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OUTCOMES FOLLOWING LIMITED LUNG RESECTION FOR NON-SMALL CELL LUNG CANCER (NSCLC) IN HIGH RISK PATIENTS

City of Hope National Medical Center, Duarte, CA

PURPOSE: This study was undertaken to assess recurrence and survival outcomes among high risk patients treated with compromise limited lung resection for NSCLC. The impact of adjuvant therapy and co-morbid disease is also evaluated.

METHODS: A retrospective review of all NSCLC patients treated with limited resection between January 1987 and November 2004 at City of Hope National Medical Center was performed. Limited lung resections were performed when the extent of co-morbid disease made performance of standard resections hazardous. Medical records were reviewed for patient and tumor characteristics, type of operation, adjuvant treatment, disease recurrence and survival.

RESULTS: Sixty-two limited lung resections were performed for clinical stage I NSCLC. The median age was 68 years for this predominantly female (64.5%) patient population. All patients had at least one, and 53% had two or more co-morbid conditions. The 30-day operative mortality was 1.6%. Nineteen percent of the study population received post-operative radiation therapy and 4.8% received post-operative chemotherapy and radiation therapy. The five-year actuarial overall survival was 38%, with a median follow-up of 35 months (range 5.9 to 134.2). The local recurrence rate was 23%. No difference in time to recurrence among patients with or without adjuvant therapy was noted. All local recurrences received radiation therapy and/or chemotherapy with a median survival of 13 months (range 3.3 to 63.2) post-treatment. Time to death from lung cancer (21.9 months) was significantly shorter than time to death from co-morbid disease (42.4 months, p=<0.011). Histological subtype, angiolymphatic invasion, margin and lymph node status did not predict recurrence.

CONCLUSION: Lung cancer patients with prohibitive co-morbid disease can undergo compromise resections safely. Despite higher local recurrence, long-term survival is achieved in many patients. Adjuvant therapy did not appear to reduce local recurrence or improve survival.

CLINICAL IMPLICATIONS: Limited lung resection may be offered to clinical stage I NSCLC patients with severe co-morbid disease with the expectation that a substantial number obtain long-term survival.

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