daß die Induktionschemotherapie für „downstaging“ und somit zum Erreichen einer Operabilität bei zentralliegendem, nicht-resezierbarem, nicht-kleinzelligem Bronchuskarzinom effektiv ist.

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Authors and Affiliations

  1. Department of Thoracic Surgery, “La Sapienza” University, I-00161, Rome, Italy

    E. A. Rendina M. D., F. Venuta, T. De Giacomo, Anna MariaCiccone & G. F. Coloni

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  1. E. A. Rendina M. D.
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  2. F. Venuta
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  3. T. De Giacomo
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  4. Anna MariaCiccone
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  5. G. F. Coloni
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Correspondence to E. A. Rendina M. D..

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Rendina, E.A., Venuta, F., De Giacomo, T. et al. Induction chemotherapy for T4 lung cancer. Acta Chir Austriaca 31, 280–285 (1999). https://doi.org/10.1007/BF02619927

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