Postoperative complications after induction chemoradiotherapy in patients with non-small-cell lung cancer

Abstract

Thoracic radiotherapy of more than 45 Gy, in combination with chemotherapy, was a significant risk factor for postoperative complications.

Inflammation and outcome after general thoracic surgery

“…To the best of our knowledge, only one other study showed a correlation between an elevation in postoperative CRP and mostly empyema or pneumonia after pneumonectomy in 151 consecutive patients [11]. In contrast to our data, preoperative CRP in that study did not discriminate patients who were likely to develop PC.…”

“…In contrast to our data, preoperative CRP in that study did not discriminate patients who were likely to develop PC. Furthermore, these investigators only focused on pneumonectomy patients and did not examine the relationship of CRP to non-pulmonary complications that have been linked to inflammatory mechanisms [11]. Recently Shaw et al [6] studied 160 patients undergoing general thoracic surgery and showed an association between single nucleotide polymorphism changes of the IL-6 and TNF genes and the development of postoperative cardiopulmonary complications.…”

“…McMillan et al [7] evaluated 772 cancer patients of whom 404 had lung cancer and found that poor prognosis correlated with increasing CRP reflecting the presence and magnitude of a systemic inflammatory response [7]. Although some workers have shown that preoperative chemotherapy induces an elevation in cytokines prior to surgery [8], it is unclear whether this heightened inflammatory state in itself is a direct cause of long-term morbidity and poor outcome independent of cancer stage severity [11,12].…”

Impact of neo-adjuvant radiochemotherapy on bronchial tissue viability☆

“…Numerous groups have reported survival benefit from various neo-adjuvant approaches in selected patient groups [2,[10][11][12][13], although the 'ideal' treatment regimen is still a subject of ongoing trials and controversies. Apart from that, the risks of treatmentrelated intra-operative and postoperative complications after induction therapy are still being debated [1,[4][5][6][7][8][9]. While the earlier studies have reported substantially increased patient morbidity and mortality following neo-adjuvant therapy, especially following pneumonectomy, more recent series qualified the associated risks [1,3,5,6] by reporting more favourable outcomes.…”

“…Since the 1990s, induction (neo-adjuvant) chemo-and radiotherapy, alone or in combination, has been increasingly used for locally advanced NSCLC, with the aim of improving resectability (down-staging) and survival by treating micrometastatic disease [1][2][3][4][5][6][7][8][9]. Numerous groups have reported survival benefit from various neo-adjuvant approaches in selected patient groups [2,[10][11][12][13], although the 'ideal' treatment regimen is still a subject of ongoing trials and controversies.…”