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Lung cancer is one of the most common cancers in the world and the leading cause of cancer-related mortality. At diagnosis, approximately 40% of patients are already at an advanced stage, and a third have locally advanced disease (stage III).
Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease which presents a major therapeutic challenge. The use of induction chemotherapy treatment with or without radiotherapy began to be a milestone after a series of clinical trials in the mid ‘80s. One of the main goals of the neoadjuvant treatment relies on an efficient induction-induced downstaging of the tumor that allows it to be completely resected. It is well known that the pre-operative performance status of patients, together with their pulmonary and cardiac functions are all important predictors of the post-operative mortality and morbidity. It has also been shown that the use of antineoplastic drugs alone (such as bleomycin, anthracyclines, cyclophosphamide or etoposide) or in combination with radiotherapy can cause cardiopulmonary toxicity. This decrease in pulmonary and cardiac function is associated with post-operative morbidity. The majority of studies have been directed to the evaluation of cardiopulmonary function at rest using spirometry and echocardiography. Only minimal research has been directed to evaluating pulmonary and cardiac function during exercise (there are available data in patients affected by malignant pleural mesothelioma or Hodgkin’s disease)1234. To our knowledge no previous longitudinal study has been directed to evaluate maximal oxygen uptake (VO2max) as assessed using cardiopulmonary exercise testing (CPET) pre and post induction chemotherapy in patients affected by non-small-cell lung cancer (NSCLC). There is evidence from a cross sectional study of a lower VO2max in patients receiving neoadjuvant chemotherapy versus patients undergoing surgery without induction therapy5. However, this study did not investigate intra-individual changes induced by neoadjuvant therapy.