Teruaki Mizobuchi1, Naoyoshi Yamamoto2, Mio Nakajima2, Masayuki Baba2, Kentaro Miyoshi3, Haruhiko Nakayama4, Syun-Ichi Watanabe5, Ryoichi Katoh6, Tadasu Kohno7, Mitsuhiro Kamiyoshihara8, Wataru Nishio9, Tadashi Kamada2, Takehiko Fujisawa10, Ichiro Yoshino11. 1. Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan Pneumothorax Research Center and Thoracic Surgery Division, Nissan Tamagawa Hospital, Tokyo, Japan tmizobuc@gmail.com. 2. Research Center for Charged Particle Therapy, National Institute of Radiological Science, Chiba, Japan. 3. Department of Thoracic Surgery, Okayama University Graduate School of Medicine, Okayama, Japan. 4. Department of Thoracic Surgery, Kanagawa Cancer Center Hospital, Yokohama, Japan. 5. Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan. 6. Department of Pulmonology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan. 7. Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan. 8. Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan. 9. Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan. 10. Research Chiba Foundations for Health Promotion and Disease Prevention Center, Chiba, Japan. 11. Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Abstract
OBJECTIVES: Carbon ion radiotherapy (CIRT) has been expected to be an alternative for surgery for early-stage non-small-cell lung cancer (NSCLC) and adopted as the second-best choice even in operable patients although local recurrence after CIRT is sometimes experienced. The purpose of this study was to investigate the demographic data, perioperative courses and therapeutic outcomes of patients who underwent salvage resection for local recurrence after CIRT. METHODS: From November 1994 to February 2012, CIRT was applied for 602 c-T1/T2/T3N0M0 NSCLC lesions of 599 patients at the National Institute of Radiological Science. A total of 95 (16%) patients were diagnosed as having local recurrence, of whom 12 underwent salvage surgeries. The medical records were retrospectively reviewed. RESULTS: There were 7 men and 5 women (mean age, 63 ± 7.4 years). The clinical stages upon initial presentation with NSCLC were as follows: 4 IA, 7 IB and 1 IIB. All the patients were operable, but refused surgery and underwent CIRT. The median progression-free survival time after CIRT was 20 months (range, 7.1-77 months), and salvage surgery was performed at a median of 24 months (range, 9-78 months) after CIRT. All surgeries were successfully performed without any significant CIRT-related adhesions during the surgery, resulting in no mortality or Clavien-Dindo grade 3-4 postoperative complications. However, the distribution of pathological stages was as follows: 4 IA, 3 IB, 2 IIB, 2 IIIA and 1 IV, which included 6 upstages from the clinical stages before CIRT. The Kaplan-Meier estimate of overall survival after the salvage surgery showed that the 3-year survival rate was 82%. CONCLUSIONS: The dose intensity of CIRT spared the hilum of the lungs and parietal pleura, none of the patients developed adhesions outside of the radiation field, such that the salvage surgeries for local recurrence after CIRT were safe and feasible.
OBJECTIVES:Carbon ion radiotherapy (CIRT) has been expected to be an alternative for surgery for early-stage non-small-cell lung cancer (NSCLC) and adopted as the second-best choice even in operable patients although local recurrence after CIRT is sometimes experienced. The purpose of this study was to investigate the demographic data, perioperative courses and therapeutic outcomes of patients who underwent salvage resection for local recurrence after CIRT. METHODS: From November 1994 to February 2012, CIRT was applied for 602 c-T1/T2/T3N0M0 NSCLC lesions of 599 patients at the National Institute of Radiological Science. A total of 95 (16%) patients were diagnosed as having local recurrence, of whom 12 underwent salvage surgeries. The medical records were retrospectively reviewed. RESULTS: There were 7 men and 5 women (mean age, 63 ± 7.4 years). The clinical stages upon initial presentation with NSCLC were as follows: 4 IA, 7 IB and 1 IIB. All the patients were operable, but refused surgery and underwent CIRT. The median progression-free survival time after CIRT was 20 months (range, 7.1-77 months), and salvage surgery was performed at a median of 24 months (range, 9-78 months) after CIRT. All surgeries were successfully performed without any significant CIRT-related adhesions during the surgery, resulting in no mortality or Clavien-Dindo grade 3-4 postoperative complications. However, the distribution of pathological stages was as follows: 4 IA, 3 IB, 2 IIB, 2 IIIA and 1 IV, which included 6 upstages from the clinical stages before CIRT. The Kaplan-Meier estimate of overall survival after the salvage surgery showed that the 3-year survival rate was 82%. CONCLUSIONS: The dose intensity of CIRT spared the hilum of the lungs and parietal pleura, none of the patients developed adhesions outside of the radiation field, such that the salvage surgeries for local recurrence after CIRT were safe and feasible.
Authors: Michael C Repka; Nima Aghdam; Shaan K Kataria; Lloyd Campbell; Simeng Suy; Sean P Collins; Eric Anderson; Jonathan W Lischalk; Brian T Collins Journal: Radiat Oncol Date: 2017-10-19 Impact factor: 4.309