Long-Term Outcomes of Lobectomy for Non-Small Cell Lung Cancer After Definitive Radiation Treatment

Abstract

Background Salvage surgical resection for non-small cell lung cancer (NSCLC) patients initially treated with definitive chemotherapy and radiation can be performed safely, but the long-term benefits are not well characterized. Methods Perioperative complications and long-term survival of all patients with NSCLC who received curative-intent definitive radiation with or without chemotherapy followed by lobectomy from 1995-2012 were evaluated. Results During the study period, 31 patients met inclusion criteria. Clinical stage distribution was: stage I (n=2,6%); stage II (n=5,16%); stage IIIA (n=15,48%);stage IIIB (n=5,16%); stage IV (n=3,10%); and unknown (n=1,3%). The reasons surgery was initially not considered were: patients deemed medically inoperable (5 [16%]); extent of disease considered unresectable (21 [68%]); small cell lung cancer misdiagnosis (1 [3%]); and unknown (4 [13%]). Definitive therapy was radiation alone (n=2, 6%), concurrent chemoradiation (n=28, 90%), and sequential chemoradiotherapy (n=1, 3%). The median radiation dose was 60 Gy. Patients were subsequently referred for resection because of obvious local relapse, medical tolerance of surgery or post-therapy imaging suggested residual disease.Median time from radiation to lobectomy was 17.7 weeks.There were no perioperative deaths, and morbidity occurred in 15 (48%) patients. None of 3 patients with residual pathologic nodal disease survived longer than 37 months, but the 5-year survival of pN0 patients was 36%. Patients who underwent lobectomy for obvious relapse (n=3) also did poorly with median overall survival of 9 months. Conclusion Lobectomy after definitive radiation therapy can be done safely and is associated with reasonable long-term survival, particularly when patients do not have residual nodal disease.

Current Topics on Salvage Thoracic Surgery in Patients with Primary Lung Cancer

“…8) Yang et al also showed that the median PFS and OS were 10.3 and 32.5 months, respectively. 18) These results indicate that salvage lung resection after definitive chemoradiation is feasible, with an encouraging survival. The median recurrence-free survival (RFS) after surgery was reported to be just 6 months after response to gefitinib administration.…”

“…Eventually, eleven papers (cases series) including various treatment methods before salvage surgery were identified ( Table 2). [8][9][10][11][12][13][14][15][16][17][18] These studies were all retrospective in nature and performed at a single institution. Furthermore, there were imbalances in the patients' characteristics that cannot be excluded due to the small number of patients.…”

Long-Term Survival With Salvage Surgery in Persistent Lung Cancer

“…In addition, the existence of viable tumor cells was supported with PET-CT, thus biopsy wasn't considered necessary. The rates of pneumonectomy in studies including more than 20 patients are 42-59% (3)(4)(5). Because of the location of recurrent disease in our case, RP was applied.…”

“…There are few published data about surgery after radical CRT. In these studies, low survival, high morbidity and mortality rates are usually reported (3)(4). Salvage surgery has been generally investigated in retrospective series.…”

Pneumonectomy with Esophageal Resection and Reconstruction for Squamous Cell Carcinoma of the Lung as Salvage Surgery

“…Uramoto stated that salvage thoracic operations, in a wide sense, can be defined as surgical resection of persistent or recurrent primary lung tumors after previous treatments, in addition to urgent matters such as hemoptysis 1) . Some reports have indicated that salvage thoracic operations after definitive chemoradiation are feasible with an encouraging survival rate, as the median progression-free survival (PFS) was 10.3-12 months with an overall survival (OS) of 30-32.5months 2,3) . Such surgery might therefore be considered a favorable treatment option for select patients.…”