Salvage Lung Resections After Definitive Chemoradiotherapy: A Safe and Effective Oncologic Option

Bograd, Adam J.; Mann, Catherine; Gorden, Jed A.; Gilbert, Christopher R.; Farivar, Alexander S.; Aye, Ralph W.; Louie, Brian E.; Vallières, Eric

doi:10.1016/j.athoracsur.2020.04.035

Cited by 21 publications

(20 citation statements)

References 22 publications

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“…As for the definition of salvage surgery, prior reports have described three categories [1,11]: (I) salvage surgery for local recurrence after SBRT for early-staged lung cancer; (II) salvage procedure for local recurrence or a persistent tumor after full-dose chemoradiotherapy for locally advanced lung cancer, and (III) emergent lung resection for serious adverse events of hemoptysis, an uncontrollable lung abscess, or empyema during/after chemotherapy and/or radiotherapy for lung cancer. Based on recently published data, surgical outcomes of salvage surgeries from categories (I) and (II) have been reported; the rates of postoperative morbidity, mortality, and 5-year overall survival were 18.9-25%, 0-4.8%, and 79.5% for category (I), respectively, and 7.9-40.0%, 0-6.7%, and 40.6-53.3% for category (II), respectively [2][3][4][5][6][7][8][9]. Although the short-and long-term results of elective salvage surgeries from categories (I) and (II) were considered feasible and acceptable, the outcomes of salvage surgeries from category (III) are less clear.…”

Section: Discussionmentioning

confidence: 99%

“…Salvage surgery is an effective therapeutic option for patients with relapses after chemoradiotherapy for advanced-stage lung cancer or after high-dose radiotherapy for early-stage lung cancer, especially under inoperable conditions [1][2][3][4][5][6][7]. Complications of these therapies, such as massive hemoptysis, lung abscess, or empyema, require timely intervention.…”

Section: Introductionmentioning

confidence: 99%

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Emergent salvage surgery for massive hemoptysis after proton beam therapy for lung cancer: a case report

et al. 2021

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Background Salvage surgery is an effective therapeutic option for patients experiencing relapses after chemoradiotherapy for advanced-stage lung cancer or after high-dose radiotherapy for early-stage lung cancer. We report a case involving an emergent salvage surgery for a patient with massive hemoptysis who developed lung cancer recurrence after undergoing proton beam therapy 7 years prior to presentation. Case presentation A 70-year-old male patient was emergently admitted due to massive hemoptysis. He had undergone proton beam therapy for a stage I adenocarcinoma of the left upper lobe 7 years ago, and was receiving chemotherapy for local recurrence. We performed an emergent salvage pulmonary resection to achieve hemostasis. During the operation, we confirmed the presence of a left broncho-pulmonary arterial fistula, which was considered as the origin of the massive hemoptysis. We repaired the fistula between the pulmonary artery and left upper bronchus without incident; an orifice of the fistula at the left pulmonary artery was sutured using a non-absorbable monofilament, and the central portion of the orifice of the fistula at the left upper bronchus was closed with a mechanical stapling device. The postoperative diagnosis was of an adenocarcinoma—ypT3(pm1) N0M1a (dissemination)-IVA, ef1b. The patient has survived for over a year with the cancer in almost complete remission following the administration of an epidermal growth factor receptor tyrosine kinase inhibitor. Conclusions Emergent salvage surgery demands high skill levels with optimal timing and correct patient selection. Our case suggested that the procedure played an important role in controlling serious bleeding and/or infectious conditions. Consequently, he could receive chemotherapy again and survive for over a year.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emergent salvage surgery for massive hemoptysis after proton beam therapy for lung cancer: a case report

