Impact of neoadjuvant therapy on tumor resectability and survival of patients with locally advanced non-small cell lung cancer

Background and aim: Surgery is the treatment of choice in early stage non small cell lung cancer (NSCLC). It is also used in some cases of locally advanced tumors, but with a low cure rate. Therefore, preoperative treatment is seeking to improve survival in these patients. The aim of this study was to evaluate tumor resectability and survival in patients with locally advanced stage (IIIA and IIIB) NSCLC treated with chemotherapy (CT) or chemotherapy and radiotherapy (CT-RT) neoadjuvant Methods: This was a restrospective study that evaluated patients with locally advanced NSCLC in a university hospital during 2000-2006, that received induction therapy. The collected variables were anthropometric values, histology, stage of the tumor, neoadjuvant treatment and therapeutic response. Kaplan-Meier curve was used to evaluate survival and analysis of variance to compare values among groups. Results: 32 patients were included; 9 subjects (28%) were diagnosed with stage IIIA and 23 (72%) stage IIIB, being the IIIB the most common indication for induction therapy. All patients were treated with CT, showing a treatment response in 80% of cases and only 7 were also required RT. Resection was indicated in 31 patients and only in 6 subjects exploratory thoracotomy was performed, seeing a downstaging in 46.9% of all the cases. Over-all 5 year survival was 27.8% with a median of 52.9 months (95% CI 38.1-67.6). This survival is dependent on the response to neoadjuvant. Conclusions: Neoadjuvant reduces tumor size resulting in a downstaging and improving the resectability of locally advanced NSCLC. It could be a viable therapeutic option to improve survival of these patients.