A retrospective study: platinum-based induction chemotherapy combined with gemcitabine or paclitaxel for stage IIB-IIIA central non-small-cell lung cancer

Abstract

BackgroundSeveral encouraging phase III clinical trials have evaluated platinum-based induction chemotherapy against stage IIB-IIIA non-small-cell lung cancer (NSCLC). Chemotherapy efficacy was assessed using common regimens in this retrospective analysis.MethodsFrom 2007 to 2011, the clinical records of stage IIB-IIIA NSCLC patients undergoing surgery after neoadjuvant chemotherapy were reviewed. Gathered data were tested for significance and variables impacting survival were assessed by univariate and Cox regression analyses.ResultsOverall, 84% of patients were male and 93% had central disease. Platinum-based chemotherapy protocols with gemcitabine or paclitaxel gave an overall response rate of 55% (45/82) and 6.1% pathological complete response (5/82). Clinical response was unassociated with regimen or histology, while more pneumonectomies were performed in the stable compared to partial response disease group (P =0.040). Postoperative mortality was 1.2% (1/82), and complications, unassociated with regimen or histology, were atelectasis (26.8%) and supraventricular arrhythmias (13.4%). Right-sided procedures appeared to increase the incidence of bronchopleural fistula (P =0.073). The median disease-free survival time was 18 months and median overall survival time was not reached. Disease-free survival rates at one, two, and three years were 54%, 47%, and 33%, while the overall survival rate was 73%, 69%, and 59%, respectively. Disease-free survival predictors were radiographic response and mediastinal lymphadenopathy before chemotherapy (P =0.012 and 0.002, respectively).ConclusionsTwo cycles of platinum-based chemotherapy with gemcitabine or paclitaxel is efficacious for patients with stage IIB-IIIA central disease. Patients achieving clinical response had improved disease-free survival times, while those with mediastinal lymphadenopathy had a higher postoperative recurrence risk.

Benefits of surgery in the multimodality treatment of stage IIB-IIIC small cell lung cancer

“…Previously, a large of studies including prospective and retrospective analyses focused on the treatment for NSCLC [8][9][10][11][12][13][14][15] , because NSCLC accounted for 85% of lung cancer cases 16 . It has been reported that surgery combined with chemotherapy/ radiotherapy may improve the survival of the patients with advanced NSCLC 9,15 .…”

Risk factors and outcomes of bronchopleural fistula after bronchoplasty in patients with non-small cell lung cancer: a retrospective multivariate analysis

“…Several studies have reported some risk factors related to the occurrence of BPF after lung surgery. Among them, the most reported risk factors include age at surgery (11,26), diabetes (9,11), COPD (27), neoadjuvant therapy (11)(12)(13), albumin level (8,28), as well as intraoperative factors such as residual margin (3), right pneumonectomy (8,17,18,29), and right middle and/or lower lobectomy (8,30). In this study, we used bronchoplasty patients as the study population, and obtained some of the same risk factors as those for the high incidence of BPF after pneumonectomy and lobectomy, such as residual margin and right middle and/or lower lobectomy.…”

Correlation of Histopathologic Response and Prognostic Markers With the Survival in Locally Advanced Non-Small Cell Lung Cancer Patients Treated With Neoadjuvant Chemotherapy

“…There are studies showing the efficacy of neoadjuvant therapy with platinum-based combination in patients with stage III NSCLC (10,11). However, a standard chemotherapy protocol could not be determined.…”