Salvage surgery after definitive chemoradiotherapy for nsclc

OBJECTIVE: Following definitive chemoradiation therapy, 24–35% of patients with locally advanced NSCLC have recurrence. Salvage surgery may be considered to improve patient survival even if poorly defined and associated with high morbidity and mortality. METHODS: from June 2006 to August 2012 53 patients were candidate to lung cancer resection (pneumonectomy, lobectomy or segmentectomy) after definitive chemoradiation therapy with intention to treat for relapse. All pts received preoperative chemotherapy (1-3 cycles) and radiotherapy (Gy mean: 51). All patients underwent total body CT scan and fdg-PET scan after the end of medical treatment and before surgery; attempt to cyto/histological confirmation of relapse with fine needle agobiopsy or bronchoscopy was performed in all patients. RESULTS: Ten patients had explorative thoracotomies, and excluded from the analysis. 43 patients underwent lung cancer resection: 22 lobectomies, 20 pneumonectomies (9 right, 11 left) and 1 segmentectomy. Completeness of resection was obtained in 41 (95%) patients. Twenty-four (55.8%) patients underwent extended resection: intrapericardial pneumonectomy (5) vascular/bronchial sleeve resection (3), atrial resection (3), tracheal sleeeve (3), superior vena cava resection/reconstruction (2), vertebrae (1) and chest wall resection (7). Median time from chemoradiation to resection was 12 weeks. Viable tumor was found in 39 (90%) patients. Major complications occurred in 11 (20.8%) patients. There were 2 (3.7%) perioperative deaths within 90 days. With mean follow up of 21 months, postoperative 2 and 3-year survival after complete resection was respectively 51% and 42%. CONCLUSIONS: Salvage lung resection after definitive chemoradiation is feasible, with an acceptable postoperative survival and complication rates.