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Completion pneumonectomy and chemoradiotherapy as treatment options in local recurrence of non-small-cell lung cancer.

Kasprzyk M, Sławiński G, Musik M, Marciniak Ł, Dyszkiewicz W, Piwkowski C, Gałęcki B - Kardiochir Torakochirurgia Pol (2015)

Bottom Line: Compared with chemoradiotherapy, surgical treatment offers a greater chance of long-term survival, but results in completion pneumonectomy and is associated with a relatively high rate of complications.Five-year survival probability was significantly higher among patients treated surgically as compared to patients undergoing systemic therapy.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland.

ABSTRACT

Introduction: The selection of treatment for local recurrence in patients with non-small-cell lung cancer (NSCLC) depends on the possibility of performing a radical tumor resection, the patient's performance status, and cardiopulmonary efficiency. Compared with chemoradiotherapy, surgical treatment offers a greater chance of long-term survival, but results in completion pneumonectomy and is associated with a relatively high rate of complications.

Aim of the study: Aim of the study was to evaluate early and long-term results of surgery and conservative treatment (chemoradiotherapy) in patients with local NSCLC recurrence.

Material and methods: Between 1998 and 2011, 1697 NSCLC patients underwent lobectomy or bilobectomy at the Department of Thoracic Surgery in Poznań. Among them, 137 patients (8.1%) were diagnosed with cancer recurrence; chemotherapy or chemoradiotherapy was provided to 116 patients; 21 patients (15.3%) were treated with completion pneumonectomy. The median time from primary surgery to recurrence was 13.4 months. No metastases to N2 lymph nodes were observed among the patients undergoing surgery; in 7 patients N1 lymph node metastases were confirmed.

Results: The rate of complications after surgery was significantly higher in comparison with conservative therapy (80.9% vs. 48.3%). Patients treated with surgery were most likely to suffer from complications associated with the circulatory system (80.9%), while hematologic complications were dominant in the group undergoing oncological treatment (41.4%). There were no perioperative deaths after completion pneumonectomy. The age of the patients was the only factor which significantly influenced the incidence of complications in both groups of patients. Analysis of the survival curves demonstrated statistically significant differences in survival between the groups treated with surgery, chemoradiotherapy, and chemotherapy (p = 0.00001). Five-year survival probability was significantly higher among patients treated surgically as compared to patients undergoing systemic therapy.

Conclusions: Despite the significant rate of postoperative complications (mostly circulatory), the long-term results of the surgical treatment of local NSCLC recurrence are more favorable than those achieved with chemoradiotherapy. The success of surgical treatment is conditioned on the exclusion of metastasis in N2 lymph nodes.

No MeSH data available.


Related in: MedlinePlus

Survival curves depending on the applied method for treating local recurrence
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Figure 0002: Survival curves depending on the applied method for treating local recurrence

Mentions: Using the Kaplan-Meier method, survival curves were calculated for the whole study group (Fig. 1) and depending on the applied treatment (Fig. 2). The mean survival time for the whole group was 15.5 months. The median survival times for patients treated with chemotherapy, chemoradiotherapy, and surgical treatment amounted to 11.1 months, 14.4 months, and 27.1 months, respectively. Comparison of the survival curves revealed statistically significant differences both between the group treated with surgery vs. the group undergoing conservative therapy (p = 0.00001) and between the groups treated with surgery, chemotherapy, and chemoradiotherapy (p = 0.00001). The best long-term results were observed among the patients who underwent surgical treatment. In the conservative therapy group, the probability of achieving 5-year survival was significantly higher in the case of multimodality therapy (chemoradiotherapy). Focusing the analysis solely on patients with N0 and N1 disease demonstrated significantly longer survival among surgery patients (there were no patients with N2 disease in the group undergoing completion pneumonectomy).


Completion pneumonectomy and chemoradiotherapy as treatment options in local recurrence of non-small-cell lung cancer.

Kasprzyk M, Sławiński G, Musik M, Marciniak Ł, Dyszkiewicz W, Piwkowski C, Gałęcki B - Kardiochir Torakochirurgia Pol (2015)

Survival curves depending on the applied method for treating local recurrence
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4520506&req=5

Figure 0002: Survival curves depending on the applied method for treating local recurrence
Mentions: Using the Kaplan-Meier method, survival curves were calculated for the whole study group (Fig. 1) and depending on the applied treatment (Fig. 2). The mean survival time for the whole group was 15.5 months. The median survival times for patients treated with chemotherapy, chemoradiotherapy, and surgical treatment amounted to 11.1 months, 14.4 months, and 27.1 months, respectively. Comparison of the survival curves revealed statistically significant differences both between the group treated with surgery vs. the group undergoing conservative therapy (p = 0.00001) and between the groups treated with surgery, chemotherapy, and chemoradiotherapy (p = 0.00001). The best long-term results were observed among the patients who underwent surgical treatment. In the conservative therapy group, the probability of achieving 5-year survival was significantly higher in the case of multimodality therapy (chemoradiotherapy). Focusing the analysis solely on patients with N0 and N1 disease demonstrated significantly longer survival among surgery patients (there were no patients with N2 disease in the group undergoing completion pneumonectomy).

Bottom Line: Compared with chemoradiotherapy, surgical treatment offers a greater chance of long-term survival, but results in completion pneumonectomy and is associated with a relatively high rate of complications.Five-year survival probability was significantly higher among patients treated surgically as compared to patients undergoing systemic therapy.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland.

ABSTRACT

Introduction: The selection of treatment for local recurrence in patients with non-small-cell lung cancer (NSCLC) depends on the possibility of performing a radical tumor resection, the patient's performance status, and cardiopulmonary efficiency. Compared with chemoradiotherapy, surgical treatment offers a greater chance of long-term survival, but results in completion pneumonectomy and is associated with a relatively high rate of complications.

Aim of the study: Aim of the study was to evaluate early and long-term results of surgery and conservative treatment (chemoradiotherapy) in patients with local NSCLC recurrence.

Material and methods: Between 1998 and 2011, 1697 NSCLC patients underwent lobectomy or bilobectomy at the Department of Thoracic Surgery in Poznań. Among them, 137 patients (8.1%) were diagnosed with cancer recurrence; chemotherapy or chemoradiotherapy was provided to 116 patients; 21 patients (15.3%) were treated with completion pneumonectomy. The median time from primary surgery to recurrence was 13.4 months. No metastases to N2 lymph nodes were observed among the patients undergoing surgery; in 7 patients N1 lymph node metastases were confirmed.

Results: The rate of complications after surgery was significantly higher in comparison with conservative therapy (80.9% vs. 48.3%). Patients treated with surgery were most likely to suffer from complications associated with the circulatory system (80.9%), while hematologic complications were dominant in the group undergoing oncological treatment (41.4%). There were no perioperative deaths after completion pneumonectomy. The age of the patients was the only factor which significantly influenced the incidence of complications in both groups of patients. Analysis of the survival curves demonstrated statistically significant differences in survival between the groups treated with surgery, chemoradiotherapy, and chemotherapy (p = 0.00001). Five-year survival probability was significantly higher among patients treated surgically as compared to patients undergoing systemic therapy.

Conclusions: Despite the significant rate of postoperative complications (mostly circulatory), the long-term results of the surgical treatment of local NSCLC recurrence are more favorable than those achieved with chemoradiotherapy. The success of surgical treatment is conditioned on the exclusion of metastasis in N2 lymph nodes.

No MeSH data available.


Related in: MedlinePlus