Risk associated with bilobectomy after neoadjuvant concurrent chemoradiotherapy for stage IIIA-N2 non-small-cell lung cancer

World J Surg. 2012 May;36(5):1199-205. doi: 10.1007/s00268-012-1472-9.

Abstract

Background: The aim of the present study was to evaluate the outcomes of surgical resection, especially bilobectomy, after chemoradiation therapy to treat stage IIIA-N2 non-small-cell lung cancer.

Methods: Data from all patients who underwent surgical resection after neoadjuvant chemoradiation therapy for stage IIIA-N2 non-small-cell lung cancer between 1998 and 2007 were analyzed retrospectively. The chemotherapy regimen consisted of weekly paclitaxel plus cisplatin or weekly paclitaxel plus carboplatin for 5 weeks. The concurrent thoracic radiotherapy dose was 45 Gy over 5 weeks. Surgical resection was planned at around 4 weeks following the completion of neoadjuvant therapy.

Results: Of 186 patients who underwent neoadjuvant therapy, 23 bilobectomies, 28 pneumonectomies, and 135 lobectomies were performed. The early postoperative mortality rate (within 30 days after operation) was 7.1, 8.7, and 1.5% for the pneumonectomy, bilobectomy, and lobectomy groups, respectively. The late postoperative mortality rate (within 90 days) of the lobectomy, bilobectomy, and pneumonectomy groups was 5.9, 13, and 10.7%, respectively. Overall survival was significantly higher among patients treated by lobectomy than among those treated by bilobectomy (p = 0.041) or pneumonectomy (p = 0.010). Recurrence was significantly lower in patients treated by lobectomy than in those treated by pneumonectomy (p = 0.034).

Conclusions: Bilobectomy is associated with high operative mortality and poor long-term survival after neoadjuvant concurrent chemoradiotherapy for stage IIIA-N2 non-small-cell lung cancer. The outcomes of bilobectomy were similar to those of pneumonectomy in terms of overall survival, disease-free survival, and postoperative mortality.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols
  • Carboplatin / therapeutic use
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / therapy*
  • Chemoradiotherapy*
  • Cisplatin / therapeutic use
  • Female
  • Humans
  • Lung Neoplasms / mortality
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy*
  • Male
  • Middle Aged
  • Neoadjuvant Therapy*
  • Neoplasm Staging
  • Paclitaxel / therapeutic use
  • Pneumonectomy / methods*
  • Pneumonectomy / mortality
  • Retrospective Studies
  • Risk
  • Survival Analysis
  • Treatment Outcome

Substances

  • Antineoplastic Agents
  • Carboplatin
  • Paclitaxel
  • Cisplatin