Surgical perspective in neoadjuvant chemoimmunotherapy for stage II-III non-small cell lung cancer.

Abstract

BACKGROUND:

There are many studies on neoadjuvant immunotherapy for locally advanced non-small cell lung cancer (NSCLC) patients. Expert consensus recommends neoadjuvant immunotherapy for patients with resectable stage IB-IIIA NSCLC. However, there are few clinical studies or cases to verify this.

METHODS:

Data were collected from all NSCLC patients who underwent surgical resection after neoadjuvant chemoimmunotherapy admitted to the Affiliated Hospital of Xuzhou Medical University and Xuzhou Central Hospital between September 2020 and April 2021. Data collected included patient information, relevant examination results, intraoperative parameters, postoperative complications, pathological changes, and 90-day mortality.

RESULTS:

In total, 25 patients achieved R0 resection. Eleven (44%) patients completed surgery by thoracotomy, and three (12%) procedures were changed from minimally invasive procedures due to dense adhesions of hilar lymph nodes, which rendered it difficult to dissect the blood vessels. Thirteen (52%) patients achieved a major pathological response (MPR) with eight (32%) of these patients having a pathological complete response (pCR). Twenty-two (88%) patients showed radiological regression, and three (12%) patients had stable disease. The median drainage time was 8.50 (3-27) days. Thirteen (52%) postoperative complications were observed, but none were above grade 3.

CONCLUSIONS:

In this study, neoadjuvant chemoimmunotherapy was found to reduce tumor volume, cause pathological downstaging, and raise the surgical resection rate of patients with locally advanced NSCLC, and achieve a 100% R0 resection rate. There was an acceptable rate of postoperative complications. Thus, neoadjuvant chemoimmunotherapy is safe and practical.

• Authors: Tao Hong, Teng Sun, Miao Zhang, Xinlong Liu, Yanliang Yuan, Ponnie Robertlee Dolo, Bi Chen, Hao Zhang
• Journal: Thoracic cancer (Thorac Cancer) Vol. 12 Issue 20 Pg. 2796-2802 (10 2021) ISSN: 1759-7714 [Electronic] Singapore
• PMID: 34463034 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

Topics

• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carcinoma, Non-Small-Cell Lung (drug therapy, surgery)
• Combined Modality Therapy
• Female
• Humans
• Immunotherapy (methods)
• Lung Neoplasms (drug therapy, surgery)
• Male
• Middle Aged
• Neoadjuvant Therapy (methods)
• Neoplasm Staging
• Postoperative Complications