Major post-operative complications after neoadjuvant chemo-radiotherapy in stage III non small cell lung cancer

The choice of neoadjuvant therapies, by now largely approved for locally advanced Non Small Cell Lung Cancers (NSCLC), is related in most authors' experience, to an increased perioperative morbidity and mortality rate. In particular a significant higher incidence of broncho-pleural fistulas (BPF) after chemo-radiotherapy (CT-RT) preoperative treatment is reported. We reviewed the records of IIIa and IIIb, NSCLC patients who have undergone neoadjuvant CT-RT to evaluate the impact on perioperative morbidity and mortality. From 1/1/'90 to 30/6/'96 we have operated 47 patients (36 ma and 11 mb) over 91 who were enrolled in the neoadjuvant protocol study (Carboplatin 90 mg/mq/day from day 1 to 4 with concurrent radiotherapy on the tumour and the mediastinum with a daily fraction dose of 180 cGy from day 1 to 28 and a total administation dose of 5040 cGy). We reported a major complication in 3 patients (6,4%). These include a BPF in 2 cases and one case of pneumonia in a patient deceased after right pneumonectomy. Complications incidence was higher in patients who underwent pneumonectomy (15,3%) compared to those who underwent lesser resections lobectomy, bilobectomy, wedge) (3%). This difference is not statistically significant. In our experience neoadjuvant CT-RT for locally advanced NSCLC has been, generally, well tolerated and it wasn't complicated by a post-operative morbidity and mortality increased rate.