Skip to main content
SpringerLink
Log in

Results of Surgical Treatment After Neoadjuvant Chemotherapy for Stage III Non-Small Cell Lung Cancer

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The potential benefits of an approach combining neoadjuvant chemotherapy and surgery in stage IIIA and IIIB NSCLC have to be weighed against a potential increase in postoperative complications. We evaluated the results in terms of postoperative complications and survival in patients with stage III NSCLC who underwent complete surgical treatment after neoadjuvant chemotherapy with two regimens: mitomycin, vinblastine, and cisplatin (MPV) versus gemcitabine and cisplatin (GC).

Methods

From March 1991 to September 2005, 110 patients with stage III NSCLC (86 stage IIIA and 24 stage IIIB) underwent complete surgical treatment after neoadjuvant chemotherapy. Ninety-two patients were men and 18 were women, with a mean age of 59 (range, 39–80) years. The neoadjuvant chemotherapy regimen was MPV in 72 patients and GC in 38.

Results

The overall response (>50%) to chemotherapy was 84%. Postoperative mortality and morbidity were 1.8% and 20%, respectively. Overall 5-year survival was 46%. Minor response to neoadjuvant chemotherapy (<50%) and residual nodal N2 involvement in stage IIIA had an adverse impact on survival (p < 0.05).

Conclusions

Favorable long-term survival was observed after neoadjuvant chemotherapy with MPV and GC regimens in stage IIIA and IIIB NSCLC, with relatively low postoperative mortality and morbidity. Caution should be taken when offering surgical treatment to patients with minor response to induction chemotherapy and residual N2 disease in view of the significantly reduced survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Rosell R, Gomez-Codina J, Camps C et al (1994) A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small cell lung cancer. N Engl J Med 330:153–158

    Article  PubMed  CAS  Google Scholar 

  2. Roth JA, Fossella F, Komaki R et al (1994) A randomized trial comparing preoperative chemotherapy and surgery and surgery alone in respectable stage IIIA non-small cell lung cancer. J Natl Cancer Inst 86:673–680

    Article  PubMed  CAS  Google Scholar 

  3. Rosell R, Gomez-Codina J, Camps C et al (1999) Preresectional chemotherapy in stage IIIA non-small cell lung cancer: a 7-year assessment of a randomized controlled trial. Lung Cancer 26:7–14

    Article  PubMed  CAS  Google Scholar 

  4. Depierre A, Milleron B, Moro-Sibilot D et al (2002) Preoperative chemotherapy followed by surgery compared with primary surgery in resectable stage I (except T1N0), II and IIIA non-small cell lung cancer. J Clin Oncol 20:247–253

    Article  PubMed  Google Scholar 

  5. Nagai K, Tsuchiya R, Mori T et al (2003) A randomized trial comparing induction chemotherapy followed by surgery with surgery alone for patients with stage IIIA N2 non-small cell lung cancer (JCOG 9209). J Thorac Cardiovasc Surg 125:254–260

    Article  PubMed  Google Scholar 

  6. De Marinis F, Gebbia V, De Petris L (2005) Neoadjuvant chemotherapy for stage IIIA-N2 non-small cell lung cancer. Ann Oncol 16(Suppl 4):116–122

    Google Scholar 

  7. Farray D, Mirkovic N, Albain KS (2005) Multimodality therapy for stage III non-small cell lung cancer. J Clin Oncol 23:3257–3269

    Article  PubMed  CAS  Google Scholar 

  8. Fowler WC, Langer CJ, Curran WJ et al (1993) Postoperative complications after combined neoadjuvant treatment of lung cancer. Ann Thorac Surg 55:986–989

    Article  PubMed  CAS  Google Scholar 

  9. Martin J, Ginsberg RJ, Abolhoda A et al (2001) Morbidity and mortality after neoadjuvant therapy for lung cancers: the risk of right pneumonectomy. Ann Thorac Surg 72:1149–1154

    Article  PubMed  CAS  Google Scholar 

  10. Mountain CF (1997) Revisions in the international system for staging lung cancer. Chest 111:171–177

    Google Scholar 

  11. Andre F, Grunenwald D, Pignon JP et al (2000) Survival of patients with resected N2 non-small cell lung cancer: evidence for a subclassification and implications. J Clin Oncol 18:2981–2989

    PubMed  CAS  Google Scholar 

  12. Sugarbaker DJ, Herndon J, Lohman LJ et al (1995) Results of CALGB 8935: a multi-institutional phase II trimodality trial for stage IIA (N2) non-small cell lung cancer. J Thorac Cardiovasc Surg 109:473–485

    Article  PubMed  CAS  Google Scholar 

  13. Betticher DC, Hsu Schmitz SF, Totsch M et al (2006) Prognostic factors affecting long-term outcomes in patients with resected stage IIIA pN2 non-small-cell lung cancer: 5-year follow-up of a phase II study. Br J Cancer 94:1099–1106

