Amanda Sammann

VATS lobectomy facilitates the delivery of adjuvant docetaxel-carboplatin chemotherapy in patients with non-small cell lung cancer

BACKGROUND To evaluate the safety and tolerability of docetaxel/carboplatin regimen in the post-operative setting of patients with non-small cell lung cancer (NSCLC). METHODS Enrolment of 133 patients with stage Ib - IIIa NSCLC was undertaken in an open-label, single arm study to assess the safety and tolerability of docetaxel (75 mg/kg) and carboplatin (AUC 5.5) administered for 3 cycles after resection for curative intent. The primary endpoint of the study was safety, as reflected by a febrile neutropenia rate of <10%. Other endpoints assessed protocol compliance and the impact of minimally invasive surgical technique. RESULTS Patient accrual was completed at 1 center in the US and 10 centers in China in <6 months. Febrile neutropenia complicated treatment in 12 patients (9.0%), below the predetermined safety threshold of 14 patients. Four VATS and 8 open thoracotomy patients experienced febrile neutropenia (P=0.26). Completion of the three-cycle adjuvant regimen was achieved in 86% (95% CI, 77-95%) of patients. Sixty-two of 66 VATS patients compared to 53 of 67 open thoracotomy patients received all three doses according to protocol (P<0.01). Thirteen serious adverse events (9.8%) and no deaths were attributed to the study regimen. CONCLUSIONS In this rapidly accrued study, docetaxel and carboplatin were well-tolerated in the adjuvant treatment of NSCLC. Adjuvant treatment compliance was higher among patients undergoing a minimally invasive surgical approach. (ClinicalTrials.gov number NCT00883675).

Novel video-assisted thoracoscopic surgery metastatectomy technique equivalent to open thoracotomy for identification of numerous and small lesions

INTRODUCTION: Pulmonary metastatectomy is an increasingly important option in a variety of clinical scenarios, including multiple and recurrent lesions. Video-assisted thoracoscopic surgery (VATS) reduces post-operative pain and recovery time, and may facilitate bilateral and repeat resections. It has been argued, however, that VATS metastatectomy may be less effective for numerous and for very small lesions, and for lesions that were not identified on pre-operative imaging. We developed a novel VATS technique that allows digital palpation ofw95% of the lung parenchyma, and compared this approach to conventional VATS and to open thoracotomy.