Abstract
BackgroundIncidence of local relapse after definitive chemoradiation (>59 Gy) for locally advanced non-small-cell lung cancer (NSCLC) is high, irrespective of high dose radiation applied. Experience with salvage lung resections in patients with locally relapsed NSCLC after definitive chemoradiation is limited. We present our series of salvage lung resections for local NSCLC relapse after curative–intent chemoradiation for locally advanced tumor.MethodsNine consecutive patients with local tumor recurrence or persistence following definitive chemoradiation were reviewed. Kaplan-Meier analysis was used to assess patient survival.ResultsAll patients received definitive radiation (median dose 66.2 Gy) with concurrent chemotherapy. Tumor stage prior to chemoradiation was IIIA in 8 patients and IV in 1. In 4 patients tumor invaded the chest wall, in 2 the spine and in 1 the aorta. Median interval between chemoradiation and salvage resection was 30.2 weeks. Nine patients underwent 9 resections (6 lobectomies, 1 bilobectomy, 1 pneumonectomy and 1 bi-segmentectomy). One death occurred on the 12th postoperative day. Median overall survival was 23 months; postoperative 3-year survival was 47 %. Median progression-free survival was 21 months.ConclusionSalvage lung resection for locally recurrent or persisted NSCLC in selected patients with locally advanced NSCLC following definitive chemoradiation is a worthwhile treatment option.
Highlights
Incidence of local relapse after definitive chemoradiation (>59 Gy) for locally advanced non-small-cell lung cancer (NSCLC) is high, irrespective of high dose radiation applied
We report on our series of patients who underwent salvage lung resections for local NSCLC relapse or tumor persistence following the definitive chemoradiation therapy (CRT)
Schreiner et al Journal of Cardiothoracic Surgery (2016) 11:9 patients were treated for locally advanced NSCLC with a high dose radiation (>59 Gy) and concurrent platinumbased chemotherapy with curative intent
Summary
The median age at the time of salvage resection was 56.2 years; 8 patients (89 %) were younger than 65. Four other reports suggest that salvage surgery is associated with prolonged survival in patients with locally recurrent or persistent tumor after definitive CRT in locally advanced NSCLC [13,14,15,16]. Some authors identified salvage lung surgery as the best option for patients with local tumor relapse, resulting in a prolonged survival [13, 23]. Kuzmik et al reviewed 14 patients who completed definitive chemoradiation with median dose of 57 Gy. After median interval between chemoradiation and surgery of 33 months [range 0–169 months] local recurrence was identified in 54 % of the cases, locoregional in 15 % and distant in 31 %. A control group of patients with local NSCLC recurrence after definitive CRT managed without salvage surgery was not available for the comparison. The individual patient targeted approach is essential and all alternative treatment options should be discussed interdisciplinary
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