Postoperative complications after combined neoadjuvant treatment of lung cancer

Fowler, Wyatt C.; Langer, Corey J.; Curran, Walter J.; Keller, Steven M.

doi:10.1016/0003-4975(93)90131-z

Cited by 189 publications

(79 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This single death (7%) was considered treatment related. A 43% mortality after pneumonectomy was reported in an induction chemoradiotherapy trial (Fowler et al, 1993). The objective radiographic response rate of 73% and the resectability of 73% of all eligible patients in this study agree with the previous trials of induction chemoradiotherapy (Rusch et al, 1993;Sugarbaker et al, 1995;Mathisen et al, 1996;Rice et al, 1998).…”

Section: Discussionsupporting

confidence: 90%

Preoperative induction chemotherapy with cisplatin and irinotecan for pathological N2 non-small cell lung cancer

et al. 2002

View full text Add to dashboard Cite

We conducted a phase I/II study to investigate whether the surgical resection after induction chemotherapy with cisplatin and irinotecan was feasible and could improve the treatment outcome for patients with pathological N 2 non-small cell lung cancer. Fifteen patients with stage IIIA non-small cell lung cancer having mediastinal lymph node metastases proved by mediastinoscopy were eligible. Both cisplatin (60 mg m 72 ) and irinotecan (50 mg m 72 ) were given on days 1 and 8. Patients received two cycles of chemotherapy after 3 -4 weeks interval. Induction was followed by surgical resection in 4 -6 weeks. Patients who had documented tumour regression after preoperative chemotherapy received two additional cycles of chemotherapy and other patients received radiotherapy postoperatively. After the induction chemotherapy, the objective response rate was 73%. All the 15 patients received surgical resection and complete resection was achieved in 11 (73%) patients. There was no operation-related death and one death due to radiation pneumonitis during postoperative radiotherapy. The median time from entry to final analysis was 46.5 months, ranging from 22 to 68 months. The 5-year survival rate was 40% for all the 15 patients and it was 55% for the 11 patients who underwent complete resection. We conclude that the surgical resection after induction chemotherapy with cisplatin and irinotecan is feasible, and associated with low morbidity and high respectability. The prognosis for non-small-cell lung cancer (NSCLC) with metastases in mediastinal nodes after surgery is generally poor because distant micrometastases are frequently present. If these nodes are found before operation by mediastinoscopy and treated with surgical resection and postoperative irradiation, the 5-year survival is only approximately 10% (Pearson et al, 1982). Although many studies have been performed to evaluate adjuvant chemotherapy, the results of these studies have been disappointing on the whole. Recently, several neoadjuvant treatment schedules using induction chemotherapy (Roth et al, 1998;Rosell et al, 1999) or chemoradiotherapy (Rusch et al, 1993;Albain et al, 1995; Sugarbaker et al, 1995;Mathisen et al, 1996; Rice et al, 1998) followed by surgical resection have shown encouraging results.We have recently reported the results of combination chemotherapy of cisplatin (CDDP) and irinotecan (CPT-11) for unresectable NSCLC (Ueoka et al, 1999). The objective response rate was 76% and the toxicity was manageable. The purpose of this study was to assess toxicity, response, and survival in patients with pathological N2, stage IIIA NSCLC who received induction chemotherapy with CDDP and CPT-11. MATERIALS AND METHODS Patient selectionInitial staging evaluation included complete history and physical examination, a complete blood cell count, standard chemistry profile, urinalysis, 24-h urine creatinine clearance, electrocardiogram, bronchoscopy, arterial blood gas analysis and pulmonary function test. Pretreatment chest X-ray, bone scan and CT of brain, ...

show abstract

Section: Discussionsupporting

confidence: 90%

Preoperative induction chemotherapy with cisplatin and irinotecan for pathological N2 non-small cell lung cancer

et al. 2002

View full text Add to dashboard Cite

show abstract

“…Particularly radiotherapy employed sequentially or simultaneously to neoadjuvant chemotherapy has been assumed to significantly increase surgical risk as it may promote fibrosis, bleeding and bronchial stump insufficiency [14]. In fact, bronchial stump insufficiency (3.8 vs 2.1%) as well as significant bleeding requiring re-thoracotomy (1.5 vs 0.7%) dominated in arm A of the present trial.…”

Section: Discussionmentioning

confidence: 76%

“…Another trial exclusively enrolling patients with stage IIIA-disease in a multi-institutional approach with conventional radiotherapy in addition to preoperative paclitaxel-containing chemotherapy reported a rate of 12.5% [15]. When applying a preoperative target volume dose of 60 Gy concomittant to chemotherapy, bronchial insufficiency developed even in 23% of cases [14]. These differences between the trials may depend on dosing and application of radiotherapy, but also on different surgical techniques.…”

Section: Discussionmentioning

confidence: 99%

Preoperative chemotherapy with and without additional radiochemotherapy: benefit and risk for surgery of stage III non-small cell lung cancer?

