[Analysis of the treatment (neoadjuvant chemotherapy and surgery) in IIb and IIIa stages of non-small cell lung cancer].
OBJECTIVE
1) comparison of NSCLC stages according to bronchoscopic and radiological findings with pathological outcome (mediastinoscopy), 2) efficacy of the neoadjuvant ChT by means of nodal involvement and primary tumour (downstaging), 3) influence of ChT on the surgical procedures' extension and its morbidity


METHODS
100 consecutive patients with resectable NSCLC in stages IIB (13 pts) or IIIA (57 pts), who were qualified to neoadjuvant ChT, participated in this study (77 men and 23 women, aged 42-73). Tumour and lymph nodes (mediastinal and hilar) were measured in CT scan. Mediastinoscopy was performed in 70 pts (70%). Majority of patients (87%) received two cycles of neoadjuvant ChT (cisplatin 80 mg/m(2) iv on day 1 and vinorelbine 25 mg/m(2) on day 1 and 5) administered every 21 days. After ChT 85 patients were qualified to surgery.


RESULTS
The metastases in mediastinoscopy were excluded in 32 out of 45 patients (71%), whose lymph nodes were enlarged in CT scan (radiological false positive). Metastases were confirmed in 4 out of 25 patients (16%), whose lymph nodes were normal in CT scan (radiological false negative). After ChT the regression of the disease (PR+CR) was noted in 37% of patients. Pneumonectomy was performed in 23 (27%) pts, bilobectomy in 11 (13%) pts, lobectomy in 39 (46%) pts and "extended" (sleeve) lobectomy in 12 (14%) pts. Resected material was examined microscopically very exactly in patients, in whom mediastinoscopy was performed before treatment. Down-staging was confirmed in 6 out of 15 patients (40%).


CONCLUSIONS
Neoadjuvant ChT was effective in 37% of patients and allowed us to perform less extensive surgery in these patients. 22 (64,7%) out of 34 patients who responded to ChT underwent lobectomy. Only 17 (36%) out of 51 patients who did not respond to ChT had lobectomy performed. Generally, 85 pts were operated with postroperative complications in 22.3% patients and 2.3% mortality rate. Pneumonol. Alergol. Pol. 2006, 74, 171:178
Ptaszek
Beata
B
III Klinika Chorób Pluc, Instytutu Gruźlicy i Chorób Płuc, Warszawie.
Chabowski
Mariusz
M
Wiatr
Elzbieta
E
Orłowski
Tadeusz M
TM
Langfort
Renata
R
Bestry
Iwona
I
Roszkowski-Sliz
Kazimierz
K
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine
D014747:Vinblastine; D002945:Cisplatin; D000077235:Vinorelbine