    Article  PubMed  CAS  Google Scholar 

  14. Albain KS, Rush VW, Crowley JJ et al (1995) Concurrent cisplatin/etoposide plus chest radiotherapy followed by surgery for stages IIIA (N2) and IIIB non-small cell lung cancer: mature results of Southwest Oncology Group phase II study 8805. J Clin Oncol 13:1880–1892

    PubMed  CAS  Google Scholar 

  15. Pezzetta E, Stupp R, Zouhair A et al (2005) Comparison of neoadjuvant cisplatin-based chemotherapy versus radiochemotherapy followed by resection for stage III (N2) NSCLC. Eur J Cardiothorac Surg 27:1092–1098

    Article  PubMed  Google Scholar 

  16. Roberts JR, Eustis C, Devore R et al (2001) Induction chemotherapy increases perioperative complications in patients undergoing resection for non-small cell lung cancer. Ann Thorac Surg 72:885–888

    Article  PubMed  CAS  Google Scholar 

  17. Perrot E, Guibert B, Mulsant P et al (2005) Preoperative chemotherapy does not increase complications after non small cell lung cancer resection. Ann Thorac Surg 80:423–427

    Article  PubMed  Google Scholar 

  18. Takeda S, Maeda H, Okada T et al (2006) Results of pulmonary resection following neoadjuvant therapy for locally advanced (IIIA–IIIB) lung cancer. Eur J Cardiothorac Surg 30:184–189

    Article  PubMed  Google Scholar 

  19. Brunelli A, Xiumé F, Al Refai M et al (2006) Gemcitabine-cisplatin chemotherapy before lung resection: a case-matched analysis of early outcome. Ann Thorac Surg 81:1963–1968

    Article  PubMed  Google Scholar 

  20. Semik M, Riesenbeck D, Linder A et al (2004) Preoperative chemotherapy with and without additional radiochemotherapy: benefit and risk for surgery of stage III non-small cell lung cancer. Eur J Cardiothorac Surg 26:1205–1210

    Article  PubMed  Google Scholar 

  21. Stamatis G, Djuric D, Eberhardt W et al (2002) Postoperative morbidity and mortality after induction chemoradiotherapy for locally advanced lung cancer: an analysis of 350 operated patients. Eur J Cardiothoracic Surg 22:292–297

    Article  Google Scholar 

  22. Voltolini L, Luzzi L, Ghiribelli C et al (2001) Results of induction chemotherapy followed by surgical resection in patients with stage IIIA(N2) non-small cell lung cancer: the importance of the nodal down-staging after chemotherapy. Eur J Cardiothorac Surg 20:1106–1112

    Article  PubMed  CAS  Google Scholar 

  23. Bueno R, Richards WG, Swanson SJ et al (2000) Nodal stage after induction therapy for stage IIIA lung cancer determines patient survival. Ann Thorac Surg 70:1826–31

    Article  PubMed  CAS  Google Scholar 

  24. Van Schil P, Van Der Schoot J, Poniewierski J et al (2002) Remediastinoscopy after neoadjuvant therapy for non-small cell lung cancer. Lung Cancer 37:281–285

    Article  PubMed  Google Scholar 

  25. Port JL, Korst RJ, Lee PC et al (2005) Surgical resection for residual N2 disease after induction chemotherapy. Ann Thorac Surg 79:1686–1690

    Article  PubMed  Google Scholar 

  26. Hellwig D, Graeter TP, Ukena D et al (2004) Value of F–18-fluorodeoxyglucose positron emission tomography after induction therapy of locally advanced bronchogenic carcinoma. J Thorac Cardiovasc Surg 128:892–899

    Article  PubMed  Google Scholar 

  27. Micames CG, McCrory DC, Pavey DA et al (2007) Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: a systematic review and meta-analysis. Chest 131:539–548

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy

    Angelo Carretta, Paola Ciriaco, Giulio Melloni, Imad Sayed, Alessandro Bandiera, Luca Ferla, Armando Puglisi & Piero Zannini

  2. Vita-Salute San Raffaele University, Milan, Italy

    Angelo Carretta, Paola Ciriaco, Giulio Melloni, Imad Sayed, Alessandro Bandiera, Luca Ferla, Armando Puglisi & Piero Zannini

Authors
  1. Angelo Carretta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paola Ciriaco
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giulio Melloni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Imad Sayed
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alessandro Bandiera
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luca Ferla
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Armando Puglisi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Piero Zannini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angelo Carretta.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carretta, A., Ciriaco, P., Melloni, G. et al. Results of Surgical Treatment After Neoadjuvant Chemotherapy for Stage III Non-Small Cell Lung Cancer. World J Surg 32, 2636–2642 (2008). https://doi.org/10.1007/s00268-008-9774-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-008-9774-7

Keywords

Search

Navigation