title: Impact and safety of adjuvant chemotherapy on pulmonary function in early stage non-small cell lung cancer.
abstract: BACKGROUND
  Pulmonary function may decline after induction chemotherapy and predict perioperative complications in non-small cell lung cancer (NSCLC). The influence of adjuvant chemotherapy is largely indeterminate.
  
  
  OBJECTIVE
  To assess whether adjuvant chemotherapy alters pulmonary function and impacts on treatment-related adverse events.
  
  
  METHODS
  In a trial on adjuvant chemotherapy (the TREAT trial), 132 patients with R0-resected NSCLC were randomised to 4 cycles of cisplatin-vinorelbine (CVb, n = 65) or cisplatin-pemetrexed (CPx, n = 67). Pulmonary function tests (forced expiratory volume in 1 s, FEV1, forced vital capacity, FVC, total lung capacity, TLC, diffusing capacity for carbon monoxide, DLCO, and blood gas analyses, BGA) were analysed before and 30 days after the last chemotherapy, and changes were calculated (Δ = mean differences).
  
  
  RESULTS
  Overall, FVC increased significantly (Δ +290 ml, n = 76; p < 0.0001), while TLC did not change (Δ +220 ml, n = 41; p = 0.174). For CPx, FEV1 increased significantly (Δ +150 ml, n = 47; p = 0.0017), but not for CVb (Δ +30 ml, n = 30). DLCO decreased only for CVb (-8%, n = 6) but not for CPx (-0.39%, n = 17; p = 0.58). BGA did not change (p = 0.99). In a Cox regression analysis, baseline pulmonary function did not influence treatment failure.
  
  
  CONCLUSIONS
  Adjuvant chemotherapy seems not to result in a decrease of pulmonary function parameters. A significant FVC increase was probably due to ongoing postoperative improvement. Decline of DLCO was noted with CVb but not with CPx. Pulmonary function does not impact on treatment failure.
authors.affiliation: Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Kreuter
authors.forename: Johan
authors.initials: J
authors.lastname: Vansteenkiste
authors.forename: Felix J F
authors.initials: FJ
authors.lastname: Herth
authors.forename: Jürgen R
authors.initials: JR
authors.lastname: Fischer
authors.forename: Wilfried
authors.initials: W
authors.lastname: Eberhardt
authors.forename: Ivan
authors.initials: I
authors.lastname: Zuna
authors.forename: Niels
authors.initials: N
authors.lastname: Reinmuth
authors.forename: Frank
authors.initials: F
authors.lastname: Griesinger
authors.forename: Michael
authors.initials: M
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005541:Forced Expiratory Volume; D005971:Glutamates / Q000008:administration & dosage; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008168:Lung / Q000473:pathology / Q000503:physiopathology*; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000068437:Pemetrexed; D011013:Pneumonectomy; D011653:Pulmonary Diffusing Capacity; D014109:Total Lung Capacity; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine; D014797:Vital Capacity
chemical_list: D005971:Glutamates; D000068437:Pemetrexed; D014747:Vinblastine; D006147:Guanine; D002945:Cisplatin; D000077235:Vinorelbine