Robert J Cerfolio1, Amar Talati, Ayesha S Bryant. 1. Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
Abstract
BACKGROUND: Neoadjuvant chemotherapy or chemoradiotherapy increases the risk of pulmonary resection. Changes in specific pulmonary function tests may be predictive. METHODS: A retrospective review of a prospective database of patients with non-small cell lung cancer who underwent neoadjuvant therapy, had pulmonary function tests performed both before and after therapy, and then underwent elective pulmonary resection was performed. Final values and change in the pulmonary function tests before and after treatment were entered as independent variables into a multivariate model in which the dependent variable was major or respiratory morbidity. RESULTS: There were 132 patients. The mean duration between pretherapy and posttherapy pulmonary function tests was 4.1 months. The mean change in the percent forced expiratory volume in 1 second, in the percent diffusion capacity of the lung for carbon monoxide, and in the percent diffusion capacity of the lung for carbon monoxide corrected for the alveolar volume was +1.0, -6.4%, and -6.6%, respectively. Fifty-five patients (42%) experienced a postoperative complication, and 39 of those patients experienced a major or respiratory complication. There were 7 (5.3%) operative mortalities (5 were respiratory related). On multivariate analysis the change in the percent diffusion capacity of the lung for carbon monoxide corrected for the alveolar volume was the only factor associated with major or respiratory morbidity (p = 0.028). When the posttherapy percent diffusion capacity of the lung for carbon monoxide corrected for the alveolar volume fell by 8% or more, there was an increased likelihood of major morbidity (p = 0.01). CONCLUSIONS: A decrease in the percent diffusion capacity of the lung for carbon monoxide corrected for the alveolar volume after neoadjuvant chemotherapy or chemoradiotherapy may predict increased risk for pulmonary resection, especially if the decrease is 8% or greater. These results should be considered in the preoperative risk assessment of patients who are to undergo pulmonary resection after induction therapy.
BACKGROUND: Neoadjuvant chemotherapy or chemoradiotherapy increases the risk of pulmonary resection. Changes in specific pulmonary function tests may be predictive. METHODS: A retrospective review of a prospective database of patients with non-small cell lung cancer who underwent neoadjuvant therapy, had pulmonary function tests performed both before and after therapy, and then underwent elective pulmonary resection was performed. Final values and change in the pulmonary function tests before and after treatment were entered as independent variables into a multivariate model in which the dependent variable was major or respiratory morbidity. RESULTS: There were 132 patients. The mean duration between pretherapy and posttherapy pulmonary function tests was 4.1 months. The mean change in the percent forced expiratory volume in 1 second, in the percent diffusion capacity of the lung for carbon monoxide, and in the percent diffusion capacity of the lung for carbon monoxide corrected for the alveolar volume was +1.0, -6.4%, and -6.6%, respectively. Fifty-five patients (42%) experienced a postoperative complication, and 39 of those patients experienced a major or respiratory complication. There were 7 (5.3%) operative mortalities (5 were respiratory related). On multivariate analysis the change in the percent diffusion capacity of the lung for carbon monoxide corrected for the alveolar volume was the only factor associated with major or respiratory morbidity (p = 0.028). When the posttherapy percent diffusion capacity of the lung for carbon monoxide corrected for the alveolar volume fell by 8% or more, there was an increased likelihood of major morbidity (p = 0.01). CONCLUSIONS: A decrease in the percent diffusion capacity of the lung for carbon monoxide corrected for the alveolar volume after neoadjuvant chemotherapy or chemoradiotherapy may predict increased risk for pulmonary resection, especially if the decrease is 8% or greater. These results should be considered in the preoperative risk assessment of patients who are to undergo pulmonary resection after induction therapy.
Authors: Jose L Lopez Guerra; Daniel R Gomez; Yan Zhuang; Lawrence B Levy; George Eapen; Hongmei Liu; Radhe Mohan; Ritsuko Komaki; James D Cox; Zhongxing Liao Journal: Int J Radiat Oncol Biol Phys Date: 2012-03-13 Impact factor: 7.038
Authors: Sai Yendamuri; Adrienne Groman; Austin Miller; Todd Demmy; Mark Hennon; Elisabeth Dexter; Anthony Picone; Chukwumere Nwogu; Grace K Dy Journal: Eur J Cardiothorac Surg Date: 2018-03-01 Impact factor: 4.191
Authors: Jose Luis Lopez Guerra; Daniel Gomez; Yan Zhuang; Lawrence B Levy; George Eapen; Hongmei Liu; Radhe Mohan; Ritsuko Komaki; James D Cox; Zhongxing Liao Journal: Int J Radiat Oncol Biol Phys Date: 2012-08-01 Impact factor: 7.038
Authors: James G Connolly; Megan Fiasconaro; Kay See Tan; Michael A Cirelli; Gregory D Jones; Raul Caso; Daniel E Mansour; Joseph Dycoco; Jae Seong No; Daniela Molena; James M Isbell; Bernard J Park; Matthew J Bott; David R Jones; Gaetano Rocco Journal: J Thorac Cardiovasc Surg Date: 2021-12-23 Impact factor: 6.439
Authors: Jarrod T Bruce; Jerry M Tran; Gary Phillips; Pat Elder; John G Mastronarde; Steven M Devine; Craig C Hofmeister; Karen L Wood Journal: Clin Lymphoma Myeloma Leuk Date: 2012-09-15