Background: The aim of this study was to elucidate a curable subgroup among patients with non–small cell lung cancer (NSCLC) who developed postoperative recurrence. Patients and Methods: Between 1986 and 2012, among the 1408 patients who underwent complete anatomic lung resection for NSCLC at our institution, 420 developed recurrence. After excluding 14 patients with insufficient information about recurrence, 406 were included in this retrospective study. We investigated the association between several clinicopathologic factors and postrecurrence overall survival (PR-OS) and postrecurrence progression-free survival (PR-PFS). Results: The 5-year PR-OS and PR-PFS rates were 14.0% and 5.9%, respectively. By multivariate analysis, female sex, longer disease-free interval, specific targeted therapy, recent recurrence, oligo-recurrence, and definitive local therapy (DLT) were found to be independent favorable prognostic factors for both PR-OS and PR-PFS. Among these 6 prognostic factors, although female sex, longer disease-free interval, and specific targeted therapy were associated with a prolonged median PR-PFS time, they were not associated with an improved 5-year PR-PFS rate. In contrast, recent recurrence, oligo-recurrence, and DLT were associated with improvement in both the median PR-PFS time and 5-year PR-PFS rate. Conclusions: We found that recent recurrence, oligo-recurrence, and DLT were associated with an improved median PR-PFS time and long-term PR-PFS rate in patients with postoperative recurrence after complete resection of NSCLC. On the basis of these results, we believe that DLT should be considered first for patients with oligo-recurrence before applying noncurative treatment.
with a median follow up of 13 months, forty-seven patients were enrolled. All patients received systemic therapy according to international guidelines. Then, patients without progression to systemic treatment, received SABR to lung metastases (30-60 Gy in 2-8 fractions) to the thoracic lesion (primary or metastatic) depending on location, size and number of lesions, always keeping BED (Biologically Effective Dose) >100 Gy at isocenter. This study was approved by Ethic and Research committees at Instituto Nacional de Cancerología (CEI/799)(013/014/ICI). Result: Most patients were women (59.6%), with a mean age of 58.9 years. Although two-thirds of patients were ever smokers (66.0%), most of them were light smokers. The most common histology was adenocarcinoma (87.2%). Contralateral lung was the most common metastatic site (40.4%). Half of the patient harbour at least one mutation, EGFR Exon 19 deletion was the most frequent mutation (38.3%). Patients received chemotherapy and EGFR-TKIs as 1 st -line treatment in the 61.1% and 38.9%, respectively. All patients received SABR, response to treatment was as follows: disease control rate was 91.5%, partial response 14.9% and complete response 63.8%. Among those with disease progression, median time to systemic progression after SABR treatment was 5.4 months (95% 2.4-8.9 months). PFS since beginning of any treatment was not reached, since only 18 patients (38.3%) had disease progression. Until now only 4 patients (8.5%) had died, thus OS is not reached. Radiographic pneumonitis was observed in 72.2% (13 patients). Grade 1, 2 and 3 pneumonitis were observed in the 69.2% (9/13), 7.7% (1/ 13) and 23.1 (3/13) of the patients with pneumonitis.
no support'; 'rehabilitation alone', and 'preoperative support'. The 'no support' group received no preoperative support and included the last consecutive 18 cases before the introduction of preoperative support. The 'rehabilitation alone' group included 18 consecutive cases, when no other support was available. The 'preoperative support' group included 18 consecutive cases, starting from the first patient receiving multi-disciplinary preoperative support. Results: Data are presented in the following order: 'no support', 'rehabilitation alone', and 'preoperative support'. Morbidity rates were 27.8%, 16.6%, and 0%, respectively. The number of days of postoperative hospital stay were 11.3/10, 8.7/8, and 6.9/7 (average/median), respectively and there was a significant difference among the groups (p¼0.000266). Univariate and multivariate analysis were performed according to the following parameters: age, sex, stage, operation time, blood loss, days of raised body temperature, postoperative complications, days of antibiotic treatment, days with a chest drain, day of first walk postoperatively, clinical path, and preoperative support. In univariate analysis, the number of days with a chest drain, the day of first walk postoperatively, clinical path, and preoperative support correlated with the postoperative stay in hospital. In multivariate analysis, preoperative support was most strongly associated with a shorter postoperative stay according to logistic regression analysis with backward stepwise deletion. Moreover, there was a reduction in the overall medical expenses per patient, in the preoperative support group (p¼0.0405). A postoperative questionnaire was administered to patients and their families. Results showed that patients recognized the effect of preoperative interventions on outcome and a shift in patient attitude, from a passive to an active mindset, was observed. Conclusion: Preoperative rehabilitation and nutritional support improve physiological function; anesthesiologist and pharmacist review identify problems and improve strategy; and hearing and explanation by nursing staff increase problem-solving capacity and coping mechanisms of patients. These effects may result in a shorter hospital stay.
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