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J Thorac Cardiovasc Surg 1999;117:225-233
© 1999 Mosby, Inc.
GENERAL THORACIC SURGERY |
From the Department of Thoracic Surgery, University "La Sapienza," Rome, Italy.
Consulting Statistician: Dr. Claudio Ceccarelli, National Institute of Statistics (ISTAT).
Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.
Received for publication May 8, 1998. Revisions requested June 30, 1998. Revisions received Aug 14, 1998. Accepted for publication Oct 1, 1998. Address for reprints: Erino A. Rendina, MD, Department of Thoracic Surgery, University "La Sapienza" Rome, Policlinico Umberto I°, 00161, Rome, Italy.
Objective: We used induction chemotherapy in a prospective, single-institution clinical trial intended to achieve resectability in patients with centrally located, unresectable T4 non–small cell lung cancer. Other types of IIIB disease were excluded.
Methods: Between January 1990 and April 1996, we enrolled 57 patients with histologically confirmed non–small cell lung cancer. Eligibility criteria for T4 were clinical (superior vena cava syndrome, 9 patients), vocal cord paralysis (6 patients), dysphagia from esophageal involvement (1 patient), radiologic (computed tomography and magnetic resonance evidence of infiltration, 10 patients), bronchoscopic (tracheal infiltration, 11 patients), and thoracoscopic (histologically proven mediastinal infiltration, 20 patients). After 3 cycles of cisplatin (120 mg/m2), vinblastine (4 mg/m2), and mitomycin (2 mg/m2), patients were reevaluated.
Results: Forty-two patients (73%; 36 men, 6 women; age range, 42-75 years; mean, 58 years) responded to therapy and underwent thoracotomy; 11 patients did not respond, and 4 patients had major toxicity. Thirty-six patients (63% of the entire group) had complete resection. We performed 4 exploratory thoracotomies, 6 pneumonectomies, 32 lobectomies (20 procedures were associated with reconstruction of hilar-mediastinal structures). Overall, 4 patients had no histologic evidence of disease. We had 2 bronchopleural fistulas with 1 death and 5 other major complications. Overall survival at 1 and 4 years is 61.4% and 19.5%, respectively. Forty-two patients (73%) underwent exploratory operation, with a 4-year survival of 25.9%; 36 patients (63%) had complete resection, with a 4-year survival of 30.5%.
Conclusions: Induction chemotherapy is effective for downstaging and surgical reconversion of centrally located T4 non–small cell lung cancer. Survival is promising, especially in patients whose disease becomes resectable.
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