Patient Outcomes Following Salvage Lung Cancer Surgery Post Definitive Chemotherapy or Radiation

ABSTRACT

Introduction: Definitive chemoradiaotherapy (dCRT) is an option for patients with lung cancer who are medically inoperable or have unresectable locally advanced disease. The local recurrence rate after dCRT is 30% and the prognosis is poor. Salvage surgery, or surgical resection of recurrent disease following dCRT, is one therapeutic option, however, optimal therapy for locoregional recurrences or residual disease is controversial. The purpose of this study was to determine the efficacy of salvage lung resection. Methods: This is a single centre retrospective database review. Patients eligible for the study received definitive chemotherapy, radiation therapy or both followed by salvage pulmonary resection for local recurrence or residual disease. Patient characteristics and outcomes were examined. Results: Sixteen patients (11 male, 5 female) out of 201 that met the inclusion criteria treated between January 2017 and August 2020 were identified with a median follow-up time of 21 months (Q1, Q3 8-37.5). The median patient age was 68. All 16 patients received radiation, 7 of whom received less than 59 Gy and 9 received greater than 59 Gy. The rationale for dCRT varied as 6 patients had disease considered to be unresectable, 5 patients were originally considered to be medically inoperable, 4 patients had a preference for non-surgical management initially, and 1 patient pursued dCRT due to uncertainty of surgical options due to the COVID-19 pandemic. The median time from radiotherapy to surgery was 22 months (Q1, Q3 14.25-27.5). The extent of salvage resections differed as 5 patients had wedge resections, 4 had lobectomies, and 5 patients had more than one lobe resected. No pneumonectomies were preformed. Two resections were aborted in the operating room due to upstaging at the time of resection. The final pathology was 9 adenocarcinomas, 5 squamous cell carcinomas, 1 adenosquamous carcinoma and 1 non-malignant (nodular fibroblastic scarring with surrounding focal organizing pneumonia). Median procedure time was 3h10.5m. Adhesions were noted in 12 cases (75%). Ninety-day mortality was 0%. Overall survival at most recent follow-up was 75% (12 patients). Conclusions: Salvage pulmonary resection after dCRT can be performed with low morbidity and mortality rates and is a good option for treatment of recurrent or residual disease after dCRT. Keywords Early stage lung cancer treatment, Salvage pulmonary resection, Definitive chemoradiaotherapy