| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;77:265
© 2004 The Society of Thoracic Surgeons
Department of Thoracic Surgery, Union Memorial Hospital, Johnston Professional Bld, Suite 610, 3333 North Calvert Street, Baltimore, MD 21218-2895, USA
e-mail: richardhe{at}helix.org
Combination therapy protocols, using preoperative chemoradiation followed by surgery, continue to demonstrate the promise of improved survival for patients with locally advance-stage lung and esophageal cancers. As a result, the clinical study by Leo and colleagues is extremely timely and important.
Historically, respiratory complications after pulmonary and esophageal surgery have been associated with increased length of stay (LOS) (often with prolonged intensive care unit stay), cost, and death. Despite all advances in perioperative care, this is still true. Therefore, if there was a way to identify patients at increased risk for postoperative respiratory complications, this would be extremely useful. According to the study by Leo and colleagues, a postchemotherapy decrease in diffusing capacity for carbon monoxide indexed for alveolar volume (DLCO/Va) of 15% identified just such a cohort of lung cancer patients.
The pulmonary toxicity of chemotherapy agents is being increasingly recognized. Dose-dependent toxicity has been demonstrated for bleomycin, chlorambucil, and nitrosoureas. The pathophysiology of bleomycin-induced pulmonary damage has been defined. Cisplatinum, one of the chemotherapies used in this study, has also been implicated as a pulmonary-toxic agent, although the prevalence and pathophysiology of this complication has not been determined.
Notably, it was not standard spirometry that detected postchemotherapy pulmonary toxicity, but DLCO. This finding is compatible with earlier independent studies demonstrating that DLCO, expressed as percent predicted, was the most reliable predictor of pulmonary complications following major lung surgery. In this study, all patients maintained their DLCO greater than 50% predicted. However, a DLCO/Va that decreased by greater than 15% after chemotherapy identified patients at increased risk of respiratory complications following subsequent surgery.
As with many good studies, some questions are answered and others are raised. What is the pathophysiology of toxicity for the chemotherapies used in this study? Can the toxicity be prevented? Is toxicity reversible, and, if so, over what course of time? Finally, should a new pulmonary function parameter be proposed based on percent change in DLCO? Future studies will need to address these questions.
We recently published our postesophagectomy morbidity, mortality, and LOS for patients initially treated with chemoradiation therapy [1]. We concluded that preoperative chemoradiation did not appear to alter the safety of subsequent esophagectomy. Several factors responsible for our findings were listed. One of these factors was allowing for some individual variance in the timing of surgery to permit recovery from preoperative therapy. In this study, the authors conclude that their results were not sufficient to justify lengthening the interval between chemotherapy and surgery. However, if further studies demonstrate that postchemotherapy toxicity is reversible, such recommendations might be indicated for select patients.
 |
References |
|---|
 Top References |
|---|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
