OBJECTIVE: For inoperable patients with pulmonary malignancy, stereotactic body radiotherapy is a reasonable therapeutic option. Despite good early tumor control, local failure occurs in up to 10% of patients by 3 years. Because management of local recurrence after stereotactic body radiotherapy is unclear, we evaluated use of surgery as a salvage option. METHODS: A retrospective review was conducted of consecutive patients from a single institution who underwent salvage resection of primary and metastatic pulmonary malignancies previously treated with stereotactic body radiotherapy. In addition, a literature search was conducted to identify previous reports of pulmonary resection for local stereotactic body radiotherapy failures, to allow cumulative analyses with previously published cases. RESULTS: A total of 21 patients met inclusion criteria. The median time between stereotactic body radiotherapy and salvage surgery was 16.2 months (range, 6.4-71.5). Postoperative complications occurred in 7 patients (18.9%), in whom atrial arrhythmias and prolonged air leaks (>5 days) were most frequent (n = 2 each, 5.4%). There was no local recurrence after salvage surgery. Distant failure occurred in 5 of 21 patients (23.8%) at a median of 36.2 months, and median disease-free survival was 19.2 months. The 30- and 90-day mortality was 4.8% (1 patient). Cumulative analysis included 37 patients from 4 institutions and comprised 26 (78.8%) primary non-small cell lung cancers and 11 (29.7%) lung metastases. Median overall survival after salvage surgery was 46.9 months, and 3-year survival was 71.8%. CONCLUSIONS: After local failure of stereotactic body radiotherapy, salvage resection remains a viable option for operable patients, with acceptable morbidity and survival. As use of stereotactic body radiotherapy continues to expand, further studies to evaluate the optimal management for local failure are needed.
OBJECTIVE: For inoperable patients with pulmonary malignancy, stereotactic body radiotherapy is a reasonable therapeutic option. Despite good early tumor control, local failure occurs in up to 10% of patients by 3 years. Because management of local recurrence after stereotactic body radiotherapy is unclear, we evaluated use of surgery as a salvage option. METHODS: A retrospective review was conducted of consecutive patients from a single institution who underwent salvage resection of primary and metastatic pulmonary malignancies previously treated with stereotactic body radiotherapy. In addition, a literature search was conducted to identify previous reports of pulmonary resection for local stereotactic body radiotherapy failures, to allow cumulative analyses with previously published cases. RESULTS: A total of 21 patients met inclusion criteria. The median time between stereotactic body radiotherapy and salvage surgery was 16.2 months (range, 6.4-71.5). Postoperative complications occurred in 7 patients (18.9%), in whom atrial arrhythmias and prolonged air leaks (>5 days) were most frequent (n = 2 each, 5.4%). There was no local recurrence after salvage surgery. Distant failure occurred in 5 of 21 patients (23.8%) at a median of 36.2 months, and median disease-free survival was 19.2 months. The 30- and 90-day mortality was 4.8% (1 patient). Cumulative analysis included 37 patients from 4 institutions and comprised 26 (78.8%) primary non-small cell lung cancers and 11 (29.7%) lung metastases. Median overall survival after salvage surgery was 46.9 months, and 3-year survival was 71.8%. CONCLUSIONS: After local failure of stereotactic body radiotherapy, salvage resection remains a viable option for operable patients, with acceptable morbidity and survival. As use of stereotactic body radiotherapy continues to expand, further studies to evaluate the optimal management for local failure are needed.
Authors: William R Kennedy; Prashant Gabani; John Nikitas; Clifford G Robinson; Jeffrey D Bradley; Michael C Roach Journal: Radiother Oncol Date: 2019-08-31 Impact factor: 6.280
Authors: Chris Dickhoff; Pedro M Rodriguez Schaap; Rene H J Otten; Martijn W Heymans; David J Heineman; Max Dahele Journal: Ther Adv Med Oncol Date: 2018-07-13 Impact factor: 8.168
Authors: Eric D Brooks; Bing Sun; Lei Feng; Vivek Verma; Lina Zhao; Daniel R Gomez; Zhongxing Liao; Melenda Jeter; Michael O'Reilly; James W Welsh; Quynh-Nhu Nguyen; Jeremy J Erasmus; George Eapen; Kamran Ahrar; Mara B Antonoff; Stephen M Hahn; John V Heymach; David C Rice; Joe Y Chang Journal: JAMA Netw Open Date: 2018-08-03
Authors: May Elbanna; Kevin Shiue; Donna Edwards; Alberto Cerra-Franco; Namita Agrawal; Jason Hinton; Todd Mereniuk; Christina Huang; Joshua L Ryan; Jessica Smith; Vasantha D Aaron; Heather Burney; Yong Zang; Jordan Holmes; Mark Langer; Richard Zellars; Tim Lautenschlaeger Journal: Clin Lung Cancer Date: 2020-06-02 Impact factor: 4.785