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The Annals of Thoracic Surgery, Vol 57, 966-973, Copyright © 1994 by The Society of Thoracic Surgeons
P Macchiarini, AR Chapelier, I Monnet, JM Vannetzel, JL Rebischung, J Cerrina, F Parquin, FL Ladurie, B Lenot and PG Dartevelle
Twenty-three patients with stage IIIb (T4) non-small cell lung cancer
received induction chemotherapy (median, 2 cycles) with (n = 12) or without
(n = 11) radiation (median, 45 Gy) before operation. Nine tumors involved
the carina (n = 8) or lateral tracheal wall (n = 1), 11 were located
centrally and invaded the proximal pulmonary artery (n = 6), veins (n = 3),
or both (n = 2), three were apical tumors involving T4 structures, and six
were associated with histologically diseased mediastinal nodes. Five
complete and 18 partial responses were observed after induction treatment.
Resection of all residual tumor at the primary site and involved vestiges
was possible in 21 patients (91%); in two apical tumors, tumor was left
behind. Nine right tracheal sleeve and 11 intrapericardial pneumonectomies
and three resections of apical tumors were performed; 11 patients (48%) had
radical mediastinal lymph node dissection. Complete sterilization of the
primary tumor was observed in 3 patients (13%). Mean operating time was
209.3 +/- 86.8 minutes, and mean blood loss was 896.9 +/- 1031 mL. Major
postoperative complications occurred in 6 patients (26%), including
hemothorax requiring drainage (n = 1) or reoperation (n = 1), acute
distress syndrome (n = 2), and bronchopleural fistula (n = 2), and their
incidence was significantly higher (p = 0.0003) among patients receiving
induction chemoradiation than among those receiving chemotherapy alone (42
versus 9%). Early (< 1 month) postoperative mortality was 8.6% (n = 2).
With a median follow-up of 25 months (range, 12 to more than 39 months),
the projected 3-year overall survival was 54%.(ABSTRACT TRUNCATED AT 250
WORDS)
ARTICLES
Extended operations after induction therapy for stage IIIb (T4) non- small cell lung cancer
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hopital Marie-Lannelongue, Paris-Sud University, Le Plessis Robinson, France.
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