Salvage Surgery in Patients with Locally Advanced or Metastatic Non-Small Cell Lung Cancer

Abstract

Abstract Background In patients with stage IIIB, stage IIIC and stage IV non-small cell lung cancer (NSCLC), guidelines generally recommend systemic therapy with or without radiotherapy. Despite this treatment, complete response remains rare. However, in a selected group of patients with either residual disease after partial response to first-line systemic treatment, or oligo-recurrence, surgical resection within a salvage concept is under evaluation as an additional treatment option. Currently, clinical data on the outcome of this approach are scarce. Aims We aimed to assess short- and long-term outcomes of salvage surgery in advanced NSCLC. Methods We retrospectively identified 35 patients with initial stage IIIB, IIIC, or IV NSCLC who underwent anatomical lung resection to treat local relapse or residual disease. All patients had initially received systemic treatment with or without radiotherapy. Patients were only included if surgical resection had not been part of the first-line treatment approach. Results Among 35 patients (54% male, mean age 60.2±10.9 years), the initial clinical UICC stage was IIIB in 4, IIIC in 4, IVA in 22, and IVB in 5 cases. The indication for salvage resection was residual disease after first-line treatment in 21 cases and local relapse in 14 cases. Anatomical lung resections included 22 lobectomies, 11 pneumonectomies, 1 bilobectomy and 1 segmentectomy. R0-resection was achieved in 94.3% and pathological complete response was found in 22.9% of all resections. 30-and 90-day mortality were 0% and 11.4%, respectively. mOS and progression-free-survival (calculated from the date of salvage surgery) of the entire cohort were 69 months [95% CI 37–101 months] and 22 months [95% CI: 0–45 months] respectively. Conclusions In selected patients with advanced stage NSCLC presenting with local relapse or residual disease after systemic treatment, anatomical salvage lung resections are associated with a favorable short- and long-term outcome. However, further prospective evaluation of this treatment approach is required.