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Respiratory function changes after chemotherapy: an additional risk for postoperative respiratory complications?
Francesco Leo1, Piergiorgio Solli, Lorenzo Spaggiari
1Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy. francescoleo@interfree.it
The Annals of Thoracic Surgery
|January 17, 2004
Summary
Lung cancer chemotherapy can improve lung function (FEV1, FVC) but impair carbon monoxide diffusion (DLCO). Reduced DLCO after chemotherapy is a key indicator of post-surgery respiratory complications in lung cancer patients.
Area of Science:
- Pulmonary Medicine
- Oncology
- Respiratory Physiology
Background:
- Lung cancer chemotherapy regimens, including cisplatinum and gemcitabine, are known to alter lung function parameters.
- Patients undergoing induction chemotherapy for lung cancer often experience changes in forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and lung diffusion for carbon monoxide (DLCO).
Purpose of the Study:
- To evaluate changes in FEV1, FVC, and DLCO after three cycles of induction chemotherapy with cisplatinum and gemcitabine in stage IIIa lung cancer patients.
- To assess the impact of these functional lung changes on the incidence of respiratory complications following lung resection surgery.
Main Methods:
- A prospective study involving 30 consecutive patients with N2 nonsmall cell lung cancer who underwent surgical resection after neoadjuvant chemotherapy.
- Comparison of pre-chemotherapy and post-chemotherapy respiratory function tests (FEV1, FVC, DLCO) between patients who developed and those who did not develop postoperative respiratory complications.
Main Results:
- All 30 patients completed chemotherapy without immediate respiratory complications. Significant improvements were observed in FEV1 and FVC post-chemotherapy (p < 0.05).
- Lung diffusion for carbon monoxide (DLCO) significantly decreased post-chemotherapy (p = 0.0006), as did DLCO adjusted for alveolar volume (DLCO/Va) (p < 0.0001).
- Patients experiencing postoperative respiratory complications (n=4) showed a higher mean increase in FEV1 and a greater mean decrease in DLCO/Va compared to those without complications.
Conclusions:
- FEV1 and FVC are not reliable predictors of postoperative respiratory complications after neoadjuvant chemotherapy in lung cancer patients.
- A decline in DLCO/Va after chemotherapy appears to be a sensitive indicator of increased risk for respiratory complications post-surgery.
- DLCO assessment before and after induction chemotherapy is recommended for risk stratification in lung cancer patients undergoing neoadjuvant therapy.