TY - JOUR
T1 - Chronic Lung Injury After Trimodality Therapy for Locally Advanced Non-Small Cell Lung Cancer
AU - Sou, Junichi
AU - Sugimoto, Seiichiro
AU - Namba, Kei
AU - Miura, Akihiro
AU - Shiotani, Toshio
AU - Yamamoto, Haruchika
AU - Suzawa, Ken
AU - Shien, Kazuhiko
AU - Yamamoto, Hiromasa
AU - Okazaki, Mikio
AU - Katsui, Kuniaki
AU - Yamane, Masaomi
AU - Kiura, Katsuyuki
AU - Kanazawa, Susumu
AU - Toyooka, Shinichi
N1 - Funding Information:
The authors wish to thank Drs. Shunsaku Miyauchi, Kota Araki, Eisuke Kurihara, Yusuke Ogoshi, Yuta Takahashi, Takahiro Yoshioka, Hidejiro Torigoe, and Hiroki Sato (Department of General Thoracic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences) for collection data from medical records.
Publisher Copyright:
© 2021 The Society of Thoracic Surgeons
PY - 2021/7
Y1 - 2021/7
N2 - 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. 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. 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. 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.
AB - 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. 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. 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. 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.
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U2 - 10.1016/j.athoracsur.2020.07.068
DO - 10.1016/j.athoracsur.2020.07.068
M3 - Article
C2 - 33068542
AN - SCOPUS:85103058128
VL - 112
SP - 279
EP - 288
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 1
ER -