title: Pulmonary rehabilitation during induction chemoradiotherapy for lung cancer improves pulmonary function.
abstract: OBJECTIVE
  Chemoradiotherapy for non-small cell lung cancer can impair pulmonary function, particularly when it is followed by surgery. This study aimed to document the changes in respiratory function as a result of a perioperative intensive pulmonary rehabilitation program in patients with non-small cell lung cancer who underwent induction chemoradiotherapy.
  
  
  METHODS
  A total of 82 consecutive patients underwent pulmonary resection after undergoing induction chemoradiotherapy. A pulmonary rehabilitation program was started at the same time as the induction chemoradiotherapy. Standard respiratory function tests were performed before and after induction chemoradiotherapy. Treatment-related mortality and the incidence of postoperative respiratory complications were investigated. The Wilcoxon signed-rank test was used to analyze the differences in spirometric changes.
  
  
  RESULTS
  All patients underwent a pulmonary rehabilitation program for an average of 10 weeks. Significant increases were observed in forced vital capacity (+6.4%, P = .0096) and forced expiratory volume in 1 second (+10.4%, P < .0001). Diffusing capacity of the lung for carbon monoxide decreased (-14.0%, P < .0001). Patients with respiratory impairment (forced vital capacity <80% predicted or forced expiratory volume in 1 second/forced vital capacity <70%) showed significant improvements in forced vital capacity (+13.9%, P = .0025) and forced expiratory volume in 1 second (+22.5%, P < .0001). Significant increases were observed in forced vital capacity (+7.0%, P = .0042) and forced expiratory volume in 1 second (+10.8%, P = .0001) in patients with a smoking history. There was no mortality, and postoperative respiratory morbidity was 6.1%.
  
  
  CONCLUSIONS
  A pulmonary rehabilitation program for patients with non-small cell lung cancer undergoing induction chemoradiotherapy seems to improve respiratory function. It is particularly recommended for smokers and patients with respiratory impairment.
authors.affiliation: Faculty of Medicine, Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Kagawa University, Kagawa, Japan. Electronic address: starumi@med.kagawa-u.ac.jp.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Tarumi
authors.affiliation: Faculty of Medicine, Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Kagawa University, Kagawa, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Yokomise
authors.affiliation: Faculty of Medicine, Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Kagawa University, Kagawa, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Gotoh
authors.affiliation: Faculty of Medicine, Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Kagawa University, Kagawa, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kasai
authors.affiliation: Faculty of Medicine, Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Kagawa University, Kagawa, Japan.
authors.forename: Natsumi
authors.initials: N
authors.lastname: Matsuura
authors.affiliation: Faculty of Medicine, Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Kagawa University, Kagawa, Japan.
authors.forename: Sung Soo
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Faculty of Medicine, Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Kagawa University, Kagawa, Japan.
authors.forename: Tetsuhiko
authors.initials: T
authors.lastname: Go
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000401:mortality; D012129:Respiratory Function Tests; D012189:Retrospective Studies