35 O Does neoadjuvant npv (nitomycin c, cisplatin. vinblastine) chemothbrapy increase to risk of bronchopleural fistulas?

Abstract

Encouraging results have been reported with neoadjuvant chemotherapy and radio-chemotherapy In the treatment of at age III non small cell lung cancer (NSCLC). However, the risk of posoperative morbidity, particularly bronchopleural fistulas (BPfa) aeema to be increased after the treatment. Nevertheless, an in-depth pathophysiological analysis of the relationship between neoadjuvant treatment and postoperative morbidity is still lacking. At our Department from November 1990 to August 1995 57 stage III NSCLC patients (36 stage IIIa and 21 stage IIIb) underwent MPV neoadjuvant chemotherapy. Xean age was 56 ysars (range 39-68). Major response was observed in 44 patients (77%) and treatment-related nortality was 4%. Following chemotherapy, 31 of the patients underwent surgical treatment. Complete resection of all residual tumor in the primary site and lymph nodes could be performed in 84% (26/31) patients. The overall complete resection rate was 46% (26/57), 66% of the patients in stage Ilia and 9.5% of the patients in stage IIIb. The median follow-up for the 57 patients that have completed the chemotherapy treatment is 20 months (5 to 57). Twenty-eight patients are still alive (49%) and 29 died as a result of disease progression; 17 out of the 26 patients who had complete resection are still alive and 9 of them died because of disease progression (median follow-up 27 months). He postoperative morbidity or mortality were observed. There were no BPFs or clinically evident mltomycin-related pulmonary toxicity. Microscopic examination of resected bronchial specimens was performed to evaluate chemotberapy-ralated histological findings. A slight evidence of microvascular trombosis and submucosal fibrosis vas found. In contrast, in a control group of patients submitted to preoperative radiotherapy (5000 coy), microvascular trombosis and submucosal fibrosis were more marked. This could partially explain the higher incidence of postoperative BPFs reported after high-dose radiotherapy than with MPV chemotherapy. In our experience MTV neoadjuvant chemotherapy has been associated with favourable response and resection rates, with limited treatment-related bronchial damage and absence of BPFs. Although further studies are needed, this approach seems to be preferable to radio-chemotherapy in the treatment of stage III MSCLC.