Each year, more people die of lung cancer than of colon, breast,
and prostate cancers combined. For patients with non-small-cell lung
cancer (NSCLC) - one of two major types of lung cancer - chemotherapy
after cancer surgery has been shown to benefit patients with larger
tumors or those with cancer in the lymph nodes.
While there is consensus regarding the use of chemotherapy after
cancer surgery, the optimal timing is poorly defined. Many clinicians
support starting chemotherapy within six to nine weeks after surgery.
But factors such as postoperative complications may affect a patient's
ability to tolerate chemotherapy following surgery.
‘Patients with non-small-cell lung cancer may benefit from delayed chemotherapy started up to four months after surgery.’
A new Yale study suggests that patients with a common form of lung
cancer may still benefit from delayed chemotherapy started up to four
months after surgery. The study was published online by JAMA Oncology
For the study, associate professor of surgery Daniel J. Boffa and coauthors used data from patients in the National Cancer
Database to examine the relationship between the timing of postoperative
chemotherapy and five-year mortality.
The study of 12,473 patients with stage I, II, or III disease who
received chemotherapy suggests that the initiation of chemotherapy
between 57 and 127 days postoperatively led to similar outcomes as
patients who started closer to the currently recommended
six-to-nine-week window, report the researchers. Furthermore, delayed
chemotherapy was associated with a lower risk of death compared to those
patients treated only with surgery.
While the study results did not establish causality, they suggest
a benefit of delayed chemotherapy for NSCLC patients, said Boffa.
"Patients treated surgically for NSCLC continue to benefit from
chemotherapy when given outside the traditional postoperative window."
"Clinicians should still consider chemotherapy in appropriately
selected patients who are healthy enough to tolerate it, up to four
months after NSCLC surgical resection," he said. "Further study is
warranted to confirm these findings." Boffa is a member of Yale Cancer
Center and clinical program leader of the Thoracic Oncology Program at
Smilow Cancer Hospital.