Extended operations after induction therapy for stage IIIb (T4) non-small cell lung cancer.
Twenty-three patients with stage IIIb (T4) non-small cell lung cancer received induction chemotherapy (median, 2 cycles) with (n = 12) or without (n = 11) radiation (median, 45 Gy) before operation. Nine tumors involved the carina (n = 8) or lateral tracheal wall (n = 1), 11 were located centrally and invaded the proximal pulmonary artery (n = 6), veins (n = 3), or both (n = 2), three were apical tumors involving T4 structures, and six were associated with histologically diseased mediastinal nodes. Five complete and 18 partial responses were observed after induction treatment. Resection of all residual tumor at the primary site and involved vestiges was possible in 21 patients (91%); in two apical tumors, tumor was left behind. Nine right tracheal sleeve and 11 intrapericardial pneumonectomies and three resections of apical tumors were performed; 11 patients (48%) had radical mediastinal lymph node dissection. Complete sterilization of the primary tumor was observed in 3 patients (13%). Mean operating time was 209.3 +/- 86.8 minutes, and mean blood loss was 896.9 +/- 1031 mL. Major postoperative complications occurred in 6 patients (26%), including hemothorax requiring drainage (n = 1) or reoperation (n = 1), acute distress syndrome (n = 2), and bronchopleural fistula (n = 2), and their incidence was significantly higher (p = 0.0003) among patients receiving induction chemoradiation than among those receiving chemotherapy alone (42 versus 9%). Early (< 1 month) postoperative mortality was 8.6% (n = 2). With a median follow-up of 25 months (range, 12 to more than 39 months), the projected 3-year overall survival was 54%.(ABSTRACT TRUNCATED AT 250 WORDS)
Macchiarini
P
P
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, Le Plessis Robinson, France.
Chapelier
A R
AR
Monnet
I
I
Vannetzel
J M
JM
Rebischung
J L
JL
Cerrina
J
J
Parquin
F
F
Ladurie
F L
FL
Lenot
B
B
Dartevelle
P G
PG
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D008937:Mitomycins / Q000008:administration & dosage; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016016:Proportional Hazards Models; D012074:Remission Induction / Q000379:methods; D015996:Survival Rate; D013997:Time Factors; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014751:Vindesine / Q000008:administration & dosage; D000077235:Vinorelbine
D008937:Mitomycins; D014747:Vinblastine; D002945:Cisplatin; D000077235:Vinorelbine; D014751:Vindesine; D005472:Fluorouracil