According to a recent article published in the Annals of Thoracic Surgery, the surgical removal of lung cancer remains safe following neoadjuvant chemotherapy plus either high-dose or low-dose radiation to the chest.

Lung cancer remains the leading cause of cancer-related deaths in the world. The disease is responsible for more deaths each year in the US than breast, colon, and prostate cancers combined.

None-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for approximately 75%-80% of all lung cancers in the US. NSCLC refers to the type of cell within the lung where the cancer originated. Standard treatment for NSCLC depends largely on the stage (extent of spread) of the disease, but often consists of surgery to remove as much of the cancer as possible, chemotherapy, radiation therapy, and/or targeted therapy.

Neoadjuvant therapy (the use of treatment prior to surgery) is being evaluated in clinical trials for various types of cancer. Neoadjuvant therapy is given in order to shrink the cancer prior to surgery and potentially allow for more complete surgical removal of the cancer. It also immediate kills cancer cells throughout the body. Normally, patients must wait until they are healed from surgery before undergoing further treatment. In theory, cancer cells elsewhere in the body have time to grow or spread during this healing period.

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Researchers from Alabamarecently analyzed data regarding the safety of neoadjuvant chemotherapy plus radiation therapy followed by the surgical removal of NSCLC. This study included 104 patients with stage IIIA NSCLC (cancer that involves one or more nearby lymph nodes, but has not spread outside the chest). All patients received initial treatment with carboplatinum (Paraplatin®)-based chemotherapy plus either high-dose or low-dose radiation therapy. Patients had their cancer surgically removed. The researchers evaluated the safety and efficacy of these treatment combinations:

  • A complete disappearance of cancer following initial treatment with chemotherapy/radiation therapy was achieved in 28% of patients treated with high-dose radiation, compared to 10% of patients treated with low-dose radiation therapy.
  • Median length of hospital stay was four days in both treatment groups.
  • Intensive Care Unit (ICU) was avoided in 74% of patients.
  • Severe reductions in quality of life (morbidity) were similar between treatment groups: 8% in those treated with low-dose radiation compared to 9% in those treated with high-dose radiation.
  • Mortality was similar between two groups: 2% for those treated with low-dose radiation therapy and 3.7% for those treated with high-dose radiation.
  • Patients who had to undergo a pneumonectomy (removal of an entire lung) had significantly worse morbidity in both groups of patients.

The researchers concluded that neoadjuvant therapy with chemotherapy plus either high or low-dose radiation therapy prior to the surgical removal of NSCLC is a safe treatment regimen. However, they caution that patients who will have a pneumonectomy may wish to forgo chemotherapy/radiation therapy prior to surgery. Longer follow-up will help determine possible survival benefits of this treatment approach. Patients with stage IIIA NSCLC may wish to speak with their physician regarding their individual risks and benefits of neoadjuvant therapy or the participation in a clinical trial evaluating novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov) and www.cancerconsultants.com.

Reference: Cerfolio R, Bryant A, Spencer S, Bartolucci A. Pulmonary Resection after High-Dose and Low-Dose Chest Irradiation. Annals of Thoracic Surgery. 2005; 80:1224-1230.

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