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Pneumonectomy after chemoradiation: the Dana-Farber Cancer Institute/Brigham and Women s Hospital experience Allen AM; Mentzer SJ; Yeap BY; Soto R; Baldini EH; Rabin MS; Sugarbaker DJ; Bueno RCancer 2008[Mar]; 112 (5): 1106-13BACKGROUND: The current study was conducted to examine the outcomes of pneumonectomy after induction chemoradiotherapy in patients with locally advanced nonsmall cell lung cancer (NSCLC). METHODS: All patients undergoing pneumonectomy after induction therapy at the Brigham and Women's Hospital were retrospectively evaluated for 30-day and 100-day mortality and treatment-related complications with Institutional Review Board approval. Multivariate and univariate analyses for clinical factors correlating with toxicity and/or survival were calculated. RESULTS: Between 1995 and 2005, 73 patients underwent pneumonectomy for NSCLC after induction therapy. All patients received radiation (median dose of 54 gray [Gy]) and 69 patients (95%) received concurrent chemotherapy. The median age was 62 years and 43 patients (59%) were male; Thirty-seven patients (51%) had American Joint Committee on Cancer stage IIIA NSCLC, 27 (37%) had stage IIIB, 6 had stage IIB, and 4 had stage IV NSCLC because of a resected solitary brain metastasis. A majority (44; 60%) of patients received the combination of carboplatin and paclitaxel, whereas 15 (21%) received the combination of cisplatin and etoposide. Forty-five patients (62%) underwent left pneumonectomy. With a median follow-up of 28 months, the 1-year and 2-year overall survival rates were 70% and 49%, respectively. The 30-day and 100-day mortality rates were 6% and 10%, respectively. Only 4 of 73 patients (6%) died of acute respiratory distress syndrome. The rate of nonfatal treatment-related morbidity was 11%. On univariate analysis, right-sided pneumonectomy was associated with a higher risk of treatment-related mortality (P = .099). CONCLUSIONS: With an acceptable mortality rate, a single-institutional series demonstrated that trimodality therapy including pneumonectomy can be safely accomplished in patients with advanced NSCLC.|*Pneumonectomy/mortality[MESH]|Adult[MESH]|Aged[MESH]|Antineoplastic Combined Chemotherapy Protocols/therapeutic use[MESH]|Carcinoma, Non-Small-Cell Lung/drug therapy/mortality/radiotherapy/*surgery[MESH]|Chemotherapy, Adjuvant[MESH]|Combined Modality Therapy[MESH]|Disease-Free Survival[MESH]|Female[MESH]|Humans[MESH]|Lung Neoplasms/drug therapy/mortality/radiotherapy/*surgery[MESH]|Male[MESH]|Middle Aged[MESH]|Neoadjuvant Therapy[MESH]|Radiotherapy, Adjuvant[MESH]|Survival Analysis[MESH]|Survival Rate[MESH] |
