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J Thorac Cardiovasc Surg 2009;138:295-299
© 2009 The American Association for Thoracic Surgery

Point/Counterpoint

COUNTERPOINT: Pneumonectomy after chemoradiation: The risks of trimodality therapy

Mark J. Krasna, MD*

Cancer Institute, St Joseph Medical Center, Towson, Md

Received for publication June 7, 2008; revisions received December 23, 2008; accepted for publication February 1, 2009.

* Address for reprints: Mark J. Krasna, MD, The Cancer Institute, St Joseph Medical center, 7501 Osler Drive, Suite 104, Towson, MD 21204. (Email: markkrasna{at}catholichealth.net).

Objective: Chemoradiation followed by resection has been studied with increasing interest. Recent publications have stressed the negative side effects of this approach when associated with a pneumonectomy. Right-sided pneumonectomy is associated with a prohibitive mortality rate after preoperative chemoradiation. The article by Boffa and colleagues proposes that this procedure can be performed with relative safety.

Methods: A review of the English literature over 5 years was undertaken to identify articles and presentations involving pneumonectomy after preoperative chemoradiation with curative intent.

Results: Eleven articles reporting results of chemoradiation followed by surgery are reviewed with attention particularly made to results of pneumonectomy. The data from these articles, including morbidity and mortality, are presented. This counterpoint purports to describe the current state of the literature surveyed related to pneumonectomy after chemoradiation.

Conclusion: The majority of articles reviewed stress the high risks of morbidity and mortality with pneumonectomy after chemoradiation. Although some centers still routinely perform this approach, results from prospectively collected data in a careful trial setting are needed to validate this approach. Until then, pneumonectomy after chemoradiation should be used with caution in experienced centers.






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