Is pulmonary function damaged by neoadjuvant lung cancer therapy? A comprehensive serial time-trend analysis of pulmonary function after induction radiochemotherapy plus surgery

Margaritora, S.; Cesario, A.; Cusumano, G.; Cafarotti, S.; Corbo, G.M.; Ferri, L.; Ceppi, M.; Meacci, E.; Valente, S.; D'Angelillo, R.M.; Russo, P.; Porziella, V.; Bonassi, S.; Pasqua, F.; Sterzi, S.; Granone, P.

doi:10.1016/j.jtcvs.2009.10.023

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 6 , Pages 1457-1463, June 2010

Is pulmonary function damaged by neoadjuvant lung cancer therapy? A comprehensive serial time-trend analysis of pulmonary function after induction radiochemotherapy plus surgery

S. Margaritora, MD
- Division of General Thoracic Surgery, Catholic University, Rome, Italy
A. Cesario, MD
- Division of General Thoracic Surgery, Catholic University, Rome, Italy
- Scientific Direction, IRCCS San Raffaele Pisana, Rome, Italy
- Address for reprints: Alfredo Cesario, MD, Division of General Thoracic Surgery, Catholic University, 00168 Rome, Largo A. Gemelli 8, Italy.
G. Cusumano, MD
- Division of General Thoracic Surgery, Catholic University, Rome, Italy
S. Cafarotti, MD
- Division of General Thoracic Surgery, Catholic University, Rome, Italy
G.M. Corbo, MD
- Department of Pulmonary Pathophysiology, Catholic University, Rome, Italy
L. Ferri, MD
- Rehabilitative Pneumology, IRCCS San Raffaele Pisana, Rome, Italy
M. Ceppi, MD
- Molecular Epidemiology, National Institute for the Research on Cancer, Genoa, Italy
E. Meacci, MD
- Division of General Thoracic Surgery, Catholic University, Rome, Italy
S. Valente, MD
- Department of Pulmonary Pathophysiology, Catholic University, Rome, Italy
R.M. D'Angelillo, MD
- Department of Radiotherapy, Campus Biomedico University, Rome, Italy
P. Russo
- Lung Cancer Unit, National Institute for the Research on Cancer, Genoa, Italy
V. Porziella, MD
- Division of General Thoracic Surgery, Catholic University, Rome, Italy
S. Bonassi, MD
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
F. Pasqua, MD
- Rehabilitative Pneumology, CdC San Raffaele Velletri, Rome, Italy
S. Sterzi, MD
- Department of Rheabilitative Medicine, University Campus Bio-Medico, Rome, Italy
P. Granone, MD
- Division of General Thoracic Surgery, Catholic University, Rome, Italy

Received 7 April 2008; received in revised form 19 August 2009; accepted 8 October 2009. published online 05 April 2010.

Objective

We have analyzed short- and long-term variations of pulmonary function in locally advanced non–small cell lung cancer after induction chemoradiotherapy.

Methods

Twenty-seven patients with stage IIIA (N2) non–small cell lung cancer underwent resection with radical intent after induction chemoradiotherapy in the period 2003 to 2006. Pulmonary function has been evaluated by spirometry, diffusing capacity of the lung for carbon monoxide, and blood gas analysis before induction chemoradiotherapy (T0), 4 weeks after induction chemoradiotherapy and before surgery (T1), and 1 (T2), 3 (T3), 6 (T4), and 12 months (T5) after surgery.

Results

A 22.80% decrease of diffusing capacity of the lung for carbon monoxide (P < .001) was observed at T1. At T2 significant decreases in the following were present: vital capacity, −20.50% (P < .001); forced vital capacity, −22.50% (P < .001); forced expiratory volume in 1 second, −23.00% (P < .001); peak expiratory flow, −29.0 (P < .001); forced expiratory flow 25% to 75%, −13.7% (P = .005); and diffusing capacity of the lung for carbon monoxide, 43.6% (P < .001). However, in the interval between T2 and T5, a progressive improvement of lung function in most parameters was observed, but only diffusing capacity of the lung for carbon monoxide presented a significant increase (P < .001). Within the same time gap (T2 to T5), subjects 65 years of age or younger showed an increasing trend for vital capacity, forced expiratory volume in 1 second, total lung capacity, and residual volume significantly different from that of elderly patients, in whom a decrease in these parameters is reported.

Conclusions

An impairment of respiratory function is evident in the immediate postoperative setting in patients with non–small cell lung cancer receiving induction chemoradiotherapy. In the long-term period, a general recovery in diffusing capacity of the lung for carbon monoxide was found, whereas an improvement of forced expiratory volume in 1 second, vital capacity, total lung capacity, and residual volume was detected in the younger population only.

CTSNet classification: 10

Abbreviations and Acronyms: CT, chemotherapy, DLCO, diffusing capacity of the lung for carbon monoxide, FEF_25%–75%, forced expiratory flow 25%–75%, FEV₁, forced expiratory volume in 1 second, FVC, forced vital capacity, IT, induction chemoradiotherapy, NSCLC, non–small cell lung cancer, Paco₂, arterial blood pressure of carbon dioxide, Pao₂, arterial blood pressure of oxygen, PEF, peak expiratory flow, RT, radiotherapy, RT-CT, radiotherapy–chemotherapy, RV, residual volume, TLC, total lung capacity, VC, vital capacity