Neoadjuvant Chemotherapy in Lung Cancer: Our Results after Twelve Years of Surgical Resection

Introduction: Lung cancer is characterized by its frequency and prognosis, which remains reserved by the fact that the diagnosis is often made at the locally evolved or metastatic stages. The aim of this study is to evaluate the contribution of neoadjuvant chemotherapy to the resectability of non-small cell lung carcinoma, while highlighting its impact on the incidence of surgical complications and the effect of this therapeutic strategy on survival. Materials: We have carried out a retrospective analysis of patients who underwent surgical treatment of nonsmall cell lung cancer (NSCLC) after neoadjuvant chemotherapy (NAC), between March 2000 and October 2012 at the Thoracic Surgery Department of Abderrahmen MAMI University Hospital. Results: During the study period, 103 patients were referred to our institution for NSCLC’s curative surgery after a NAC. Ninety five (95) patients are operated and 8 were not because of tumor progression after NAC or a high risk of operative mortality. The evaluation after the NAC showed a partial response in 77 cases (75%). More than half patients (57 cases: 55.7%) had a down-staging after the NAC. Male gender, and age increase postoperative complications significantly (p=0.042). Global survival was calculated for 87 patients 85%, 56%, 50% respectively at 1 year, 2 years and 5 years. The mean survival was 25 (range: 2 to 132) months. Global survival was increased significantly with T1 status (p=0.003) and M0 status (p<0.005) before NAC and also after NAC (p=0.032). Tumor localization had a significant impact on survival (p=0.034) with best survival with tumor in middle lobe and worst survival with bilobar tumors. Conclusion: We noticed an increased survival with age <60 years, feminine gender, well differentiated tumor, patient with no parietal involvement, NAC protocol other than Gemzar-Cisplatine, complete or partial response to NAC, pneumonectomy as the type of resection, no enlargement resection, uneventful postoperative, R0 resection, N0 status after NAC and finally pN0 status.