Induction chemotherapy followed by parenchyma-sparing surgery in medically inoperable NSCLC—Results of a feasibility study

• Published in: Lung cancer (Amsterdam, Netherlands) Netherlands), 2008-11, Vol.62 (2), p.228-235
• Main Authors: Pless, M, Gambazzi, F, Stillhart, P, Lieb, Th, Brutsche, M
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - therapy; Cisplatin - administration & dosage; Cisplatin - adverse effects; Combined Modality Therapy; Disease-Free Survival; Feasibility Studies; Female; Hematology, Oncology and Palliative Medicine; Humans; Induction chemotherapy; Lung Neoplasms - mortality; Lung Neoplasms - therapy; Male; Medical sciences; Medically inoperable lung cancer; Middle Aged; NSCLC; Parenchyma-sparing surgery; Pneumology; Pneumonectomy - methods; Pulmonary function; Pulmonary/Respiratory; Taxoids - administration & dosage; Taxoids - adverse effects; Tumors; Tumors of the respiratory system and mediastinum
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2008.03.006

Summary Purpose Feasibility trial to test the toxicity and outcome of three cycles of induction chemotherapy followed by limited surgery in medically inoperable early stage NSCLC patients. Patients and methods Thirteen patients with NSCLC (stages I–IIIB) with insufficient cardio-respiratory reserves for the oncologically required lung resection, received three cycles of induction chemotherapy with cisplatin (100 mg/m2 ) and docetaxel (85 mg/m2 ) followed by parenchyma-sparing lung surgery. Operability was evaluated with pulmonary function tests, perfusion scintigraphy and cardiopulmonary exercise testing. In selected patients coronary angiography or myocardial perfusion scintigraphy was performed. Rate of R0-resections was taken as primary outcome. Results Twelve of 13 patients received the three cycles of chemotherapy as planned. The main grade 3/4 hematological toxicity was neutropenia (62%), non-hematological toxicity was neutropenic fever (23%) and cough/dyspnea (31%). Complete, partial and stable responses to chemotherapy were seen in 1, 10 and 2 patients, respectively—the overall response rate was 85%. No patient had tumor progression. Eleven/13 (85% (CI 95% 54, 97) %) patients underwent surgery (4 lobectomies, 2 segmentectomies, and 5 wedge resections), all had a pathologically complete resection of the tumor. There was one postoperative death due to myocardial infarction. The median disease-free and overall survivals were 57(CI 95% 36–78) months and 66(CI 95% 40–92) months, with a median follow up time of 58 months. The 1-, 2- and 4-year OS was 85%, 85% and 67%, respectively. There were no significant changes in any lung function parameter compared to the preoperative assessment. The FEV1 showed a trend for improved values after surgery. Conclusion Induction chemotherapy in medically inoperable patients followed by parenchyma-sparing surgery is feasible and yields very promising results.