Outcomes of surgical resection after neoadjuvant chemoimmunotherapy in locally advanced stage IIIA non-small-cell lung cancer


Por: Roman, AR, de la Cruz, JLCC, Macia, I, Campuzano, IE, Almanzar, SF, Roel, MD, Munoz, CG, Fontan, EMG, Trueba, IM, Vielva, LR, Garcia, JRC, Tellez, EM, Gonzalez, CP, Lopez, MFJ, Maestre, UJ, Poce, RM, Lorente, DS, Kindelan, AA, Pulla, MP

Publicada: 1 jul 2021 Ahead of Print: 1 mar 2021
Resumen:
OBJECTIVES: This analysis aimed to evaluate perioperative outcomes of surgical resection following neoadjuvant treatment with chemotherapy plus nivolumab in resectable stage IIIA non-small-cell lung cancer. METHODS: Eligible patients received neoadjuvant chemotherapy (paclitaxel + carboplatin) plus nivolumab for 3 cycles. Reassessment of the tumour was carried out after treatment and patients with at least stable disease as best response underwent pulmonary resection. After surgery, patients received adjuvant treatment with nivolumab for 1year. Surgical data were collected from the NADIM database and patient charts were reviewed for additional surgical details. RESULTS: Among 46 patients who received neoadjuvant treatment, 41 (89.1%) underwent surgery. Two patients rejected surgery and 3 did not fulfil resectability criteria. There were 35 lobectomies (85.3%), 3 of which were sleeve lobectomies (9.4%), 3 bilobectomies (7.3%) and 3 pneumonectomies (7.3%). Video-assisted thoracoscopy was the initial approach in 51.2% of cases, with a conversion rate of 19% (n=4). There was no operative mortality at either 30 or 90days. The most common complications were prolonged air leak (n=8), pneumonia (n=5) and arrhythmia (n=4). Complete resection (R0) was achieved in all patients who underwent surgery, downstaging was observed in 37 patients (90.2%) and major pathological response in 34 patients (82.9%). CONCLUSIONS: Surgical resection following induction therapy with chemotherapy plus nivolumab appears to be safe and offers appropriate oncological outcomes. Perioperative morbidity and mortality rates in our study were no higher than previously reported in this setting. A minimally invasive approach is, therefore, feasible.

Filiaciones:
Roman, AR:
 Hosp Univ Puerta de Hierro Majadahonda, Dept Thorac Surg, Calle Manuel de Falla S-N, Madrid 28222, Spain

de la Cruz, JLCC:
 Hosp Univ Puerta de Hierro Majadahonda, Dept Thorac Surg, Calle Manuel de Falla S-N, Madrid 28222, Spain

Macia, I:
 Hosp Univ Puerta de Hierro Majadahonda, Dept Thorac Surg, Calle Manuel de Falla S-N, Madrid 28222, Spain

Campuzano, IE:
 Hosp Univ Puerta de Hierro Majadahonda, Dept Thorac Surg, Calle Manuel de Falla S-N, Madrid 28222, Spain

 Univ Barcelona, Inst Invest Biomed Bellvitge IDIBELL, Hosp Univ Bellvitge, Dept Thorac Surg, Barcelona, Spain

 Univ Barcelona, Unit Human Anat & Embryol, Dept Pathol & Expt Therapeut, Fac Med & Ciencies Salut, Barcelona, Spain

 Univ Barcelona, Dept Clin Sci, Fac Med & Ciencies Salut, Barcelona, Spain

Almanzar, SF:
 Hosp Clin Univ Valencia, Dept Thorac Surg, Valencia, Spain

Roel, MD:
 Complejo Hosp Univ A Coruna, Dept Thorac Surg, La Coruna, Spain

Munoz, CG:
 Hosp Gen Univ Alicante, Dept Thorac Surg, Alicante, Spain

Fontan, EMG:
 Complejo Univ Vigo, Dept Thorac Surg, Vigo, Spain

Trueba, IM:
 Hosp Univ Fdn Jimenez Diaz, Dept Thorac Surg, Madrid, Spain

Vielva, LR:
 Hosp Valle De Hebron, Dept Thorac Surg, Barcelona, Spain

Garcia, JRC:
 Complejo Hosp Univ Insular Gran Canaria, Dept Thorac Surg, Las Palmas Gran Canaria, Spain

Tellez, EM:
 Hosp Univ Santa Creu & St Pau, Dept Thorac Surg, Barcelona, Spain

Gonzalez, CP:
 Hosp Univ La Paz, Dept Thorac Surg, Madrid, Spain

Lopez, MFJ:
 Hosp Univ Salamanca, Dept Thorac Surg, Salamanca, Spain

Maestre, UJ:
 Hosp Univ Cruces, Dept Thorac Surg, Bizkaia, Spain

Poce, RM:
 Hosp Reg Univ Malaga, Dept Thorac Surg, Malaga, Spain

Lorente, DS:
 Hosp Clin Barcelona, Dept Thorac Surg, Barcelona, Spain

Kindelan, AA:
 Hosp Univ Reina Sofia Cordoba, Dept Thorac Surg, Cordoba, Spain

Pulla, MP:
 Hosp Univ Puerta de Hierro Majadahonda, Dept Med Oncol, Madrid, Spain
ISSN: 10107940





EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
Editorial
OXFORD UNIV PRESS INC, JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA, Países Bajos
Tipo de documento: Article
Volumen: 60 Número: 1
Páginas: 81-88
WOS Id: 000684103600011
ID de PubMed: 33661301
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