Is Surgery Worthwhile in Locally-advanced NSCLC Patients with Persistent
N2-disease After Neoadjuvant Therapy?

Lococo, Filippo; Chiappetta, Marco; Sassorossi, Carolina; Nachira, Dania; Evangelista, Jessica; Ciavarella, Leonardo Petracca; Congedo, Maria Teresa; Porziella, Venanzio; Boldrini, Luca; Larici, Annarita; Bria, Emilio; Margaritora, Stefano

doi:10.2174/1574887117666220518102321

Cited by 2 publications

(1 citation statement)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Comparing the 5-year survival rate of patients operated on for locally advanced NSCLC (29.8%) [ 33 ], or with oligometastatic disease (29.4%) [ 34 , 35 ] or who underwent salvage surgery (5-yr survival, ranging from 20% to 78%) [ 36 ], the survival data of our series appear really encouraging (66.0%).…”

Section: Discussionmentioning

confidence: 75%

Rescue Surgery after Immunotherapy/Tyrosine Kinase Inhibitors for Initially Unresectable Lung Cancer

Galetta

Marinis

Spaggiari

2022

Cancers

View full text Add to dashboard Cite

Background: We report the outcomes for unresectable patients with locally advanced or oligometastatic non-small cell lung cancer (NSCLC) treated with tyrosine kinase inhibitor (TKI) or immunotherapy who achieved a clinical downstaging so as to re-enter resectability. Methods: We retrospectively reviewed the clinical, surgical, and pathological data of 42 patients with histologically proven, inoperable NSCLC who received rescue surgery after a good response to TKI or immunotherapy between March 2014 and December 2021. Results: Of 42 patients, 39 underwent pulmonary resection with therapeutic intent (three explorative thoracotomies). There were 26 males, with a median age of 64 years (range, 41–78 years). Twenty-three patients received TKIs and 19 immunotherapies. Anatomic resection was performed in 97.4% of resected patients (38/39) including 30 lobectomies, one right upper sleeve lobectomy, five pneumonectomies, one tracheal sleeve pneumonectomy, and one bilobectomy; a patient underwent wedge resection. Of 10 procedures attempted via a robotic approach, two required conversion to thoracotomy. No intraoperative morbidity/mortality occurred. The median operative time was 190 (range, 80–426) minutes; estimated blood loss was 200 mL (range, 35–780 mL). Morbidity occurred in 13/39 (33.3%). The median length of hospital stay was 6.5 days (range, 4–23 days). Pathologic downstaging was 74.4% (29/39). With a median follow-up of 28.7 months, the 5-year disease-free interval was 46.5%, and the 5-year overall survival was 66.0%; 32/39 patients (82.1%) are alive, 10 with the disease. Conclusions: Lung resection for suspected residual disease after immunotherapy or TKIs is feasible, with encouraging pathological downstaging. Surgical operation may be technically challenging due to the presence of fibrosis, but significant morbidity appears to be rare. Outcomes are encouraging, with reasonable survival during the short-interval follow-up.

show abstract