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Clinical benefit of neoadjuvant chemoradiotherapy for the avoidance of pneumonectomy; assessment in 12 consecutive centrally located non-small cell lung cancers

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Abstract

Background

Considering that pneumonectomy itself is a disease, avoidance of pneumonectomy needs to be deliberated. Herein, we evaluated the role of neoadjuvant chemoradiotherapy for avoidance of pneumonectomy in patients with centrally located locally advanced non-small cell lung cancer.

Methods

Patients who underwent neoadjuvant chemoradiotherapy after being judged to require pneumonectomy by cancer board between 1997 and 2011 were retrospectively evaluated.

Results

Twelve patients, including 10 males and 2 females with median age 63.5 years, were referred. Clinical stage was IB (1 patient), IIB (2 patients), IIIA (8 patients), and IIIB (1 patient). There were no disease progression after neoadjuvant chemoradiotherapy, and all patients underwent curative resection. For 8 patients, pneumonectomy was avoided, with 3 bronchoplasties and 3 pulmonary arterial angioplasties. We had 4 pneumonectomies: three cases of metastatic enlarged lymph nodes invading either the carina or a more central portion of the pulmonary artery than the left A3 branch or vein which needs incision of the inner pericardium and 1 case with a tumor involving the upper lobe bronchus to the inferior lobe bronchus. There were no postoperative deaths and 1 case of bronchopleural fistula. The 5-year disease-free and overall survival rates were 55.6 and 72.7% without stump or anastomotic recurrence.

Conclusions

Neoadjuvant chemoradiotherapy for centrally located NSCLC appeared to be a useful treatment option for avoiding pneumonectomy without impairing curability and safety, especially in highly selected cases without invasion to carina or right-or-left main trunk of pulmonary artery or vein at pretreatment.

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References

  1. Shapiro M, Swanson SJ, Wright CD, Chin C, Sheng S, Wisnivesky J, et al. Predictors of major morbidity and mortality after pneumonectomy utilizing the Society for Thoracic Surgeons General Thoracic Surgery Database. Ann Thorac Surg. 2010;90:927–34 (discussion 934-925).

    Article  PubMed  Google Scholar 

  2. Committee for Scientific Affairs TJAfTS, Masuda M, Okumura M, Doki Y, Endo S, Hirata Y, et al. Thoracic and cardiovascular surgery in Japan during 2014: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2016;64:665–97.

    Article  Google Scholar 

  3. Kopec SE, Irwin RS, Umali-Torres CB, Balikian JP, Conlan AA. The Postpneumonectomy State. Chest. 1998;114:1158–84.

    Article  CAS  PubMed  Google Scholar 

  4. Deslauriers J, Gregoire J, Jacques LF, Piraux M, Guojin L, Lacasse Y. Sleeve lobectomy versus pneumonectomy for lung cancer: a comparative analysis of survival and sites or recurrences. Ann Thorac Surg. 2004;77:1152–6 (discussion 1156).

    Article  PubMed  Google Scholar 

  5. Kim YT, Kang CH, Sung SW, Kim JH. Local control of disease related to lymph node involvement in non-small cell lung cancer after sleeve lobectomy compared with pneumonectomy. Ann Thorac Surg. 2005;79:1153–61 (discussion 1153-1161).

    Article  PubMed  Google Scholar 

  6. Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Matsuoka H, Satake S, et al. Extended sleeve lobectomy for lung cancer: the avoidance of pneumonectomy. J Thorac Cardiovasc Surg. 1999;118:710–3 (discussion 713-714).

    Article  CAS  PubMed  Google Scholar 

  7. Rendina EA, Venuta F, de Giacomo T, Rossi M, Coloni GF. Parenchymal sparing operations for bronchogenic carcinoma. Surg Clin North Am. 2002;82:589–609, (vii).

  8. Albain KS, Swann RS, Rusch VW, Tuttisi AT, Shepherd FA, Smith C, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet. 2009;374:379–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Cerfolio RJ, Bryant AS, Spencer SA, Bartolucci AA. Pulmonary resection after high-dose and low-dose chest irradiation. The Annals of thoracic surgery. 2005;80:1224–1230 (discussion 1230).

  10. Daly BD, Fernando HC, Ketchedjian A, Dipetrillo TA, Kachnic LA, Morelli DM, et al. Pneumonectomy after high-dose radiation and concurrent chemotherapy for nonsmall cell lung cancer. Ann Thorac Surg. 2006;82:227–31.

    Article  PubMed  Google Scholar 

  11. Eberhardt W, Wilke H, Stamatis G, Stuschke M, Harstrick A, Menker H, et al. Preoperative chemotherapy followed by concurrent chemoradiation therapy based on hyperfractionated accelerated radiotherapy and definitive surgery in locally advanced non-small-cell lung cancer: mature results of a phase II trial. J Clin Oncol. 1998;16:622–34.

