Cho, Jong Ho; Kim, Jhingook; Kim, Kwhanmien; Shim, Young Mog; Kim, Hong Kwan; Choi, Yong Soo
World journal of surgery
2012May ; 36 ( 5 ) :1199-205.
PMID : 22374538
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Cho, Jong Ho -
Kim, Jhingook -
Kim, Kwhanmien -
Shim, Young Mog -
Kim, Hong Kwan -
Choi, Yong Soo -
ABSTRACT
BACKGROUND: The aim of the present study was to evaluate the outcomes of surgical resection, especially bilobectomy, after chemoradiation therapy to treat stage IIIA-N2 non-small-cell lung cancer.
METHODS: Data from all patients who underwent surgical resection after neoadjuvant chemoradiation therapy for stage IIIA-N2 non-small-cell lung cancer between 1998 and 2007 were analyzed retrospectively. The chemotherapy regimen consisted of weekly paclitaxel plus cisplatin or weekly paclitaxel plus carboplatin for 5 weeks. The concurrent thoracic radiotherapy dose was 45 Gy over 5 weeks. Surgical resection was planned at around 4 weeks following the completion of neoadjuvant therapy.
RESULTS: Of 186 patients who underwent neoadjuvant therapy, 23 bilobectomies, 28 pneumonectomies, and 135 lobectomies were performed. The early postoperative mortality rate (within 30 days after operation) was 7.1, 8.7, and 1.5% for the pneumonectomy, bilobectomy, and lobectomy groups, respectively. The late postoperative mortality rate (within 90 days) of the lobectomy, bilobectomy, and pneumonectomy groups was 5.9, 13, and 10.7%, respectively. Overall survival was significantly higher among patients treated by lobectomy than among those treated by bilobectomy (p = 0.041) or pneumonectomy (p = 0.010). Recurrence was significantly lower in patients treated by lobectomy than in those treated by pneumonectomy (p = 0.034).
CONCLUSIONS: Bilobectomy is associated with high operative mortality and poor long-term survival after neoadjuvant concurrent chemoradiotherapy for stage IIIA-N2 non-small-cell lung cancer. The outcomes of bilobectomy were similar to those of pneumonectomy in terms of overall survival, disease-free survival, and postoperative mortality.
Adult; Aged; Antineoplastic Agents/therapeutic use; Antineoplastic Combined Chemotherapy Protocols; Carboplatin/therapeutic use; Carcinoma, Non-Small-Cell Lung/mortality/pathology/*therapy; *Chemoradiotherapy; Cisplatin/therapeutic use; Female; Humans; Lung Neoplasms/mortality/pathology/*therapy; Male; Middle Aged; *Neoadjuvant Therapy; Neoplasm Staging; Paclitaxel/therapeutic use; Pneumonectomy/*methods/mortality; Retrospective Studies; Risk; Survival Analysis; Treatment Outcome
MESH
Adult, Aged, Antineoplastic Agents/therapeutic use, Antineoplastic Combined Chemotherapy Protocols, Carboplatin/therapeutic use, Carcinoma, Non-Small-Cell Lung/mortality/pathology/*therapy, *Chemoradiotherapy, Cisplatin/therapeutic use, Female, Humans, Lung Neoplasms/mortality/pathology/*therapy, Male, Middle Aged, *Neoadjuvant Therapy, Neoplasm Staging, Paclitaxel/therapeutic use, Pneumonectomy/*methods/mortality, Retrospective Studies, Risk, Survival Analysis, Treatment Outcome
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