Neoadjuvant tedavi sonrası küçük hücreli dışı akciğer kanseri olan hastaların cerrahi sonuçları

Yıl 2018, , 101 - 107, 31.10.2018

İlhan Ocakcıoglu Levent Alpay Nezih Onur Ermerak Hakan Kıral Cagatay Tezel Volkan Baysungur İrfan Yalcınkaya

https://doi.org/10.5472/marumj.474165

Öz

Amaç: Neoadjuvan tedaviyi takiben küçük hücreli dışı akciğer

kanseri (KHDAK)’nin anatomik rezeksiyonu halen tartışmalı olsa

da, torasik cerrahi uygulamada yaygın kabul gören bir yaklaşımdır.

Bu çalışmanın amacı, neadjuvan tedaviyi takiben kurumumuzda

cerrahi operasyon uygulanan lokal ileri evre KHDAK’i, pancoast

tümörü ve soliter beyin metastazı olan akciğer kanseri hastalarının

klinik sonuçlarını, uzun dönem sağkalımını ve sağkalımı etkileyen

faktörleri kısaca değerlendirmektir.

Gereç ve Yöntem: Mart 2006 ve Mart 2012 tarihleri arasında

neoadjuvan tedaviyi takiben anatomik pulmoner rezeksiyon

uygulanan 70 KHDAK tanılı hasta çalışmaya alındı.

Bulgular: Üç yıllık sağkalım (% 39) ve 5 yıllık sağkalım (% 29)

sırasıyla 16±6,8 ve 37±9,89 ay idi. Ortalama sağ kalım 37,15±3,06 ay

olarak bulundu. Sağkalım oranı tümörün anatomik lokalizasyonuna

göre değerlendirildiğinde santral ve sol üst lob tümörlerinde daha

düşüktü (P=0,042). 5 yıllık ortalama sağkalım süreleri evre 0

hastalarda 50,00±5,65 ay, evre 1 hastalarda 35,39±5,85 ay, evre 2

hastalarda 37,40±6,89 ay ve evre 3 hastalarda 21,44±3,10 ay idi.

Sonuç: Neoadjuvan tedaviyi takiben anatomik pulmoner

rezeksiyon ile önemli sağkalım sonuçları elde edebiliriz.

Anahtar Kelimeler

Küçük hücreli dışı akciğer kanseri, Neoadjuvan tedavi, Kemoterapi, Radyoterapi, Cerrahi

Surgical outcomes of patients with non-small cell lung cancer following neoadjuvant treatment

Öz

Objective: Although, anatomical resection of non-small cell

lung cancer (NSCLC) following neoadjuvant therapy is still

controversial, it is a widely accepted approach for thoracic surgery

practice. The aim of this study is to briefly evaluate clinical results,

long term survival, and factors affecting survival of the patients

with locally advanced NSCLC, pancoast tumour and lung cancer

with solitary brain metastasis, who have been operated at our

institution following neoadjuvant therapy.

Materials and Method: Between March 2006 and March

2012, 70 patients with NSCLC diagnosis who underwent anatomic

pulmonary resection following neoadjuvant therapy were included

in the study.

Results: A three year survival (39%) and a 5-year survival

(29%) were 16±6.8 and 37±9.89 months, respectively. The mean

survival was found to be 37.15±3.06 months. When survival rate

was evaluated according to localization of tumor, it was lower in

central and left upper lobe tumors compared to other anatomical

localizations (P=0.042). The mean 5-year survival times were

50.00±5.65 months in stage 0 patients, 35.39±5.85 months in stage

1 patients, 37.40±6.89 months in stage 2 patients and 21.44±3.10

months in stage 3 patients.

Conclusion: We can achieve significant survival results by the

anatomical pulmonary resection following neoadjuvant therapy.

Anahtar Kelimeler

Non-small cell lung cancer, Neoadjuvant therapy, Chemotherapy, Radiotherapy, Surgery

