26. Safe Pulmonary Resection after Neoadjuvant Therapy with Greater than 59Gy External Irradiation

Joshua Sonett, Mark Krasna, Julie Schuetz, Mohan Suntharalingam, Ziv Gamliel, Joseph McLaughlin

University of Maryland Medicine

Baltimore, Md.

Pulmonary resection after high dose thoracic irradiation is reported to be associated with a high morbidity and mortality and has been considered a prohibitive risk factor to resection. We report safe pulmonary resection in 15 consecutive patients receiving neoadjuvant therapy that included greater than 59 Gy thoracic radiation. The mean thoracic radiation dose was 61.8 Gy (range 59.5-66.5) and age was 51 years old (range 36-72). Cell type was adenocarcinoma (seven), squamous (six), and other nsclc (two). Three patients received sequential chemotherapy, and eight patients concurrent chemotherapy. Median time from end of treatment to surgical resection was 58 days (range 22-258). Surgical resection included 10 lobectomies and five pneumonectomies (three right, two left). A complete pathologic response was seen in seven patients, 12 patients has pathologic downstaging. Three patients required intraoperative transfusion of blood (max two units). Mean ICU stay was 1.8 days, and mean LOS was 7.4 days. There were two postoperative complications; one bronchopulmonary fistula, and one subarachnoid-pleural fistula. There were no incidence of ARDS or operative mortality Pulmonary resection, including pneumonectomy, after chemotherapy and high dose thoracic radiation (>59.5GY) may be performed safely with a low rate of intraoperative and postoperative complications.