Advertisement

Surgery Today

, Volume 49, Issue 3, pp 197–205 | Cite as

Pneumonectomy after induction chemoradiotherapy for locally advanced non-small cell lung cancer: should curative intent pulmonary resection be avoided?

  • Masafumi YamaguchiEmail author
  • Shinichiro Shimamatsu
  • Makoto Edagawa
  • Fumihiko Hirai
  • Ryo Toyozawa
  • Kaname Nosaki
  • Takashi Seto
  • Mitsuhiro Takenoyama
  • Yukito Ichinose
Original Article
  • 45 Downloads

Abstract

Purpose

We conducted a retrospective analysis to assess the practicality of pneumonectomy, especially after concurrent induction chemoradiotherapy (i-CRT), for locally advanced non-small cell lung cancer (LA-NSCLC). The operative risks vs. the survival benefit of this procedure for such patients is a subject of controversy.

Methods

The subjects of this retrospective study were 71 consecutive LA-NSCLC patients with cStage IIIA-C NSCLC, who underwent i-CRT followed by curative intent pulmonary resection between February, 2001 and March, 2013.

Results

Thirty-two patients underwent pneumonectomy (group P) and 39 patients underwent lobectomy (group L). In group P, 17 (54.8%) patients underwent right pneumonectomy. There was no 30-day postoperative mortality in either group and no significant difference in 90-day postoperative mortality between the groups (3.1% vs. 2.6% in groups P and L, respectively). The 5-year overall survival (OS) rate was 58.7% (95% CI: 41.5–75.9%) in group P and 57.3% (95% CI 41.2–73.4%) in group L, without a significant difference between the groups.

Conclusion

Our findings suggest that i-CRT followed by pneumonectomy is feasible, with a similar survival benefit to lobectomy. Thus, pneumonectomy after i-CRT should not be avoided as it is a potentially curative intent strategy for carefully selected patients.

Keywords

Locally advanced non-small cell lung cancer Induction chemoradiotherapy Pneumonectomy 

Notes

Funding

This study received no funding.

Compliance with ethical standards

Conflict of interest

Masafumi Yamaguchi: No conflict of interest. Shinichiro Shimamatsu: No conflict of interest. Makoto Edagawa: No conflict of interest. Fumihiko Hirai: No conflict of interest. Ryo Toyozawa: No conflict of interest. Kaname Nosaki: No conflict of interest. Takashi Seto: Received honoraria (lecture fees) from AstraZeneca, Eli Lilly Japan and Ono Pharmaceutical. Received research grants from Astellas Pharma, AstraZeneca, Chugai Pharmaceutical, Daiichi Sankyo, Eli Lilly Japan, Merck Serono, Nippon Boehringer Ingelheim, Novartis Pharma and Pfizer Japan. Mitsuhiro Takenoyama: Received research grants from Eli Lilly Japan and Ono Pharmaceutical. Yukito Ichinose: No conflict of interest.