Kaynakça

• 1. Faber LP, Kittle CF, Warren WH, et al. Preoperative chemotherapy and irradiation for stage III non-small cell lung cancer. Ann Thorac Surg 1989;47: 669-77. doi:10.1016/0003-4975(89)90115-X
• 2. Skarin A, Jochelson M, Sheldon T, et al. Neoadjuvant chemotherapy in marginally resectable stage III M0 nonsmall cell lung cancer: long-term follow-up in 41 patients. J Surg Oncol 1989;40: 266-74. doi: 10.1002/jso.2930400413
• 3. Roth JA, Fossella F, Komaki R, et al. A randomized trial comparing preoperative chemotherapy and surgery and surgery alone in resectable III A non-small cell lung cancer. J Natl Cancer Inst 1994;86: 673-80. doi: 10.1093/jnci/86.9.673
• 4. Rusch VW, Giroux DJ, Kraut MJ, et al. Induction chemoradiation and surgical resection for non-small cell lung carcinomas of the superior sulcus: initial results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160). J Thorac Cardiovasc Surg 2001;121:472-83. doi: 10.1067/mtc.2001.112465
• 5. Albain K, Swann R, Rusch V. Phase III study of concurrent chemotherapy and radiotherapy (CT/RT) versus CT/RT followed by surgical resection for stage IIIA (pN2) nonsmall-cell lung cancer (NSCLC): Outcomes update of North American Intergroup 0139 (RTOG 9309) J Clin Oncol 2005;23:624S. doi: 10.1200/jco.2005.23.16_suppl.7014
• 6. Bueno R, Richards WG, Swanson SJ, et al. Nodal stage after induction therapy for stage IIIA lung cancer determines patient survival. Ann Thorac Surg 2000;70: 1826-31. doi:10.1016/S0003-4975(00)01585-X
• 7. Port JL, Korst RJ, Lee PC, et al. Surgical resection for residual N2 disease after induction chemotherapy. Ann Thorac Surg 2005;79:1686-90. doi: 10.1016/j.athoracsur.2004.10.057 8. Spira A, Ettinger DS. Multidisciplinary management of lung cancer. N Engl J Med 2004;350:379-92. doi: 10.1056/ NEJMra035536
• 9. Takeda S, Maeda H, Okada T, et al. Results of pulmonary resection following neoadjuvant therapy for locally advanced (IIIA-IIIB) lung cancer. Eur J Cardiothorac Surg 2006;30:184-9. doi: 10.1016/j.ejcts.2006.03.054
• 10. Cerfolio RJ, Bryant AS. Survival of patients with unsuspected N2 (stage IIIA) nonsmall-cell lung cancer. Ann Thorac Surg 2008;86:362-7. doi: 10.1016/j.athoracsur.2008.04.042.
• 11. Carretta A, Ciriaco P, Melloni G, et al. Results of surgical treatment after neoadjuvant chemotherapy for stage III nonsmall cell lung cancer. World J Surg 2008; 32:2636-42. doi:10.1007/s00268-008-9774-7.
• 12. Jaklitsch MT, J.E. Herndon JE, DeCamp MM, et al. Nodal downstaging predicts survival following induction chemotherapy for stage IIIA (N2) non-small cell lung cancer in CALGB protocol #8935. J Surg Oncol 2006;94:599-606. doi: 10.1002/jso.20644
• 13. Deslauriers J, Grégoire J, Jacques LF, et al. Sleeve lobectomy versus pneumonectomy for lung cancer: a comparative analysis of survival and sites or recurrences. Ann Thorac Surg 2004;77:1152-56. doi:10.1016/j.athoracsur.2003.07.040
• 14. Kim AW, Liptay MJ, Bonomi P, et al. Neoadjuvant chemoradiation for clinically advanced non-small cell lung cancer: An analysis of 233 patients. Ann Thorac Surg 2011;92:233-43. doi: 10.1016/j.athoracsur.2011.03.001
• 15. Martin J, Ginsberg RJ, Abolhoda A, et al. Morbidity and mortality after neoadjuvant therapy for lung cancers: The risk of right pneumonectomy. Ann Thorac Surg 2001; 72:1149-54. doi: 10.1016/S0003-4975(01)02995-2
• 16. Van Schil P, Van Meerbeeck J, Kramer G, et al. Morbidity and mortality in the surgery arm of EORTC 08941 trial. Eur Respir J 2005;26: 192-7. doi: 10.1183/09031936.05.00127204
• 17. Bakir M, Fraser S, Routledge T, et al. Is surgery indicated in patients with stage IIIa lung cancer and mediastinal nodal involvement? Interact Cardiovasc Thorac Surg 2011;13:303-10. doi: 10.1510/icvts.2011.267872
• 18. Borri A, Leo F, Veronesi G, et al. Extended pneumonectomy for non-small cell lung cancer: morbidity, mortality, and longterm results. J Thorac Cardiovasc Surg 2007;134:1266-72. doi:10.1016/j.jtcvs.2007.01.021
• 19. Marino P, Preatoni A, Cantoni A. Randomized trials of radiotherapy alone versus combined chemotherapy and radiotherapy in stage IIIa and IIIb non-small cell lung cancer. A meta-analysis. Cancer 1995;76:593-601. doi:10.1002/1097-0142(19950815)76:4<593::AIDCNCR2820760409>3.0.CO;2-N
• 20. Decaluwé H, De Leyn P, Vansteenkiste J, et al. Surgical multimodality treatment for baseline resectable stage IIIA-N2 non-small cell lung cancer. Degree of mediastinal lymph node involvement and impact on survival. Eur J Cardiothorac Surg 2009; 36:433-9. doi: 10.1016/j.ejcts.2009.04.01
• 21. Tanaka F, Yanagihara K, Otake Y et al. Prognostic factors in resected pathologic (p-) stage IIIA-N2, non-small-cell lung cancer. Ann Surg Oncol 2004;11:612-8. doi: 10.1245/ASO.2004.07.013
• 22. Van Raemdonck DE, Schneider A, Ginsberg RJ. Surgical treatment for higher stage non-small cell lung cancer. Ann Thorac Surg 1992;54:999-1013. doi: 10.1016/0003-4975(92)90677-V
• 23. Rowell NP, O’rourke NP. Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev 2004 Oct 18; (4):CD002140.