Semik

Riesenbeck

Linder

et al. 2004

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

Objective: Multi-modality approaches are increasingly employed to improve prognosis in surgically treated stage III non-small cell lung cancer (NSCLC). Risk and benefit of the preoperative therapeutic chemotherapy or combined radiochemotherapy on surgical morbidity and mortality are still a matter of debate. Methods: In 1995, a national phase III trial was started to compare (arm A) preoperative chemotherapy followed by twice-daily chemoradiation and consecutive surgery, with (arm B) preoperative chemotherapy alone followed by surgery and consecutive radiotherapy. An interim analysis with 277 patients was performed to assess surgical risk and complication rates. Results: Of the 385 patients, 273 (71%) underwent thoracotomy, 130 (73%) in arm A and 143 (69%) in arm B. Of the 273 patients undergoing thoracotomy, 168 had stage IIIB disease. Complete resection (R0) was achieved in 212 patients (78%), 104 in arm A (80%) and 108 in arm B (76%) (PZ n.s.). There was no difference in the proportion of complex resections between treatment arms (41% in arm A; 48% in arm B). Whilst bronchial stump insufficiency (3.8 vs 2.1%) and bleeding requiring re-thoracotomy (1.5 vs 0.7%) prevailed slightly in arm A, the occurrence of pneumonia divided similar on both treatment arms (4.6 vs 4.9%). Surgical mortality reached 6.1% in arm A (8/130) and 5.6% in arm B (6/143) (PZn.s.). Conclusions: In both treatment arms, a similar percentage of patients could be forwarded to surgery, even in stage IIIB disease. Bimodality induction seems to be superior with regard to resection rates (R0) (n.s.), but was associated with a higher complication rate, especially bronchial stump insufficiency. q

show abstract

“…In a smaller series of 13 patients, FOWLER et al [4] reported an overall operative mortality of 23%, which increased to 43% after pneumonectomy. An accompanying editorial cautioned for this excessively high risk [9].…”

Section: Resultsmentioning

confidence: 93%

“…Variable results of surgical treatment after induction chemotherapy or chemoradiotherapy have been reported, and high mortality rates after right pneumonectomy are of special concern [4,5]. In the present study, the surgical results of the operated patients in EORTC 08941 trial, with special emphasis on mortality, are reported in relation to the extent of resection.…”

mentioning

confidence: 86%

Morbidity and mortality in the surgery arm of EORTC 08941 trial

Schil¹

2005

Eur Respir J

View full text Add to dashboard Cite

Controversial results of surgical treatment after induction chemotherapy, especially in relation to the extent of resection, have previously been reported. Mortality and morbidity were studied in the surgical arm of the European Organisation for Research and Treatment of Cancer (EORTC) 08941 trial.EORTC 08941 is a multicentre, prospective, randomised, phase-III trial of surgical resection versus radiotherapy in patients with proven stage IIIA-N2 nonsmall cell lung cancer after an objective response to platinum-based induction chemotherapy. Operative results in the 167 patients randomised in the surgical arm are presented within this study. Among these patients, one switched to the radiotherapy arm and 17 patients did not get any protocol treatment or information is not yet available.Radical resection with negative surgical margins was obtained in 74 patients (49.7%). In 61 patients (40.9%), a pathological down-staging to N0 or N1 was present. Operative 30-day mortality was 4.0%. Post-operative complications were mainly pneumonia, respiratory insufficiency, arrhythmias, air leak, cardiac decompensation, empyema and bronchopleural fistula. In total, 12 (8.1%) patients underwent re-operation due to positive margins, haemothorax, empyema and bronchopleural fistula.In conclusion, surgical resection after induction chemotherapy in the multicentre European Organisation for Research and Treatment of Cancer trial has yielded acceptable rates of morbidity and mortality.

show abstract

Postoperative complications after combined neoadjuvant treatment of lung cancer

Cited by 189 publications

References 21 publications

Preoperative induction chemotherapy with cisplatin and irinotecan for pathological N2 non-small cell lung cancer

Preoperative induction chemotherapy with cisplatin and irinotecan for pathological N2 non-small cell lung cancer

Preoperative chemotherapy with and without additional radiochemotherapy: benefit and risk for surgery of stage III non-small cell lung cancer?

Morbidity and mortality in the surgery arm of EORTC 08941 trial

Contact Info

Product

Resources

About