References

  1. 1.
    Ginsberg RJ, Rubinstein LV, Lung Cancer Study Group. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Ann Thorac Surg. 1995;60:615–22 (discussion 22–3)CrossRefGoogle Scholar
  2. 2.
    network NCC. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Non-small cell lung cancer version 2.2013. 2013. http://www.nccn.com.
  3. 3.
    Lim E, Baldwin D, Beckles M, Duffy J, Entwisle J, Faivre-Finn C, et al. Guidelines on the radical management of patients with lung cancer. Thorax. 2010;65(Suppl 3):iii1–27.CrossRefGoogle Scholar
  4. 4.
    Ramnath N, Dilling TJ, Harris LJ, Kim AW, Michaud GC, Balekian AA, et al. Treatment of stage III non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143:e314S–40S.CrossRefGoogle Scholar
  5. 5.
    Vansteenkiste J, De Ruysscher D, Eberhardt WE, Lim E, Senan S, Felip E, et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi89–98.CrossRefGoogle Scholar
  6. 6.
    Albain KS, Swann RS, Rusch VW, Turrisi AT, Shepherd FA, Smith C, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet. 2009;374:379–86.CrossRefGoogle Scholar
  7. 7.
    Doddoli C, Barlesi F, Trousse D, Robitail S, Yena S, Astoul P, et al. One hundred consecutive pneumonectomies after induction therapy for non-small cell lung cancer: an uncertain balance between risks and benefits. J Thorac Cardiovasc Surg. 2005;130:416–25.CrossRefGoogle Scholar
  8. 8.
    Park JS, Yang HC, Kim HK, Kim K, Shim YM, Choi YS, et al. Sleeve lobectomy as an alternative procedure to pneumonectomy for non-small cell lung cancer. J Thorac Oncol. 2010;5:517–20.CrossRefGoogle Scholar
  9. 9.
    Takeda S, Maeda H, Koma M, Matsubara Y, Sawabata N, Inoue M, et al. Comparison of surgical results after pneumonectomy and sleeve lobectomy for non-small cell lung cancer: trends over time and 20-year institutional experience. Eur J Cardiothorac Surg. 2006;29:276–80.CrossRefGoogle Scholar
  10. 10.
    Yamamoto K, Miyamoto Y, Ohsumi A, Kojima F, Imanishi N, Matsuoka K, et al. Sleeve lung resection for lung cancer: analysis according to the type of procedure. J Thorac Cardiovasc Surg. 2008;136:1349–56.CrossRefGoogle Scholar
  11. 11.
    Maurizi G, D’Andrilli A, Anile M, Ciccone AM, Ibrahim M, Venuta F, et al. Sleeve lobectomy compared with pneumonectomy after induction therapy for non-small-cell lung cancer. J Thorac Oncol. 2013;8:637–43.CrossRefGoogle Scholar
  12. 12.
    Yildizeli B, Fadel E, Mussot S, Fabre D, Chataigner O, Dartevelle PG. Morbidity, mortality, and long-term survival after sleeve lobectomy for non-small cell lung cancer. Eur J Cardiothorac Surg. 2007;31:95–102.CrossRefGoogle Scholar
  13. 13.
    Ichinose Y, Nakai Y, Kudoh S, Semba H, Yoshida S, Nukiwa T, et al. Uracil/tegafur plus cisplatin with concurrent radiotherapy for locally advanced non-small-cell lung cancer: a multi-institutional phase II trial. Clin Cancer Res. 2004;10:4369–73.CrossRefGoogle Scholar
  14. 14.
    Yamaguchi M, Toyokawa G, Ohba T, Sasaki T, Kometani T, Hamatake M, et al. Preoperative concurrent chemoradiotherapy of S-1/cisplatin for stage III non-small cell lung cancer. Ann Thorac Surg. 2013;96:1783–9.CrossRefGoogle Scholar
  15. 15.
    Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.CrossRefGoogle Scholar
  16. 16.
    Travis WD, Corrin B, Shimosato Y, Brambilla E. and Collaborators from 14 Countries. Histological typing of lung and pleural tumors. In: World Health Organization. International histological classification of tumors, 3th edn. Berlin:Springer; 1999.Google Scholar
  17. 17.
    Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11:39–51.CrossRefGoogle Scholar
  18. 18.
    Okada M, Yamagishi H, Satake S, Matsuoka H, Miyamoto Y, Yoshimura M, et al. Survival related to lymph node involvement in lung cancer after sleeve lobectomy compared with pneumonectomy. J Thorac Cardiovasc Surg. 2000;119:814–9.CrossRefGoogle Scholar
