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Chronic Lung Injury After Trimodality Therapy for Locally Advanced Non-Small Cell Lung Cancer.

Authors :
Soh J
Sugimoto S
Namba K
Miura A
Shiotani T
Yamamoto H
Suzawa K
Shien K
Yamamoto H
Okazaki M
Katsui K
Yamane M
Kiura K
Kanazawa S
Toyooka S
Source :
The Annals of thoracic surgery [Ann Thorac Surg] 2021 Jul; Vol. 112 (1), pp. 279-288. Date of Electronic Publication: 2020 Oct 14.
Publication Year :
2021

Abstract

Background: Trimodality therapy is a treatment option for patients with locally advanced non-small cell lung cancer (LA-NSCLC). Thoracic radiation has both early (radiation pneumonitis) and late (chronic lung injury [CLI]) adverse effects on the lung. While CLI is expected to result in various problems in long-term survivors, these manifestations have not been precisely investigated.<br />Methods: We enrolled 112 LA-NSCLC patients who had received induction chemoradiotherapy followed by surgery, and then undergone follow-up computed tomography (CT) every 6 months for greater than 1 year. All chest CT images were reviewed to evaluate any injury of the pulmonary parenchyma.<br />Results: CLI at 1 year after surgery and its progression were observed in 94 (84%) and 38 (34%) patients, respectively. Progressive lung fibrosis as the first manifestation of CLI progression was most frequent after right middle and lower lobectomy. Cavity formation was the subsequent manifestation after progressive lung fibrosis , and chronic infection was the final stage of CLI. The cumulative rate of chronic infection was 76.4% at 10 years in patients with cavity formation. Ten patients with chronic infection included 7 cases of pulmonary aspergillosis and 2 cases of cavity infections with methicillin-resistant Staphylococcus aureus or Stenotrophomonas maltophilia. Among them, 4 patients required surgical interventions including completion pneumonectomy or fenestration.<br />Conclusions: CLI is a common incidence after trimodality therapy for LA-NSCLC. CLI frequently results in cavity formation, which is a precursor of highly refractory chronic infections requiring surgical intervention. Appropriate management needs to be established for CLI developing after trimodality therapy.<br /> (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1552-6259
Volume :
112
Issue :
1
Database :
MEDLINE
Journal :
The Annals of thoracic surgery
Publication Type :
Academic Journal
Accession number :
33068542
Full Text :
https://doi.org/10.1016/j.athoracsur.2020.07.068