Pneumonectomy after neoadjuvant chemoradiation safe, effective in locally advanced NSCLC

SEATTLE — Neoadjuvant chemoradiation therapy followed by pneumonectomy conferred favorable outcomes with manageable toxicity in patients with locally advanced non–small cell lung cancer, according to results of a retrospective review presented at the American Association for Thoracic Surgery Annual Meeting.

Patients with locally advanced non–small cell lung cancer typically have a poor prognosis, and new effective treatments are urgently needed, according to study background.

Kazunori Okabe, MD, of the department of thoracic surgery at Yamaguchi Ube Medical Center in Ube, Japan, and colleagues retrospectively reviewed outcomes for 16 consecutive patients during a 7-year period who underwent neoadjuvant chemoradiation therapy followed by pneumonectomy.

Median patient age was 59 years (range, 41-70), and 13 (81.2%) of the patients were men.

The most common diagnosis was adenocarcinoma (n = 7), followed by squamous cell carcinoma (n = 6), adenosquamous cell carcinoma (n = 1) and large cell neuroendocrine carcinoma (n = 1). One patient had atypical carcinoid that was diagnosed preoperatively as squamous cell carcinoma.

The most common pretreatment stage was IIIa (n = 8), followed by stage IIIb (n = 6), stage IIa (n = 1) and stage Ib (n = 1). The left side was involved in considerably more cases than the right side (13 vs. 3).

All patients received a standard neoadjuvant chemoradiation therapy regimen of cisplatin 40 mg/m² and docetaxel hydrate 40 mg/m² administered on days 1, 8, 29 and 36, as well as concurrent irradiation of 46 Gy (2 Gy per day) administered to the tumor, hilum and mediastinum. Patients underwent pneumonectomy 4 to 6 weeks after completion of radiotherapy. Patients did not receive adjuvant treatment until recurrent lesions were observed.

Median duration of pneumonectomy was 4 hours, 35 minutes (range, 2 hours, 35 minutes, to 7 hours, 30 minutes), and the median bleeding amount was 175 g (range, 60-560).

All 16 cases were R0 resection, and intrapericardial pneumonectomy was performed in seven cases.

Six patients (38%) achieved pathologically complete response. Among the other patients, the most common postoperative stages were IIa (n =3) and Ia (n = 3), followed by stage IIIa (n = 2), stage IIIb (n = 1) and stage Ib (n = 1). All abnormal blood tumor markers returned to normal levels post-treatment, according to the researchers.

All patients remained alive and in “excellent condition” at a median follow-up of 40 months (range, 12-93), Okabe and colleagues wrote. Eleven of 13 patients remained free of recurrence.

At the time of analysis, five patients had survived 5 years. Four of them had pretreatment stage IIIb, and one had pretreatment stage IIIa.

Results showed the approach was well tolerated, as researchers reported manageable toxicities, no deaths and no serious complications.

“Pneumonectomy after neoadjuvant concurrent chemoradiation therapy for locally advanced non–small cell lung cancer is feasible and highly effective,” Okabe and colleagues wrote. “This combined-modality treatment strategy may greatly improve the prognosis of locally advanced non–small cell lung cancer.” – by Mark Leiser

Reference:

Okabe K, et al. Abstract T14. Presented at: American Association for Thoracic Surgery Annual Meeting; April 25-29, 2015; Seattle.

Disclosure: The researchers report no relevant financial disclosures.