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.
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.
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.
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.
Pathological response is good prognostic indicator for the patient who underwent induction therapy.
Yukihito Saito, None.