Brown University Oncology Group, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Ann Surg Oncol. 2010 Feb;17(2):476-82. doi: 10.1245/s10434-009-0810-0.
Intergroup 0139 Trial suggests an increase in mortality after pneumonectomy in patients receiving preoperative chemotherapy and radiation. We evaluate our outcomes with pneumonectomy after neoadjuvant chemotherapy and radiation.
Neoadjuvant chemotherapy and radiation consisted of cisplatin 50 mg/m2 on days 1, 8, 29, and 36 and etoposide 50 mg/m2 on days 1-5 and 29-33 given concurrently with 5,040 cGy radiation. From a prospective database, results after pneumonectomy were compared between patients receiving and not receiving neoadjuvant chemotherapy and radiation during the same time period.
Over 7 years, 50 pneumonectomies were performed for non-small-cell carcinoma; 18 received neoadjuvant chemotherapy and radiation (group A) and 32 did not (group B). Comparing group A with group B, there was no significant difference in patient demographics, blood loss, transfusion requirements or pneumonectomy side. Group A had more patients with stage III disease [17/ 18 (94%) versus 15/32 (47%), P = 0.001] and also more often had vascularized flap for bronchial stump coverage [17/18 (94%) versus 4/32 (13%), P < 0.001]. There was no significant difference in operative morbidity or mortality. Mortality for group A was 0/18 and for group B was 2/32 (6.3%) (P = 0.530). Group A patients with IIIA(N2) disease (n = 13) had median recurrence-free survival of 12.4 months, median overall survival of 25 months, and 3- year overall survival of 22.2%.
Using a multidisciplinary team approach at a tertiary care center, pneumonectomy can be performed successfully after neoadjuvant chemotherapy and radiation for advanced-stage lung cancer. Vascularized flap for bronchial stump coverage may be important in this regard.
Intergroup 0139 试验表明，接受术前化疗和放疗的患者在肺切除术后死亡率增加。我们评估了新辅助化疗和放疗后行肺切除术的结果。
新辅助化疗和放疗包括顺铂 50mg/m2 第 1、8、29 和 36 天，依托泊苷 50mg/m2 第 1-5 和 29-33 天，同时给予 5040cGy 放疗。从一个前瞻性数据库中，比较了在同一时期接受和不接受新辅助化疗和放疗的患者行肺切除术后的结果。
7 年内，50 例非小细胞肺癌患者行肺切除术；18 例接受新辅助化疗和放疗（A 组），32 例未接受（B 组）。与 B 组相比，A 组患者的临床特征、失血量、输血需求或肺切除侧无显著差异。A 组有更多的 III 期疾病患者[17/18（94%）比 15/32（47%），P=0.001]，也有更多的患者行支气管残端血管化皮瓣覆盖[17/18（94%）比 4/32（13%），P<0.001]。手术发病率或死亡率无显著差异。A 组死亡率为 0/18，B 组为 2/32（6.3%）（P=0.530）。A 组 IIIA（N2）疾病患者（n=13）的无复发生存期中位数为 12.4 个月，总生存期中位数为 25 个月，3 年总生存率为 22.2%。
在三级医疗中心，采用多学科团队方法，新辅助化疗和放疗后可成功进行肺切除术治疗晚期肺癌。支气管残端血管化皮瓣覆盖可能对此很重要。
