Pneumonectomy following induction chemoradiotherapy (CRT) in NSCLC at Fox Chase Cancer Center (FCCC): Peri-operative mortality rate is lower than expected

Abstract

7107 Background: Induction CRT is used commonly prior to resection for NSCLC. Selected data cite increased operative mortality in patients (pts) requiring pneumonectomy following induction CRT (> 25% in RTOG 9309). We reviewed the FCCC experience with pneumonectomy for NSCLC and compared operative outcomes in pts who had induction CRT to those who had surgery (S) as initial treatment. Methods: Retrospective review of pts undergoing pneumonectomy for NSCLC from 1993–2005. Perioperative variables were analyzed for impact on operative mortality and complications. Results: 169 pts were analyzed: 110 (65%) were male; median age was 64 (range 39–84). 39 had induction CRT; 16 had preoperative chemo only and 3 had preoperative radiation only. Overall operative mortality was 13/169 (7.7%); for CRT pts, mortality was 5/39 (12.8%) compared to 7/111 (6.3%) for S pts (p = NS). In the CRT group, one pt died from respiratory failure due to radiation pneumonitis of the remaining lung; one pt died from complications of pneumonia, and the remainder died of respiratory failure. In the S group, 3 pts died of respiratory failure, 2 died after discharge of unknown causes, and one each died of pulmonary hypertension and empyema. Complications occurred in 19/39 (48.7%) of CRT pts compared to 39/111 (35%) in S patients (p = NS). Cardiac arrhythmias and pneumonia were the most common complications in both groups. A pre-op DLCO <60% predicted was associated with increased operative death (p = 0.045) and complications (p = 0.066) in the CRT group; this association was not present in the S group. There was no difference in DLCO between the groups. Age, diabetes, tobacco, laterality of surgery, and pre-op FEV1 did not predict operative complications or death in any group. Conclusions: Induction chemoradiotherapy pre-pneumonectomy is not associated with a statistically significant increase in perioperative morbidity or mortality vs those undergoing surgery alone. Mortality rate for CRT appears lower than that seen in RTOG 9309. DLCO <60% is a risk factor in pts with induction CRT, but not in our pts undergoing surgery alone. No significant financial relationships to disclose.