title: Results of pulmonary resection following neoadjuvant therapy for locally advanced (IIIA-IIIB) lung cancer.
abstract: OBJECTIVE
  We performed this study to determine the role and prognostic factors of neoadjuvant therapy followed by surgery for locally advanced non-small cell cancer.
  
  
  METHODS
  One hundred patients with clinical stage III non-small cell lung cancer (79 IIIA, 21 IIIB; 78 males, 22 females; average age 60.5 years) received neoadjuvant therapy, of whom 84 received two cycles of platinum chemotherapy combined with an average radiation dose of 41.5Gy, and 16 patients underwent chemotherapy alone. The mean follow-up duration was 80.9 months. Survival rate was estimated by the Kaplan-Meier method, and a Cox proportional hazards model was applied to determine the prognostic factors.
  
  
  RESULTS
  The operative procedures included 74 lobectomies, 7 bi-lobectomies, and 19 pneumonectomies. Two patients died within 30 days due to adult respiratory distress syndrome and acute pulmonary embolism, respectively. The overall 5-year survival rate was 39.7% with a median survival time (MST) of 39.6 months. The 5-year survival rate for downstaged (pN1,2) patients was 53.5% while it was 16.3% for patients with residual N2. There was no difference in survival between lobectomy and pneumonectomy (MST 38 months vs 42 months). Univariate and multivariate analyses revealed that nodal status and tumor size after neoadjuvant therapy were independent prognostic factors.
  
  
  CONCLUSIONS
  Neoadjuvant therapy was shown to deliver the optimal effect for surgery for cIIIA/IIIB NSCLC with acceptable mortality. Re-staging to exclude the residual multiple nodal metastasis can lead to the proper patient selection. A pneumonectomy, as a last option, following neoadjuvant therapy did not affect the mortality.
authors.affiliation: Department of General Thoracic Surgery and Pulmonary Medicine, Toneyama National Hospital, Toneyama 5-1-1, Toyonaka City, Osaka 560-8552, Japan. stakeda@toneyama.hosp.go.jp
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Takeda
authors.forename: Hajime
authors.initials: H
authors.lastname: Maeda
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Okada
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Masaru
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Soichiro
authors.initials: S
authors.lastname: Yokota
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Sawabata
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Ohta
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis