Salvage surgery after definitive chemo-radiotherapy for patients with Non-Small Cell Lung Cancer

Vielva, Laura Romero; Viteri, Santiago; Moya-Horno, Irene; Toscas, José Ignacio; Maestre-Alcácer, José Antonio; Cajal, Santiago Ramón y; Rosell, Rafael

doi:10.1016/j.lungcan.2019.05.010

Cited by 24 publications

(25 citation statements)

References 42 publications

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“…In contrast, for patients with OFR, local ablative treatment is more reasonable and should be considered. Our study confirmed the previously described role of ablative salvage treatment in patients with OFR [29,[36][37][38][39][40][41][42][43][44].…”

Section: Discussionsupporting

confidence: 91%

Pattern-of-failure and salvage treatment analysis after chemoradiotherapy for inoperable stage III non-small cell lung cancer

et al. 2020

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Background: Loco-regional and distant failure are common in inoperable stage III non small-cell lung cancer (NSCLC) after chemoradiotherapy (CRT). However, there is limited real-world data on failure pattern, patient prognosis and salvage options. Methods: We analysed 99 consecutive patients with inoperable stage III NSCLC treated with CRT between 2011 and 2016. Follow up CT scans from date of the first-site failure were matched with the delivered radiation treatment plans. Intra-thoracic loco-regional relapse was defined as in-field (IFR) vs. out-of-field recurrence (OFR) [invs. outside 50Gy isodose line in the involved lung], respectively. Extracranial distant (DMs) and brain metastases (BMs) as first site of recurrence were also evaluated. Using the Kaplan-Meier method, impact of salvage surgery (sS), radiotherapy (sRT), chemotherapy (sCT) and immunotherapy (sIO) on patient survival was assessed. Results: Median follow-up was 60.0 months. Median PFS from the end of CRT for the entire cohort was 7.5 (95% CI: 6.0-9.0 months) months. Twenty-six (26%) and 25 (25%) patients developed IFR and OFR. Median time to diagnosis of IFR and OFR was 7.2 and 6.2 months. In the entire cohort, onset of IFR and OFR did not influence patient outcome. However, in 73 (74%) patients who survived longer than 12 months after initial diagnosis, IFR was a significant negative prognostic factor with a median survival of 19.3 vs 40.0 months (p < 0.001). No patients with IFR underwent sS and/or sRT. 18 (70%) and 5 (19%) patients with IFR underwent sCT and sIO. Three (12%) patients with OFR underwent sS and are still alive with 3-year survival rate of 100%. 5 (20%) patients with OFR underwent sRT with a median survival of 71.2 vs 19.1 months (p = 0.014). Four (16%) patients with OFR received sIO with a numerical survival benefit (64.6 vs. 26.4 months, p = 0.222). DMs and BMs were detected in 27 (27%) and 16 (16%) patients after median time of 5.8 and 5.13 months. Both had no impact on patient outcome in the entire cohort. However, patients with more than three BMs showed significantly poor OS (9.3 vs 26.0 months; p = 0.012).

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Section: Discussionsupporting

confidence: 91%

Pattern-of-failure and salvage treatment analysis after chemoradiotherapy for inoperable stage III non-small cell lung cancer

et al. 2020

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“…These results are in line with those achieved with salvage surgery for patients with recurrent or persistent NSCLC after CRT, who are operated in centers with experience in pulmonary resections after high-dose radiotherapy. 6,[8][9][10] Approximately one-third of patients with SCLC present with LS-SCLC, and international guidelinerecommended therapy for fit patients is combined modality treatment with chemotherapy and concurrent radiotherapy. 3 Nevertheless, most patients had a relapse (local, distant or both) within 2 years of treatment.…”

Section: Discussionmentioning

confidence: 99%

Salvage Surgery for Patients With Local Recurrence or Persistent Disease After Treatment With Chemoradiotherapy for SCLC

Joosten

Winkelman

Heineman

et al. 2021

JTO Clinical and Research Reports

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Introduction: The role of salvage surgery for patients with locoregional (LR) recurrence or persistent SCLC after radical chemoradiotherapy (CRT) for limited-stage disease is not well established. We evaluated our experience. Methods:We conducted a retrospective study of consecutive patients who underwent salvage pulmonary resection for LR-recurrent or persistent SCLC between 2008 and 2020 at the Amsterdam University Medical Center.Results: A total of 10 patients were identified. Median age at initial diagnosis of limited-stage SCLC was 58.5 years (48-71 y). All patients had radical-intent concurrent CRT. Of the 10 patients, 9 were diagnosed with LR-recurrent or persistent disease with a median of 18 months (3-78 y) after CRT. All patients underwent an anatomical radical resection and mediastinal lymph node dissection. No 90-day mortality was recorded. In addition, one patient developed a LR recurrence 7 months after resection. Distant progression was found in three patients at 6, 32, and 61 months after surgery, all of whom subsequently died of progressive SCLC. Median follow-up was 22.5 months (2-86 mos). Disease-free survival was 34 months; overall survival was not reached.Conclusions: For highly selected patients with LRrecurrent or persistent SCLC after CRT, salvage surgery is feasible and can result in clinically meaningful survival. Such patients should be presented to the multidisciplinary tumor board.

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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%

“…2 First Department of Internal Medicine, Division of Thoracic Oncology, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka 573-1191, Japan. 3 First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka 573-1191, Japan. 4 Department of Pathology and Laboratory Medicine, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka 573-1191, Japan.…”

Section: Supplementary Informationmentioning

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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Salvage surgery after definitive chemo-radiotherapy for patients with Non-Small Cell Lung Cancer

Cited by 24 publications

References 42 publications

Pattern-of-failure and salvage treatment analysis after chemoradiotherapy for inoperable stage III non-small cell lung cancer

Pattern-of-failure and salvage treatment analysis after chemoradiotherapy for inoperable stage III non-small cell lung cancer

Salvage Surgery for Patients With Local Recurrence or Persistent Disease After Treatment With Chemoradiotherapy for SCLC

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

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