et al. 2021

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“…Up to date, experiences with salvage surgery after dCRT in lung cancer are still limited to report from each single institute [3,4,[7][8][9][10]. High-dose radiation and long interval from dCRT to salvage surgery increase the risk of tissue ischemia and fibrosis in the operated field and subsequently increase the technical difficulty and operative comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…The possibility of persistent or recurrent local disease after dCRT has raised the discussion of lung resection after dCRT as a chance for improving long-term survival. Salvage lung resection is thus defined as the surgery performed beyond 90 days after high-dose dCRT for curative intent in patients with no initial plan for surgery [4,5].…”

mentioning

confidence: 99%

“…Salvage surgery may confront technical difficulties during operation, such as unclear tissue planes in the field operated on due to post-radiation fibrosis, to result in higher surgical complication rate and compromised wound healing [6]. Tissue ischemia after lung tissue radiation may also increase the risk of post-resection bronchopleural fistulas (BPF) [4]. Thus, the issue of salvage lung resection is still under debate.…”

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confidence: 99%

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Salvage surgery after definitive chemoradiotherapy through VATS for an initial unresectable locally advanced lung cancer: an alternative consolidative modality to radiotherapy?

Chen

Yeh

et al. 2021

surg case rep

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Background Definitive chemoradiotherapy (dCRT) is the first choice treatment for patients with locally advanced non-small cell lung cancer (NSCLC), but up to 35% of dCRT-treated tumors may have persistent or recurrent disease. Since the last decades, multimodality therapy showing potential for cure has become the mainstream for treatment of locally advanced NSCLCs, even some that were initially inoperable. Although salvage lung resection after dCRT has been reported with acceptable survivals, experiences in this respect are still limited. Other concerns remain debatable and inconclusive, such as dosage of radiation exposure, long interval between dCRT and surgery, and surgical comorbidity. Case presentation A 73-year-old male former smoker with diagnosis of right lower lobe of lung squamous cell carcinoma (SqCC) with multiple mediastinal lymphadenopathy, cT4N2M0, stage IIIB, received salvage right lower lobe + right middle lobe bilobectomy through video-assisted thoracoscopic surgery (VATS) after dCRT and adjuvant CRT to a total of 9000 cGy dosage of radiation. The interval from the 1st and 2nd ends of radiation to the salvage surgery was 980 and 164 days, respectively. The pre-operative forced expiratory volume in the first second was 2.33 L (101% predicted) and the diffusing capacity of the lungs for carbon monoxide was 56% predicted. The operating time was 6.5 h, and the total estimated blood loss was 50 ml. The patient was discharged on the 7th postoperative day without major complications or bronchopleural fistulas. The patient was still alive 42 months after the initial diagnosis of advanced N2 lung SqCC, and kept progression-free for 7 months after salvage lung resection. Conclusions Salvage lung resection performed long after high-dose radiation therapy of dCRT is technically feasible through VATS approach in a patient with initially inoperable cT4N2M0 stage IIIB NSCLC, and can be an alternative consolidative treatment for locally advanced NSCLC.

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The oncologic efficacy of extended resections for lung cancer

Etienne

Kalt

Park

et al. 2023

Journal of Surgical Oncology

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Extended lung resections for T3-T4 non-small-cell lung cancer remain challenging.Multimodal management is mandatory in multidisciplinary tumor boards, and here the determination of resectability is key. Long-term oncologic efficacy depends mostly on complete resection (R0) and the extent of N2 disease. The development of novel innovative treatments (targeted therapy and immune checkpoint inhibitors) sets interesting perspectives to reinforce current therapeutic options in the induction and adjuvant setting.

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Salvage Lung Resections After Definitive Chemoradiotherapy: A Safe and Effective Oncologic Option

Cited by 21 publications

References 22 publications

Emergent salvage surgery for massive hemoptysis after proton beam therapy for lung cancer: a case report

Emergent salvage surgery for massive hemoptysis after proton beam therapy for lung cancer: a case report

Salvage surgery after definitive chemoradiotherapy through VATS for an initial unresectable locally advanced lung cancer: an alternative consolidative modality to radiotherapy?

The oncologic efficacy of extended resections for lung cancer

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