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RESULTS OF LUNG CANCER RESECTION FOLLOWING NEOADJUVANT THERAPY

RESULTS OF LUNG CANCER RESECTION FOLLOWING NEOADJUVANT THERAPY. Yüksel M, Batırel HF, Laçin T, Yıldızeli B, Bostancı K, Akgül Aslı Gül , Evman S. Marmara Üniversitesi Tıp Fakültesi Göğüs Cerrahisi AD. Main objective in lung cancer is to increase long-term survival.

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RESULTS OF LUNG CANCER RESECTION FOLLOWING NEOADJUVANT THERAPY

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  1. RESULTS OF LUNG CANCER RESECTION FOLLOWING NEOADJUVANT THERAPY Yüksel M, Batırel HF, Laçin T, Yıldızeli B, Bostancı K, Akgül Aslı Gül, Evman S. • Marmara Üniversitesi Tıp Fakültesi Göğüs Cerrahisi AD

  2. Main objective in lung cancer is to increase long-term survival. • Neoadjuvant treatment protocols using either preoperative chemotherapy or combined chemotheraphy and radiotheraphy succeeded by surgery are tried.

  3. Although the definitive benefit of surgical resection after induction theraphy is still in question, long term survival of patients receiving induction theraphy is achieved in patients where mediastinal nodal disease was eradicated. • Sugarbaker DJ, et al. J Thorac Cardiovasc Surg 1995;109:473-83. • Voltolini L, et al. Eur J Cardiothorac Surg 2001;20:1106-12. • Sonett JR, et al. Ann Thorac Surg 2004;78:1200-6. • Takeda S, et al. Eur J Cardothorac Surg 2006;30:184-89.

  4. Between 1994-2006, 24 of 348 lung cancer patients who were operated, received neoadjuvant theraphy.

  5. Patient Characteristics n (%) • Sex • M 20 (83) • F 4 (17) • Median Age (years/range) 54,8 (41-78) • Histology • Squamous cell 16 (67) • Adenocarcinoma 8 (33) • Preinduction Stage • IIb (Pancoast) 5 (20) • T3N0M0 5 • IIIa 15 (63) • T1N2M0 4 • T2N2M0 8 • T3N2M0 3 • IIIb 1 (4) • T4N1M0 1 • IV 3 (13) • (solitary brain metastasis) 2 • (pleural nodule, single) 1

  6. Patient Characteristicsn (%) • Smoking 15 (62) • Major co-morbidity (KAD, DM) 6 (25) • Neoadjuvant theraphy 24 • Median chemotheraphy cycles 4 • KT+RT (42 Gy) 7 (29)

  7. Re-evaluation after neoadjuvant theraphy; • CT all pts. • PET 12 pts. • Mediastinoscopy 1 pt. • Mediastinotomy 1 pt.

  8. 12 pts. (50%); down stage after neoadjuvant theraphy • Median time to surgical resection after cessation of neoadjuvant theraphy was; 32 days. • Surgical procedure; Pneumonectomy in 7 Lobectomy in 16 Wedge resection in 1

  9. Postop Patological Stage Preop stageT1N0 T2N0 T1N1 T2N1 T3N0 T1N2 T2N2 T3N1 T3N2 T4N0 T3N0M0 1 1 3 T1N2M0 2 1 1 T2N2M0 5 2 1 T3N2M0 2 1 T4N1M0 1 T2N0M1 1 T2N1M1 1 1

  10. Median ICU stay 1.76 days (1-7) • Median hospital stay 10.56 days (3-41) • Postop Morbidity 10 (%42) • Atelectasis, space 5 (%21) • Postop Mortality 1 (%4,1) • Pulmonary artery bleeding

  11. Postop pathology; • Incomplete resection (3 pts) • N2 (+) (3 pts) received adjuvant theraphy Median follow-up; 18.5 months 8 pts; died due to recurrent tumor 6 pts; alive with disease 9 pts (37.5%); alive without disease

  12. DISCUSSION • N2 (+), stage IIIA NSCLC; surgery following neoadjuvant is better than surgery alone • N2 (+) disease after neoadjuvant therapy; Curative chemo/radiotherapy

  13. DISCUSSION • N0 after neoadjuvant • Resectable with lobectomy; better results in locally control and survival with surgery. • Following neoadjuvant treatment re-staging in lymph nodes must be done.

  14. Although there is still no randomized phase III trial to show neoadjuvant theraphy to increase survival, neoadjuvant theraphy increases resectability in locally advanced lung cancer.

  15. We need standardized multidisiplinary protocols with large series to get significant conclusions.

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