Patient outcomes following salvage lung cancer surgery after definitive chemotherapy or radiation

ABSTRACT

Background: Definitive chemoradiotherapy (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 1 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 was 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 who met the inclusion criteria treated between January 2017 and August 2020 were identified with a median follow-up time of 21 months (interquartile range [IQR] 8-37.5). The median patient age was 68 years. All 16 patients received radiation, 7 of whom received < 59 Gy and 9 of whom received > 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 nonsurgical management initially, and 1 patient pursued dCRT owing to uncertainty of surgical options because of the COVID-19 pandemic. The median time from radiotherapy to surgery was 22 months (IQR 14.25-27.5). The extent of salvage resections differed, as 5 patients had wedge resections, 4 had lobectomies, and 5 patients had > 1 lobe resected. No pneumonectomies were performed. Two resections were aborted in the operating room owing to upstaging at the time of resection. The final pathology was 9 adenocarcinomas, 5 squamous cell carcinomas, 1 adenosquamous carcinoma and 1 nonmalignant (nodular fibroblastic scarring with surrounding focal organizing pneumonia). Median procedure time was 3h 10.5 min. Adhesions were noted in 12 cases (75%). Ninety-day mortality was 0%. Overall survival at the most recent follow-up was 75% (12 patients). Conclusion: 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.