  19. 19.
    Bagan P, Berna P, Pereira JC, Le Pimpec Barthes F, Foucault C, Dujon A, et al. Sleeve lobectomy versus pneumonectomy: tumor characteristics and comparative analysis of feasibility and results. Ann Thorac Surg. 2005;80:2046–50.CrossRefGoogle Scholar
  20. 20.
    Deslauriers J, Gregoire J, Jacques LF, Piraux M, Guojin L, Lacasse Y. Sleeve lobectomy versus pneumonectomy for lung cancer: a comparative analysis of survival and sites or recurrences. Ann Thorac Surg. 2004;77:1152–6. (discussion 6).CrossRefGoogle Scholar
  21. 21.
    Lausberg HF, Graeter TP, Tscholl D, Wendler O, Schafers HJ. Bronchovascular versus bronchial sleeve resection for central lung tumors. Ann Thorac Surg. 2005;79:1147–52. (discussion–52).CrossRefGoogle Scholar
  22. 22.
    Balduyck B, Hendriks J, Lauwers P, Van Schil P. Quality of life after lung cancer surgery: a prospective pilot study comparing bronchial sleeve lobectomy with pneumonectomy. J Thorac Oncol. 2008;3:604–8.CrossRefGoogle Scholar
  23. 23.
    d’Amato TA, Ashrafi AS, Schuchert MJ, Alshehab DS, Seely AJ, Shamji FM, et al. Risk of pneumonectomy after induction therapy for locally advanced non-small cell lung cancer. Ann Thorac Surg. 2009;88:1079–85.CrossRefGoogle Scholar
  24. 24.
    Allen AM, Mentzer SJ, Yeap BY, Soto R, Baldini EH, Rabin MS, et al. Pneumonectomy after chemoradiation: the Dana-Farber Cancer Institute/Brigham and Women’s Hospital experience. Cancer. 2008;112:1106–13.CrossRefGoogle Scholar
  25. 25.
    Eberhardt WE, Pottgen C, Gauler TC, Friedel G, Veit S, Heinrich V, et al. Phase III study of surgery versus definitive concurrent chemoradiotherapy boost in patients with resectable stage IIIA(N2) and selected IIIB non-small-cell lung cancer after induction chemotherapy and concurrent chemoradiotherapy (ESPATUE). J Clin Oncol. 2015;33:4194–201.CrossRefGoogle Scholar
  26. 26.
    Gaissert HA, Keum DY, Wright CD, Ancukiewicz M, Monroe E, Donahue DM, et al. POINT: operative risk of pneumonectomy–influence of preoperative induction therapy. J Thorac Cardiovasc Surg. 2009;138:289–94.CrossRefGoogle Scholar
  27. 27.
    Pless M, Stupp R, Ris HB, Stahel RA, Weder W, Thierstein S, et al. Induction chemoradiation in stage IIIA/N2 non-small-cell lung cancer: a phase 3 randomised trial. Lancet. 2015;386:1049–56.CrossRefGoogle Scholar
  28. 28.
    Stupp R, Mayer M, Kann R, Weder W, Zouhair A, Betticher DC, et al. Neoadjuvant chemotherapy and radiotherapy followed by surgery in selected patients with stage IIIB non-small-cell lung cancer: a multicentre phase II trial. Lancet Oncol. 2009;10:785–93.CrossRefGoogle Scholar
  29. 29.
    Weder W, Collaud S, Eberhardt WE, Hillinger S, Welter S, Stahel R, et al. Pneumonectomy is a valuable treatment option after neoadjuvant therapy for stage III non-small-cell lung cancer. J Thorac Cardiovasc Surg. 2010;139:1424–30.CrossRefGoogle Scholar
  30. 30.
    Daly BD, Fernando HC, Ketchedjian A, Dipetrillo TA, Kachnic LA, Morelli DM, et al. Pneumonectomy after high-dose radiation and concurrent chemotherapy for nonsmall cell lung cancer. Ann Thorac Surg. 2006;82:227–31.CrossRefGoogle Scholar
  31. 31.
    Ichinose Y, Seto T, Sasaki T, Yamanaka T, Okamoto I, Takeda K, et al. S-1 plus cisplatin with concurrent radiotherapy for locally advanced non-small cell lung cancer: a multi-institutional phase II trial (West Japan Thoracic Oncology Group 3706). J Thorac Oncol. 2011;6:2069–75.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Masafumi Yamaguchi
    • 1
    Email author
  • Shinichiro Shimamatsu
    • 1
  • Makoto Edagawa
    • 1
  • Fumihiko Hirai
    • 1
  • Ryo Toyozawa
    • 1
  • Kaname Nosaki
    • 1
  • Takashi Seto
    • 1
  • Mitsuhiro Takenoyama
    • 1
  • Yukito Ichinose
    • 1
  1. 1.Department of Thoracic OncologyNational Kyushu Cancer CenterFukuoka CityJapan

Personalised recommendations