Abstract
OBJECTIVE: Optimal management of stage IIIA-N2 non–small cell lung cancer remains controversial. The use of neoadjuvant chemoradiotherapy can present challenges in the perioperative management of patients undergoing lung resection for non-small cell lung cancer. Preoperative chemoradiotherapy may reduce pulmonary function, and can result in significant fibrosis around key anatomic structures, making dissection difficult and hazardous.
METHODS: This is a retrospective study of 40 consecutive patients with T1-3 N2 M0 lung cancer who underwent induction chemoradiation before surgical intervention from January 2005 through December 2011. Induction chemotherapy consisted of cisplatin, and etoposide; and concurrent radiotherapy to a mean of 59.3 Gy. Lung resection was performed within 6 weeks of completion of chemoradiation.
RESULTS: Twenty-five patients were submitted to pneumonectomy, simple or intrapericardial one, 10 to lobectomies and 5 either to segmentectomies or atypical resection. R0 resection was achieved in all cases. The overall operative mortality rate was 2.5% (one died in the lobectomy group). No important morbidity was noted and the overall hospital stay ranged from 7 to 14 days.
CONCLUSION: Chemoradiation before pulmonary resection in carefully selected patients with surgically resectable stage IIIA (N2) non–small cell lung cancer can be performed with low mortality and morbidity and might lead to improved overall and disease-free survival.
- © 2012 ERS