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SINGLE INSTITUTION EXPERIENCE OF INDUCTION THERAPY FOLLOWED BY SURGERY FOR LOCALLY ADVANCED NSCLC IN 102 CONSECUTIVE PATIENTS FREE TO VIEW

Yukihito Saito, MD*; Tomohiro Maniwa, MD; Hiroyuki Kaneda, MD; Ken-ichiro Minami, MD; Hiroji Imamura, MD
Author and Funding Information

Kansai Medical University, Osaka, Japan


Chest


Chest. 2005;128(4_MeetingAbstracts):206S-b-207S. doi:10.1378/chest.128.4_MeetingAbstracts.206S-b
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Published online

Abstract

PURPOSE:  Neoadjuvant treatment for locally advanced non-small-cell lung cancer stage IIIA and IIIB promises higher resection rates because of a reduction of the primary tumor and sterilisation of mediastinal nodes. In this study we analyse the perioperative course and the long-term survival of patients with induction therapy.

METHODS:  Between Jan. 1990 and Dec. 2004, 102 patients with NSCLC underwent resection after induction treatment. Included were 82 males and 20 females, median age 63 year-old (39–74), of whom 81 were stage IIIA patients, 21 were stage IIIB patients. Induction therapy included four different regimens, intravenous mitomycin C+vindesine+and cisplatin (MVP), bronchial arterial infusion of CDDP and mitomycin C followed by intravenous vindesin (BAl-MVP), concurrent chemoradiothreapy with 30Gy irradiation+ CBDCA and CBDCA+PTX. 30 patients received MVP, 10 patients received BAI-MVP and 60 patients received CBDCA with concurrent irradiation, 2 patients received CBDCA+PTX followed by surgery. In patients with N3 disease and malignant pleural effusion were excluded.

RESULTS:  Resections included 20 pneumonectomies (19.6%), 5 sleeve lobectomies (4.9%), 67 lobectomies (65.7%), and 10 explorative thoracotomies (9.8%). In-hospital mortality rates amounted to 4.9% (5 patients). Bronchopleural fistulas occurred in 2 patients (1.9%). The protection of the bronchial stump or anastomosis with viable tissue, like pedicled pericardial flap or intercostals muscle flap, proves to be a significant factor for the reduction of septic complications. For NSCLC, the 5-year survival rates were 40.2%. Induction therapy significantly increases the survival rate of stage IIIA and IIIB NSCLC compared with historical controls. There was a significant difference in the survival between patients with a major pathologic response to induction therapy as opposed to those who had a minor response.

CONCLUSION:  This intensive treatment proves to be feasible. Treatment-related toxicities are overall moderate and acceptable. Accurate cardiopulmonary evaluation before surgery and reinforcement of bronchial stump or anastomosis can contribute to reducing complications. Long-term survival rates for selected groups look very promising when compared to historical controls.

CLINICAL IMPLICATIONS:  Pathological response is good prognostic indicator for the patient who underwent induction therapy.

DISCLOSURE:  Yukihito Saito, None.

2:30 PM - 4:00 PM


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