P1.08-079 Sulvage Surgery after Definitive Radiotherapy or Chemoradiotherapy for Lung Cancer

Abstract

Reports of salvage surgery especially bronchoplasty after definitive radiation therapy for locally advanced lung cancer are small. In addition, reports of surgery after stereotactic body radiotherapy (SBRT) are also small. Between 2011 and 2015, 3 patients who underwent salvage pulmonary resection after definitive radiation therapy (Group A) and 3 patients after SBRT (Group B) were identified. Group A: One of two patients who underwent boronchoplasty failed in anastomosis failure. A 40-year-old woman underwent right upper sleeve lobectomy after chemo-radiation therapy including bevacizumab for primary lung adenocarcinoma (cT3N2M0 Stage IIIA). Two months after surgery, anastomosis dehiscence occurred. She underwent right completion pneumonectomy after preparing an omental flap. Bronchial stump was closed in overholt method with wrapping of omental flap. After surgery, left kidney and supraclavicular lymph node metastasis were detected, she was administered crizotinib. She is alive at 48 months after surgery. The other two patients are alive without recurrence at 8 and 35 months, respectively. Group B: The dose of radiation was 48Gy (12 Gy x 4 fractions). Period from SBRT until surgery was 14, 18, 30 months, respectively. One patient underwent SBRT for second lung cancer after left upper lobectomy for first lung cancer. He died of respiratory failure on 103 days after surgery. The clinical courses of other two patients were uneventful. One patient died of distant metastasis at 7 months, and other one is alive without recurrence at 8months. There were no severe adhesion on both hilar and chest wall after SBRT. Caution is needed in the salvage pulmonary resection after chemo-radiation therapy including bevacizumab. On the other hand, there was not strong influence to the bronchial stump after SBRT.