title: Impact of lung function changes after induction radiochemotherapy on resected T4 non-small cell lung cancer outcome.
abstract: BACKGROUND
  Induction radiochemotherapy, followed by resection, for T4 non-small cell lung cancer, has shown promising long-term survival but may be associated with increased postoperative morbidity and death, depending on patient selection. Here, we determined the effect of induction radiochemotherapy on pulmonary function and whether postinduction pulmonary function changes predict hospital morbidity and death and long-term survival.
  
  
  METHODS
  A consecutive prospective cohort of 72 patients with T4 N0-2 M0 non-small cell lung cancer managed by radiochemotherapy, followed by resection, is reported. All patients underwent thoracoabdominal computed tomography or fusion positron emission tomography-computed tomography, brain imaging, mediastinoscopy, echocardiography, ventilation-perfusion scintigraphy, and pulmonary function testing before and after induction therapy. Resection was performed if the postoperative forced expiratory volume in 1 second and diffusion capacity of the lung for carbon monoxide exceeded 30% predicted and if the postoperative maximum oxygen consumption exceeded 10 mL/kg/min.
  
  
  RESULTS
  The postoperative 90-day mortality rate was 8% (lobectomy, 2%; pneumonectomy, 21%; p=0.01). All deaths after pneumonectomy occurred after right-sided procedures. The 3-year and 5-year survival was 50% (95% confidence interval, 36% to 62%) and 45% (95% confidence interval, 31% to 57%) and was significantly associated with completeness of resection (p=0.004) and resection type (pneumonectomy vs lobectomy, p=0.01). There was no correlation between postinduction pulmonary function changes and postoperative morbidity or death or long-term survival in patients managed by lobectomy or pneumonectomy.
  
  
  CONCLUSIONS
  In properly selected patients with T4 N0-2 M0 non-small cell lung cancer, resection after induction radiochemotherapy can be performed with a reasonable postoperative mortality rate and long-term survival, provided the resection is complete and a right-sided pneumonectomy is avoided. Postinduction pulmonary function changes did not correlate with postoperative morbidity or death or with long-term outcome.
authors.affiliation: Department of Thoracic and Vascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Jean
authors.initials: J
authors.lastname: Perentes
authors.forename: Sabina
authors.initials: S
authors.lastname: Bopp
authors.forename: Thorsten
authors.initials: T
authors.lastname: Krueger
authors.forename: Michel
authors.initials: M
authors.lastname: Gonzalez
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Jayet
authors.forename: Alban
authors.initials: A
authors.lastname: Lovis
authors.forename: Oscar
authors.initials: O
authors.lastname: Matzinger
authors.forename: Christiane
authors.initials: C
authors.lastname: Ruffieux
authors.forename: Hans-Beat
authors.initials: HB
authors.lastname: Ris
authors.forename: Igor
authors.initials: I
authors.lastname: Letovanec
authors.forename: Solange
authors.initials: S
authors.lastname: Peters
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011013:Pneumonectomy; D049268:Positron-Emission Tomography; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D012129:Respiratory Function Tests; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome