Original Article

Late Stage (III and IV) Non-small Cell Cancer of the Lung: Results of Surgical Resection at Inova Fairfax Hospital

Authors: Paul D. Kiernan, MD, Michael J. Sheridan, SCD, James Lamberti, MD, Thomas LoRusso, MD, Vivian Hetrick, RN, Betty Vaughan, RN, Paula Graling, RN

Abstract

One hundred forty-two patients underwent surgery and related treatment for advanced stage (III, IV) non-small cell cancer of the lung. One hundred seventeen patients underwent up-front surgery, with a hospital mortality rate of 1.7% (2/117). Kaplan-Meier 5-year survival in this group was 31% (± 5). Twenty-five patients underwent neoadjuvant therapy followed by surgical resection, with respective rates of hospital mortality, complete pathologic response, and major pathologic response of 0%, 16%, and 64%. Kaplan-Meier 5-year survival in this latter group was 34% (± 11). Of the 16 patients undergoing neoadjuvant therapy who had complete pathologic response or significant downstaging from stage III disease, Kaplan-Meier 5-year survival was 61% (± 15).Three clinical observations of interest emerged regarding survival. First, in those patients with postresection FEV1 < 1.0 L, hospital mortality rate was 20%, and there were no 5-year survivors (P < 0.0001). Second, where neoadjuvant therapy was associated with complete pathologic response or significant downstaging of disease, there was a trend for improved survival in the downstaged group, but it did not reach statistical significance (P = 0.14). Third, adjuvant therapy was associated with improved 5-year survival (P = 0.03), particularly for combination chemotherapy and radiotherapy (P = 0.02).


Key Points


* One hundred seventeen patients underwent up-front surgery with respective hospital mortality rates and 5-year survival of 1.7% and 31%.


* Twenty-five patients, most with bulky mediastinal disease, underwent neoadjuvant therapy followed by surgical resection with respective rates of hospital mortality, complete pathologic response, major pathologic response, and 5-year survival of 0%, 16%, 64%, and 34%.


* Of the 16 patients undergoing neoadjuvant therapy who had complete pathologic response or significant downstaging of disease, 5-year survival was 61%.


* Among patients with an estimated postoperative FEV1 < 1.0 L, there were no 5-year survivors (P < 0.0001).


* Adjuvant therapy was associated with improved 5-year survival (P = 0.03), particularly for combination chemotherapy and radiotherapy (P = 0.02).

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