Yoshihisa Shimada1, Kenji Suzuki2, Morihito Okada3, Haruhiko Nakayama4, Hiroyuki Ito4, Tetsuya Mitsudomi5, Hisashi Saji6, Kazuya Takamochi2, Yujin Kudo1, Aritoshi Hattori2, Takahiro Mimae3, Keiju Aokage7, Teppei Nishii4, Masahiro Tsuboi7, Norihiko Ikeda8. 1. Department of Thoracic Surgery, Tokyo Medical University Hospital, Tokyo, Japan. 2. Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan. 3. Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan. 4. Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan. 5. Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka, Japan. 6. Department of Chest Surgery, St Marianna University School of Medicine, Kawasaki, Japan. 7. Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan. 8. Department of Thoracic Surgery, Tokyo Medical University Hospital, Tokyo, Japan ikeda@wd5.so-net.ne.jp.
Abstract
OBJECTIVES: For highly selected patients with Stage III non-small-cell lung cancer (NSCLC) who relapse or have residual disease after definitive chemoradiotherapy, salvage lung resection is likely to be one of the options for local control and possible better prognosis. However, the long-term benefit has not been verified. METHODS: We conducted a retrospective study on salvage surgery on a multicentre basis. Patients included in this study met the following criteria: (i) prior treatment of lung cancer with curative-intent radiotherapy (≥60 Gy); (ii) no a priori plans for induction multimodality therapy; (iii) confirmation of loco-regional recurrence or persistent tumour in the irradiated area; (iv) pretherapeutic pathological results of NSCLC and (v) Stage III disease prior to chemoradiotherapy. RESULTS: A total of 18 patients were eligible for evaluation (Stage IIIA/IIIB, 14/4). The prior median radiation therapy dose was 60 Gy (60-74 Gy), and the median time between the last day of radiotherapy and resection was 38 weeks. The indications for surgery were primary tumour regrowth (10 patients) or tumour persistence (8 patients). Surgical procedures included lobectomy in 13 patients and pneumonectomy in 5 patients. Postoperative complications occurred in 5 patients (28%) without perioperative death. Complete resection was shown in 16 patients (89%) and a complete pathological response in 5 patients (28%). The median follow-up time was 1405 days, and the 3-year overall survival and recurrence-free survival rates were 78 and 72%, respectively. CONCLUSIONS: In the highly selected Stage III NSCLC after curative-intent chemoradiation therapy, salvage surgery was safely performed and contributed to satisfactory long-term survival.
OBJECTIVES: For highly selected patients with Stage III non-small-cell lung cancer (NSCLC) who relapse or have residual disease after definitive chemoradiotherapy, salvage lung resection is likely to be one of the options for local control and possible better prognosis. However, the long-term benefit has not been verified. METHODS: We conducted a retrospective study on salvage surgery on a multicentre basis. Patients included in this study met the following criteria: (i) prior treatment of lung cancer with curative-intent radiotherapy (≥60 Gy); (ii) no a priori plans for induction multimodality therapy; (iii) confirmation of loco-regional recurrence or persistent tumour in the irradiated area; (iv) pretherapeutic pathological results of NSCLC and (v) Stage III disease prior to chemoradiotherapy. RESULTS: A total of 18 patients were eligible for evaluation (Stage IIIA/IIIB, 14/4). The prior median radiation therapy dose was 60 Gy (60-74 Gy), and the median time between the last day of radiotherapy and resection was 38 weeks. The indications for surgery were primary tumour regrowth (10 patients) or tumour persistence (8 patients). Surgical procedures included lobectomy in 13 patients and pneumonectomy in 5 patients. Postoperative complications occurred in 5 patients (28%) without perioperative death. Complete resection was shown in 16 patients (89%) and a complete pathological response in 5 patients (28%). The median follow-up time was 1405 days, and the 3-year overall survival and recurrence-free survival rates were 78 and 72%, respectively. CONCLUSIONS: In the highly selected Stage III NSCLC after curative-intent chemoradiation therapy, salvage surgery was safely performed and contributed to satisfactory long-term survival.
Authors: Bing Sun; Eric D Brooks; Ritsuko Komaki; Zhongxing Liao; Melenda Jeter; Mary McAleer; Peter A Balter; James D Welsh; Michael O'Reilly; Daniel Gomez; Stephen M Hahn; Boris Sepesi; David C Rice; John V Heymach; Joe Y Chang Journal: J Thorac Oncol Date: 2017-03-01 Impact factor: 20.121
Authors: Paul E Van Schil; Lawek Berzenji; Suresh K Yogeswaran; Jeroen M Hendriks; Patrick Lauwers Journal: Front Oncol Date: 2017-10-26 Impact factor: 6.244