Induction chemoradiotherapy to avoid pneumonectomy in centrally located non-small cell lung cancer

Pneumonectomy is associated with substantial perioperative morbidity and long-term cardiopulmonary function impairment. Therefore, avoiding pneumonectomy whenever oncologically feasible is an important goal in managing centrally located non-small cell lung cancer. This study evaluated the feasibility and oncologic outcomes of induction chemoradiotherapy administered to avoid pneumonectomy.

We retrospectively reviewed patients with centrally located non-small cell lung cancer initially considered candidates for pneumonectomy but underwent induction chemoradiotherapy to reduce surgical margins between April 2010 and December 2025. Induction treatment comprised concurrent chemoradiotherapy with platinum-based doublet chemotherapy and thoracic radiotherapy. Radiological responses, surgical procedures, perioperative outcomes, pathological responses, and survival rates were analyzed.

Eleven patients received induction chemoradiotherapy; nine underwent surgical resection, and two declined surgery. Pneumonectomy was avoided and complete resection (R0) was achieved in all patients. Sleeve lobectomy was performed in four patients and extended sleeve lobectomy in four patients. Pulmonary artery plasty was performed in three patients, two sleeve plasty and one wedge plasty. Postoperative complications occurred in four patients (44.4%), with no perioperative mortality. A major pathological response was achieved in eight patients (88.9%), including a pathological complete response in seven patients (77.8%). At a median follow-up of 30 months, the 3-year overall survival was 100%, the recurrence-free survival was favorable, and no locoregional recurrence occurred.

Induction chemoradiotherapy may facilitate lung-sparing surgery in selected patients with centrally located non-small cell lung cancer. However, the small retrospective nature of this study and potential selection bias warrant cautious interpretation.