EXTENDED OPERATIONS AFTER INDUCTION THERAPY FOR STAGE IIIB (T4) NONSMALL CELL LUNG-CANCER

Twenty-three patients with stage IIIb (T4) non-small cell lung cancer received induction chemotherapy (median, 2 cycles) with (n = 12) or wi thout (n = 11) radiation (median, 45 Gy) before operation. Nine tumors involved the carina (n = 8) or lateral tracheal wall (n = I), 11 were located centrally and invaded the proximal pulmonary artery (n = 6), veins (n = 3), or both (n = 2), three were apical tumors involving T4 structures, and six were associated with histologically diseased media stinal nodes. Five complete and 18 partial responses were observed aft er induction treatment. Resection of all residual tumor at the primary site and involved vestiges was possible in 21 patients (91%); in two apical tumors, tumor was left behind. Nine right tracheal sleeve and 1 1 intrapericardial pneumonectomies and three resections of apical tumo rs were performed; 11 patients (48%) had radical mediastinal lymph nod e dissection. Complete sterilization of the primary tumor was observed in 3 patients (13%). Mean operating time was 209.3 +/- 86.8 minutes, and mean blood loss was 896.9 +/- 1031 mL. Major postoperative complic ations occurred in 6 patients (26%), including hemothorax requiring dr ainage (n = 1) or reoperation (n = 1), acute distress syndrome (n = 2) , and bronchopleural fistula (n = 2), and their incidence was signific antly higher (p = 0.003) among patients receiving induction chemoradia tion than among those receiving chemotherapy alone (42 versus 9%). Ear ly (<1 month) postoperative mortality was 8.6% (n = 2). With a median follow-up of 25 months (range, 12 to more than 39 months), the project ed 3-year overall survival was 54%. Further follow-up will define whet her this aggressive approach should become standard fare for selected IIIb (T4) non-small cell lung cancer patients.