Salvage surgery for local recurrence after stereotactic body radiotherapy for early stage non-small cell lung cancer: a systematic review

Abstract

Introduction:Stereotactic body (or ablative) radiotherapy (SBRT/SABR) is now a guideline-recommended treatment for medically inoperable patients with peripherally-located, stage I non-small cell lung cancer (NSCLC), and for medically operable patients who decline surgery. The 5-year local failure rate after SBRT is about 10% and in highly selected patients, surgery has been used as a salvage therapy. We performed a systematic review to address the feasibility, safety, and outcome of salvage surgery for locally recurrent early stage NSCLC after SBRT.Methods:A systematic literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed, Embase and Cochrane databases were searched and two authors independently assessed the articles. A total of seven eligible articles were identified.Results:All seven articles were retrospective case series, representing a total of 47 patients. Surgery was completed in all patients. Where reported in sufficient detail, morbidity (four studies) was between 29 and 50% (series of two patients) and 90-day mortality (six studies) was between 0% (four studies) and 11% (n = 1, disease progression). Median (n = 5)/mean (n = 1) reported or calculated follow ups were 7–54.5/17.3 months. Median overall survival was reported in three studies and ranged between 13.6–82.7 months. Crude survival in three others was 2–35 months.Conclusion:Limited, low-level evidence prevents firm conclusions, but based on the existing data, salvage surgery after local recurrence of NSCLC following SBRT appears technically feasible, with acceptable morbidity and mortality in appropriately selected and counselled patients who are fit enough and who accept the risks (level of evidence 4, strength of recommendation C).

Long Term Results of Single-Fraction Carbon-Ion Radiotherapy for Non-small Cell Lung Cancer

“…In our study, local recurrence was observed in approximately 10% of the patients within 5 years, and in two cases, more than 4 years after CIRT. Some patients with local recurrence after radiotherapy are eligible for salvage surgery [ 16 , 17 ] or reirradiation [ 18 , 19 ]. Dickhoff et al reported that salvage surgery for local recurrence after SBRT was technically feasible with acceptable 90-day mortality (0–11%) in their systematic review [ 16 ].…”

Salvage surgery in lung cancer following definitive therapies

“…Adhesions were noted in almost all the patients (36 of 37, 97.3%) and 10 (47.6%) had adhesions described as extensive or severe. 15 In a separate review by Dickhoff et al, 53 seven studies were reviewed and while a correlation was not able to be deduced regarding the degree of adhesions and optimal approach the author advocated for the future study between the location of tumor recurrence, degree of adhesion formation by SBRT, and their impact on surgical planning (i.e. whether to opt for minimally invasive approaches as compared to thoracotomy).…”

[Retracted] Isovitexin Suppresses Stemness of Lung Cancer Stem‐Like Cells through Blockage of MnSOD/CaMKII/AMPK Signaling and Glycolysis Inhibition

“…Non-small-cell lung cancer (NSCLC) has a relatively poor prognosis and is a leading cause of cancer-related death worldwide. The treatment failure and low survival rates of patients with NSCLC are mainly due to drug resistance, metastasis, and recurrence of tumor [ 1 ]. Recently, a small subpopulation of lung cancer stem-like cells (LCSLCs), characterized by expression of stem cell markers, self-renewing ability, multidifferentiating potential, and high tumorigenicity in vivo , were identified and considered to be responsible for drug resistance, metastasis, and recurrence of cancers [ 2 ].…”