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| Pneumonectomy after Chemo- or Chemoradiotherapy for advanced Non- Small Cell Lung Cancer | |
Walter Weder1, Stéphane Collaud1, Thomas Krbek2, Sven Hillinger1, Sylvia Fechner2, Peter Kestenholz1, Rolf Stahel1, Georgios Stamatis2; 1Zurich University Hospital, Zürich, Switzerland; 2Ruhrlandklinik, Essen, Germany
Methods: 827 patients underwent induction therapy for NSCLC after staging with CT, PET-CT and/or mediastinoscopy in two different centers from 1998-2007. Induction chemotherapy consisted mainly of 3 cycles of a platin-based regimen. Chemoradiotherapy consisted of an additional radiation of 45 Gy. Re-staging was performed with CT, PET-CT and/or re-mediastinoscopy prior to surgical resection. Patients who underwent a pneumonectomy were further analyzed. Results: 176 pneumonectomies were performed. 117 (66%) were extended resections including pericardium in 108 (60%), left atrium in 31 (18%), diaphragm in 10 (6%), chest wall in 8 (5%), superior vena cava in 7 (4%), aorta in 7 (4%) and oesophageal muscle in 5 (3%) patients. R0-resection was achieved in 165 (94%). Pre-induction clinical stage was IIB in 8 (5%), IIIA in 96 (54%), IIIB in 71 (40%) and IV in 1 (1%) patient. Post-induction pathological stage was a complete response in 36 (20%), stage I in 31 (18%), II in 39 (22%), III in 58 (33%) and IV in 12 (7%). There were 6 perioperative deaths (3% mortality) due to pulmonary embolism in 3, respiratory failure (pneumonia/ARDS) in 2 and cardiac failure in 1 patient. Within 90 post-operative days, 22 major complications occurred in 19 patients (11%): 6 (27%) broncho-pleural fistulas (BPF), 6 (27%) pneumonias/ARDS, 5 (23%) empyemas without BPF, 4 (18%) pulmonary embolism and 1 (5%) gastric herniation due to displacement of the diaphragmatic repair. 3- and 5-year survivals for the overall population were 55% and 38%, respectively. Conclusion: Pneumonectomy after chemo- or chemoradiotherapy as induction for advanced NSCLC can be performed with a perioperative mortality rate of 3 % and should not exclude patients from surgical resection. The achieved 5-year survival rate of 38% justifies aggressive surgery within a multimodality concept for selected cases. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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