To determine the role of pulmonary dysfunction as a reason for inoperability for patients with NSCLC who were considered for surgical treatment at the time of diagnosis.
We studied all patients with NSCLC referred for preoperative evaluation to our pulmonary function laboratory between January 2001 and November 2001. Clinical characteristics, staging, smoking history, comorbidities, and clinical notes were reviewed. Pulmonary function testing consisted of spirometry, lung volumes, DLCO, 133Xenon quantitative V/Q studies, and exercise testing when indicated.
We evaluated 206 patients (M=120;F=86) with NSCLC. Mean age was 64.7±10.1 yrs. Average predicted FEV1=70.3%±19.6% (range 25%-123%). One hundred and thirty- two (64%) patients had at least one comorbidity: DM 15 (7%), HTN 66 (32%), CAD 47(23%), COPD 18(9%), and asthma 5(2%). In addition, 59(29%) had history of other malignancies. One hundred and ninety-one (93%) were smokers or former smokers. After completion of their evaluation, tumor staging was: IA:28 (14%), IB:27(13%), IIA:8(4%), IIB:31(15%), IIIA:48(23%), IIIB:39(19%) and IV:25(13%). The histologic types were: adenocarcinoma 87(42%), squamous 72(35%), large cell 43(21%), and BAC 4(2%). One hundred had surgery. The remaining 106 did not have surgery because of the following reasons:.
Pulmonary dysfunction alone is the cause for inoperability for nearly one-fifth of patients initially considered for surgical treatment for NSCLC.
Clear understanding of the frequency of pulmonary dysfunction amongst lung cancer patients is cornerstone for development of treatment strategies alternative to surgery ( ie conformal XRT) or methods of improving lung function preoperatively (ie lung volume reduction or pulmonary rehabilitation).
Reason for InoperabilityN=206 (%)Pulmonary dysfunction38 (19%)Unresectable local-regional disease34 (17%)Distant metastasis22 (11%)Cardiac dysfunction2 (1%)Cardiac risk+pulmonary dysfunction2 (1%)Recurrence of disease2 (1%)Patient refusal1 (0.5%)Lost F/U5 (2%)
Sevin Baser, None.