Lung Cancer.pdf

Implementation of Multidisciplinary Care 19
Table 1–4. Results of Randomized Trials of Surgery versus
Neoadjuvant Chemotherapy plus Surgery
for Advanced-Stage NSCLC
Median 3-Year
Investigators No. of Resection Survival Survival
and Treatment
Rosell et al, 1994
Patients Rate (%) (mo) Rate (%)
Surgery XRT 30 90 8.0 0
Chemo surgery XRT
Roth et al, 1994
29 85 26.0 29
Surgery 32 66 11.0 15
Chemo surgery
Pass et al, 1992
28 61 64.0 56
Surgery 14 86 15.6 23
Chemo surgery 13 85 28.7 50
Chemo indicates chemotherapy; XRT, radiation therapy.
NSCLC. Advanced-stage NSCLC (stages IIIA with N2 involvement, IIIB,
and IV) cannot typically be treated effectively with a single modality (i.e.,
chemotherapy or radiation therapy).
Surgery. Most patients with advanced-stage NSCLC are treated nonsurgically.
However, some patients with advanced-stage disease may benefit
from surgical resection. In deciding whether surgery is appropriate, the
surgeon must balance the value of mechanical extirpation of the local disease
(e.g., local disease control, pain relief, and the potential for improved
survival) with the risks associated with a surgical procedure. Typically, the
risks exceed the potential benefits and surgery is not considered; however,
in some patients, surgery for advanced-stage lung cancer may provide
benefit in the form of local tumor control, palliation of symptoms, improved
quality of life, and the potential for improved survival.
Surgery is warranted in patients with an isolated brain metastasis because
surgery in this situation can improve quality of life and survival.
The primary lung tumor can then be treated according to the T and N
stage.
Multispecialty surgical care may be beneficial for resection of complex
tumors that extend into the spinal column. In such cases, neurosurgical or
orthopedic reconstruction and stabilization of the spine are performed
concurrently with resection of the primary tumor. A multispecialty surgical
approach can render previously “unresectable” disease resectable
with negative margins. Tumors that involve contiguous structures such
as the great vessels or portions of the heart, diaphragm, or chest wall can
be resected using cardiovascular reconstruction and surgical techniques.