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Safety and efficacy of pulmonary resection after low and high dose neoadjuvant radiotherapy with concurrent chemotherapy Although the ideal treatment for stage IIIA disease from N2 non-small cell lung cancer is unproven many academic centers are adding pre-operative radiotherapy to neo-adjuvant chemotherapy. The reason for this paradigm shift is that the addition of pre-operative radiotherapy leads to improved pathologic response. Since it has been shown that improved pathologic response may correlate with increased long term survival, radiotherapy has been increasingly used. Approximately 7 years ago, we decided to use curative doses (60 Gy or higher) of preoperative radiotherapy concomitant with chemotherapy. The reason for this decision was to avoid long periods of delay for patients who received the typical dose of 45 Gy of preoperative radiotherapy and then did not undergo complete resection because of recalcitrant N2 disease or because their disease progressed during their preoperative therapy. This period of delay (often a few months) between the 45 Gy dose and the completion dose of up to 60 Gy decreases the efficacy of the radiotherapy. Thus we decided to use a curative dose of 60 Gy initially in all patients prior to restaging or surgical exploration and resection. In this manner, the patients maximal medical therapy with doses of 60 Gy or higher is delivered irrespective of surgical resection. Our manuscript that studies 104 patients shows that pulmonary resection is safe even after neoadjuvant doses of 60 Gy or higher. Moreover it affords an increase in complete pathologic response without increasing surgical morbidity or mortality. We found no significant difference in the operation or in the post-operative period in patients who underwent low dose (45 Gy) or high dose (60 Gy) therapy. However patients who undergo right pneumonectomy after high dose pre-operative radiochemotherapy may be at increased risk.
Bibliographic reference:
Robert J Cerfolio Division of Cardiothoracic Surgery, Department of
Surgery, University of Alabama, Birmingham, Alabama, USA
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