    Article  CAS  PubMed  Google Scholar 

  12. Galetta D, Cesario A, Margaritora S, Porziella V, Piraino A, D’Angelillo RM, et al. Multimodality treatment of unresectable stage III non-small cell lung cancer: interim analysis of a phase II trial with preoperative gemcitabine and concurrent radiotherapy. J Thorac Cardiovasc Surg. 2006;131:314–21.

    Article  CAS  PubMed  Google Scholar 

  13. Pourel N, Santelmo N, Naafa N, Serre A, Hilgers W, Mineur L, et al. Concurrent cisplatin/etoposide plus 3D-conformal radiotherapy followed by surgery for stage IIB (superior sulcus T3N0)/III non-small cell lung cancer yields a high rate of pathological complete response. Eur J Cardio-Thorac Surgery Off J Eur Assoc Cardio-Thorac Surg. 2008;33:829–36.

    Article  Google Scholar 

  14. Sonett JR, Suntharalingam M, Edelman MJ, Patel AB, Gamliel Z, Doyle A, et al. Pulmonary resection after curative intent radiotherapy (>59 Gy) and concurrent chemotherapy in non-small-cell lung cancer. Ann Thorac Surg. 2004;78:1200–1205 (discussion 1206).

  15. Yashar J, Weitberg AB, Glicksman AS, Posner MR, Feng W, Wanebo HJ. Preoperative chemotherapy and radiation therapy for stage IIIa carcinoma of the lung. Ann Thorac Surg. 1992;53:445–8.

    Article  CAS  PubMed  Google Scholar 

  16. Weder W, Collaud S, Eberhardt WE, Hillinger S, Welter S, Stahel R, et al. Pneumonectomy is a valuable treatment option after neoadjuvant therapy for stage III non-small-cell lung cancer. J Thorac Cardiovasc Surg. 2010;139:1424–30.

    Article  PubMed  Google Scholar 

  17. Albain KS, Rusch VW, Crowley JJ, Rice TW, Turrisi AT, Weick JK, et al. 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. 1995;13:1880–92.

    Article  CAS  PubMed  Google Scholar 

  18. Sher DJ, Fidler MJ, Seder CW, Liptay MJ, Koshy M. Relationship between radiation therapy dose and outcome in patients treated with neoadjuvant chemoradiation therapy and surgery for stage IIIA non-small cell lung cancer: a population-based, comparative effectiveness analysis. Int J Radiat Oncol Biol Phys. 2015;92:307–16.

    Article  PubMed  Google Scholar 

  19. Burfeind WR Jr, D’Amico TA, Toloza EM, Wolfe WG, Harpole DH. Low morbidity and mortality for bronchoplastic procedures with and without induction therapy. The Annals of thoracic surgery. 2005;80:418–21 (discussion 422).

    Article  PubMed  Google Scholar 

  20. Kim AW, Boffa DJ, Wang Z, Detterbeck FC. An analysis, systematic review, and meta-analysis of the perioperative mortality after neoadjuvant therapy and pneumonectomy for non-small cell lung cancer. J Thorac Cardiovasc Surg. 2011;143:55–63.

    Article  PubMed  Google Scholar 

  21. Sawabata N, Miyaoka E, Asamura H, Nakanishi Y, Eguchi K, Mori M, et al. Japanese lung cancer registry study of 11,663 surgical cases in 2004: demographic and prognosis changes over decade. J Thorac Oncol. 2011;6:1229–35.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Keizo Misumi, Norifumi Tsubokawa, Yasuhiro Tsutani, Kotaro Matsumoto, Yoshihiro Miyata & Morihito Okada

  2. Department of Respiratory Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan

    Hiroaki Harada & Yoshinori Yamashita

Authors
  1. Keizo Misumi
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  2. Hiroaki Harada
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  3. Norifumi Tsubokawa
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  4. Yasuhiro Tsutani
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  5. Kotaro Matsumoto
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  6. Yoshihiro Miyata
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  7. Yoshinori Yamashita
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  8. Morihito Okada
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Correspondence to Morihito Okada.

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Misumi, K., Harada, H., Tsubokawa, N. et al. Clinical benefit of neoadjuvant chemoradiotherapy for the avoidance of pneumonectomy; assessment in 12 consecutive centrally located non-small cell lung cancers. Gen Thorac Cardiovasc Surg 65, 392–399 (2017). https://doi.org/10.1007/s11748-017-0776-y

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  • DOI: https://doi.org/10.1007/s11748-017-0776-y

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