CHICAGO -- When treating non-small cell lung cancer, the success of trimodality therapy -- chemoradiation followed by pneumonectomy -- depends upon the experience of the clinical center and the location of the lesion.
CHICAGO, Nov. 2 -- When treating non-small-cell lung cancer, the success of trimodality therapy -- chemoradiation followed by pneumonectomy -- depends upon the experience of the clinical center and the location of the lesion.
Unlike a national multicenter trial, which reported post-operative morality of 26%, the 30-day mortality rate for stage III A/B NSCLC patients who underwent trimodality therapy at a nationally-recognized cancer center was 4%, said Aaron Allen, M.D., of the department of radiation oncology at the Dana-Farber Cancer Institute in Boston.
The 90-day mortality was 7% or about a quarter of the mortality reported in by the Intergroup Trial 0139, he reported at the International Association for the Study of Lung Cancer symposium on malignancies of the chest and head and neck.
Dr. Allen said his retrospective analysis suggests that the success of trimodality therapy was dependent upon two factors, the experience of the clinical center and the location of the lesion.
"Right-sided pneumonectomies do have a higher complication rate than left-sided pneumonectomies," he said. In his study all treatment-related deaths occurred in patients with right-sided lesions.
Antoinette Wozniak M.D. of Hudson-Webber Cancer Research Center at Wayne State in Detroit, who moderated the oral abstract session, said Dr. Allen's data underline the message that "many of these treatments work well in the hands of experienced operators," but may not translate well into the low-volume, community-based care.
Dr. Allen reviewed NSCLC cases treated with trimodality therapy from 1994 though 2005. All patients underwent pneumonectomy at Brigham and Women's Hospital, which is affiliated with Dana-Farber.
Most patients underwent neoadjuvant therapy at outside institutions.
The median number of chemoradiation cycles was three with 93% of patients treated with Paraplatin (carboplatin)/Taxol (paclitaxel) with thoracic radiotherapy median dose 54 Gy. The remainder of patients received Platinol (cisplatin)/Etoposide (VP-16) and the same radiotherapy dose.
Seventy-four patients underwent trimodality therapy during the study period. The median age of patients was 58 and roughly 40% were men. Fifty-nine percent of cases were squamous cell carcinoma and 41% were adenocarcinoma. The cases were evenly divided between stage IIIA and IIIB.
Forty patients had left-sided pneumonectomies.
Three patients died with the first 30 days and one more died by 90 months. The causes of death were pulmonary edema, arrhythmia and acute respiratory distress syndrome.
Combined modality toxicity following surgery was seen in 11%. Non-fatal complications included bronchopleural fistula, deep vein thrombosis, atrial fibrillation, heart failure and hemothorax.
The one-year survival rate was 64% and the two-year survival was 40%. Almost all deaths occurring after 90 days were because of disease progression, Dr. Allen said.