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

• Published in: Surgery today (Tokyo, Japan) Vol. 49; no. 3; pp. 197 - 205
• Main Authors: Yamaguchi, Masafumi, Shimamatsu, Shinichiro, Edagawa, Makoto, Hirai, Fumihiko, Toyozawa, Ryo, Nosaki, Kaname, Seto, Takashi, Takenoyama, Mitsuhiro, Ichinose, Yukito
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.03.2019
• Subjects: Medicine; Medicine & Public Health; Original Article; Surgery; Surgical Oncology; Locally advanced non-small cell lung cancer; Induction chemoradiotherapy; Pneumonectomy
• ISSN: 0941-1291; 1436-2813; 1436-2813
• DOI: 10.1007/s00595-018-1751-7

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.