Long-Term Survival after Salvage Surgery for Local Failure after Definitive Chemoradiation Therapy for Locally Advanced Non-small Cell Lung Cancer

Abstract

SLS in patients with locally advanced non-small cell lung surgery following dCRT is feasible, prolongs long-term survival and allows local tumor control. Selection criteria remain undefined and patients should be considered surgical candidates during multidisciplinary team conference.

Salvage surgery for recurrent or persistent tumour after radical (chemo)radiotherapy for locally advanced non-small cell lung cancer: a systematic review

“…Where reported, mediastinal lymph node dissection was performed in a varying number of patients; 14/24 (58%); 5 ‘routinely performed’; 7 all patients had lymph nodes resected but number of stations varied between one and eight (median four); 8 18/18 (100%) with varying extent; 9 8/8 (100%) 10 based on pN staging reported for all patients; ‘all patients’ underwent radical lymphadenectomy with systematic node dissection; 11 ‘all lung resections were followed by systematic hilar and mediastinal lymph node dissection’. 12 Where reported, the incidence of pathologically confirmed N2 disease in the resection specimen was 3, 7 8, 12 13, 8 21 5 and 50%. 10 In addition, some patients who had stage IV disease prior to CRT or salvage surgery were included: the incidence was 3, 11 8, 5 8, 12 13 7 and 14%.…”

“… 12 Where reported, the incidence of pathologically confirmed N2 disease in the resection specimen was 3, 7 8, 12 13, 8 21 5 and 50%. 10 In addition, some patients who had stage IV disease prior to CRT or salvage surgery were included: the incidence was 3, 11 8, 5 8, 12 13 7 and 14%. 6 There were two patients in one study who had adjuvant chemotherapy for N2 disease found on pathological examination of the resected specimen.…”

“…All selected articles were retrospective series, published during the previous decade (2008–2018). The articles included 158 patients, 5 – 12 and the first reported patient was operated on in 1995. 7 However, not all of these patients had full-dose (C)RT 6 , 7 , 11 or local tumour recurrence within the previous radiotherapy volume, 5 , 6 and some reports included patients that were operated within 3 months of the last day of radiotherapy, 5 , 7 , 9 , 11 reflecting the wide variety of definitions and indications for salvage surgery used in the literature ( Table 2 ).…”

“…The median radiotherapy dose during primary treatment varied from 57 to 66 Gy in six studies, 5 – 9 , 12 with one study reporting the mean (58 Gy) 11 and one not reporting either. 10 The majority of patients received concurrent, carbo-/cisplatinum-based chemotherapy ( Table 1 ).…”

“…In 7/8 of the studies, suspected mediastinal lymph involvement was not considered a reason to exclude patients from salvage surgery. 5 , 7 – 12 Several authors reported that they performed mediastinoscopy and provided some numerical data: Casiraghi and colleagues performed the procedure in 20/35 (57%) patients and did not specifically describe any related complications; 11 Yang and colleagues performed mediastinoscopy ‘along with lobectomy’ in 15/31 patients (48%), with no specific mention of complications. 7 They had one patient with mediastinal nodal involvement (N2) in their series; this was station five, which had not been evaluated by preoperative mediastinoscopy; Baumann and colleagues performed mediastinoscopy in 19/24 (79%) patients (including one repeat) and described a patient who needed aortic arch replacement following injury during mediastinoscopy.…”