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The Annals of Thoracic Surgery, Vol 55, 986-989, Copyright © 1993 by The Society of Thoracic Surgeons
WC Fowler, CJ Langer, WJ Curran Jr and SM Keller
Preoperative chemotherapy and radiation administered separately or in
combination have been used in the treatment of locally advanced non- small
cell lung cancer. To assess the postoperative morbidity and mortality
associated with aggressive neoadjuvant therapy, we reviewed the records of
13 patients who underwent resection of locally advanced non-small cell lung
cancer after two monthly cycles of infusional 5- fluorouracil, 640 to 800
mg/m2 (days 1 through 5); cisplatin, 20 mg/m2 (days 1 through 5);
etoposide, 50 mg/m2 (days 1, 3, and 5); and concomitant radical thoracic
irradiation (6,000 cGy) administered in 200-cGy daily fractions. Six
patients underwent lobectomy with no mortality, whereas 7 pneumonectomies
were associated with three deaths (43%). Culture-negative, diffuse
pulmonary infiltrates developed 3 to 6 days after operation in 5 of 7
pneumonectomy patients and in 1 of 6 lobectomy patients. Two patients who
had undergone pneumonectomy died of progressive adult respiratory distress
syndrome. A third death resulted from a bronchopleural fistula that
developed 30 days after pneumonectomy. Morbidity and mortality were not
associated with preoperative pulmonary function test results, nutritional
status, or intraoperative inspired oxygen fraction (p > 0.05 by chi 2
test). Only pneumonectomy correlated with increased morbidity and mortality
(p < 0.05 by chi 2 test). We conclude that lobectomy may be performed
safely after this combination of aggressive chemotherapy and high-dose
radiation, but pneumonectomy is associated with unacceptable morbidity and
mortality.
ARTICLES
Postoperative complications after combined neoadjuvant treatment of lung cancer
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
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