İlhan OCAKCIOĞLU, Levent ALPAY, Nezih Onur ERMERAK, Hakan KIRAL, Çağatay Saim TEZEL, S. Volkan BAYSUNGUR, Irfan YALCINKAYA

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

Amaç: Neoadjuvan tedaviyi takiben küçük hücreli dışı akciğerkanseri (KHDAK)’nin anatomik rezeksiyonu halen tartışmalı olsada, torasik cerrahi uygulamada yaygın kabul gören bir yaklaşımdır.Bu çalışmanın amacı, neadjuvan tedaviyi takiben kurumumuzdacerrahi operasyon uygulanan lokal ileri evre KHDAK’i, pancoasttümörü ve soliter beyin metastazı olan akciğer kanseri hastalarınınklinik sonuçlarını, uzun dönem sağkalımını ve sağkalımı etkileyenfaktörleri kısaca değerlendirmektir.Gereç ve Yöntem: Mart 2006 ve Mart 2012 tarihleri arasındaneoadjuvan tedaviyi takiben anatomik pulmoner rezeksiyonuygulanan 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 ayolarak bulundu. Sağkalım oranı tümörün anatomik lokalizasyonunagöre değerlendirildiğinde santral ve sol üst lob tümörlerinde dahadüşüktü (P=0,042). 5 yıllık ortalama sağkalım süreleri evre 0hastalarda 50,00±5,65 ay, evre 1 hastalarda 35,39±5,85 ay, evre 2hastalarda 37,40±6,89 ay ve evre 3 hastalarda 21,44±3,10 ay idi.Sonuç: Neoadjuvan tedaviyi takiben anatomik pulmonerrezeksiyon 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

Objective: Although, anatomical resection of non-small cell

Keywords:

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

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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.