Abstract
IntroductionThe literature on surgical salvage, i.e. lung resections in patients who develop a local recurrence following stereotactic ablative radiotherapy (SABR), is limited. We describe our experience with salvage surgery in nine patients who developed a local recurrence following SABR for early stage non-small cell lung cancer (NSCLC).MethodsPatients who underwent surgical salvage for a local recurrence following SABR for NSCLC were identified from two Dutch institutional databases. Complications were scored using the Dindo-Clavien-classification.ResultsNine patients who underwent surgery for a local recurrence were identified. Median time to local recurrence was 22 months. Recurrences were diagnosed with CT- and/or 18FDG-PET-imaging, with four patients also having a pre-surgical pathological diagnosis. Extensive adhesions were observed during two resections, requiring conversion from a thoracoscopic procedure to thoracotomy during one of these procedures. Three patients experienced complications post-surgery; grade 2 (N = 2) and grade 3a (N = 1), respectively. All resection specimens showed viable tumor cells. Median length of hospital stay was 8 days (range 5–15 days) and 30-day mortality was 0 %. Lymph node dissection revealed mediastinal metastases in 3 patients, all of whom received adjuvant therapy.ConclusionsOur experience with nine surgical procedures for local recurrences post-SABR revealed two grade IIIa complications, and a 30-day mortality of 0 %, suggesting that salvage surgery can be safely performed after SABR.
Highlights
The literature on surgical salvage, i.e. lung resections in patients who develop a local recurrence following stereotactic ablative radiotherapy (SABR), is limited
Materials & methods We queried the institutional databases at both the VU University Medical Center (VUmc) and the Erasmus Medical Center Rotterdam (EMCR), which represent two of the earliest adopters of SABR for lung cancer in the Netherlands [7, 8], in order to identify patients who had undergone a surgical resection for a local recurrence
One patient was excluded as details of both the surgical procedure and early post-operative course were unavailable, even though this patient died of unrelated causes 39 months after salvage surgery
Summary
Of 11 potential patients identified for further study, nine patients were included in this report. All nine patients had been initially considered to be medically operable at the time of diagnosis (Table 1), but had been referred for SABR following discussions at a multidisciplinary tumor board, and with patients themselves. Lobectomy was converted to an open pneumonectomy when extensive peritumoral and pleural adhesions were encountered In yet another patient, a planned sleevelobectomy was performed as a pre-operative hilar lymph node metastasis had been identified. One other patient developed a persistent airway leakage, which required a new thoracic tube (grade IIIa complication) This was not the patient in who the bronchial stump was covered using an intercostal muscle flap. One patient died within 90 days following surgery due to disease progression (90-day mortality 11 %) Five patients had their disease upstaged during surgery: two had a final diagnosis of a T3 tumor and three had mediastinal lymph node metastases. Median overall survival for all patients was 26 months, a figure that should be interpreted with caution given the small size of our patient group and the relatively short period of follow-up
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