Neoadjuvante Radiochemotherapie gefolgt von kurativer Resektion im fortgeschrittenen Stadium IIIA/IIIB eines nicht kleinzelligen Lungenkarzinoms: prognostische Faktoren und Ergebnisse

Zusammenfassung

Die Rolle der nachgeschalteten Lungenresektion nach neo-adjuvanter Radiochemotherapie (RCT) bei Patienten mit einem lokal fortgeschrittenen nicht kleinzelligen Lungenkarzinom (NSCLC) ist nicht eindeutig definiert. Ziel unserer Studie war das postoperative Überleben zu untersuchen und wichtige Prognosefaktoren zu identifizieren. Im Zeitraum von Februar 2008 bis Februar 2015 wurde bei 46 Patienten mit einem lokal fortgeschrittenen NSCLC (IIIA/IIIB) eine kurative Lungenresektion nach neo-adjuvanter RCT durchgeführt. Die retrospektive Datenanalyse erfasste die präoperative Regression, die perioperative Mortalität, das postoperative Überleben, die pathohistologische Remission, das Rezidivverhalten sowie mehrere prognostische Faktoren. Eine neo-adjuvante RCT mit einer medianen Strahlendosis von 50,4 [45–60] Gy wurde bei 44 (96 %) Patienten durchgeführt. Eine partielle und/oder komplette klinische Remission war in 32 (70 %) Fällen festzustellen. Eine R0-Resektion war bei 44 (96 %) Patienten möglich. Die 30-Tage-Letalität war 4 %. Die perioperative Morbidität war bei 17 (37 %) Patienten festzustellen. Das allgemeine und tumorfreie 5-Jahres-Überleben war 47 % bzw. 45 % [im Median 58 Monate]. Das 5-Jahres-Gesamtüberleben war in der „Responder“-Gruppe mit 64 % signifikant höher als in der „Non-Responder“-Gruppe 24 % (p = 0.038). Die Prognose im Stadium des lokal fortgeschrittenen NSCLC (IIIA/IIIB) wird durch eine trimodale Therapie verbessert. Die pathohistologisch vollständige Tumorremission bleibt ein wichtiger prognostischer Faktor. Eine Differenzierung in „Responder“ und „Non-Responder“ nach neo-adjuvanter RCT hat möglicherweise eine therapeutische Konsequenz.

Abstract

The role of surgical lung resection following neo-adjuvant radio-chemotherapy (RCT) in patients with locally advanced non-small cell lung cancer (NSCLC) is yet not clearly defined. The aim of our study was to analyze the postoperative survival and to identify relevant prognostic factors. 46 patients underwent curative resections after neo-adjuvant RCT for locally advanced NSCLC (IIIA/IIIB) between February 2008 and February 2015. A retrospective data analysis regarding preoperative regression status, perioperative mortality, postoperative survival, patho-histological remission, relapse pattern and other prognostic factors was performed. A neo-adjuvant RCT with a median radiation dose of 50.4 [range, 45–60] Gy was performed in 44 (96 %) patients. Partial and/or complete regression was observed in 32 (70 %) patients. R0-resection was achieved in 44 (96 %) patients. The 30-day mortality was 4 % and the perioperative morbidity was 37 %. The overall and progression free 5-year survival rate was 47 % and respectively 45 % [in median 58 months]. The 5-year survival rate of 64 % in the “responder”-group was significantly better when compared with 24 % in the “non-responder”-group (p = 0.038). The tri-modality therapy improved the prognosis in patients with locally advanced NSCLC (stage IIIA/IIIB). The complete patho-histological remission is an important prognostic factor for better long term survival. Dividing the patients in “responder” and “non-responder” after neo-adjuvant RCT may have large therapeutically consequences in the future.

Schlüsselwörter

Stadium III - lokal fortgeschrittenes nicht kleinzelliges Lungenkarzinom - neoadjuvante Therapie - komplette pathohistologische Regression

Key words

stage III - complete pathohistological regression - neoadjuvant therapy - locally advanced non-small cell lung cancer

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