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van Dorp M, Ünal S, Gooijer S, Dickhoff C, van den Broek FJC, Kazemier G, Schreurs WH, Schneiders FL, Dahele M, Heineman DJ. Salvage surgery for local recurrences after stereotactic ablative radiotherapy of colorectal pulmonary metastases. J Surg Oncol 2023; 128:1114-1120. [PMID: 37477423 DOI: 10.1002/jso.27404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Local control following stereotactic ablative radiotherapy (SABR) for patients with colorectal pulmonary metastases is reportedly lower than for metastases from other tumors. Such recurrences may still be amenable to salvage therapy. We describe our experience with salvage surgery in 17 patients. METHODS Patients who underwent salvage metastasectomy for a local recurrence following SABR for colorectal pulmonary metastases were identified from the surgical institutional databases of three Dutch major referral hospitals. Kaplan-Meier survival analysis was performed to determine survival. RESULTS Seventeen patients underwent 20 salvage resections for local recurrence of colorectal pulmonary metastases. All patients had a progressive lesion on consecutive CT scans, with local uptake on 18 fluorodeoxyglucose-positron emission tomography computed tomography (FDG-PET CT), and were discussed in a thoracic oncology tumor board. Median time to local recurrence following SABR was 20 months (interquartile range [IQR]: 13-29). Fourteen procedures were performed minimally invasively. Extensive adhesions were observed during three procedures. A Clavien-Dindo grade III-IV complication occurred after four resections (20%). The 90-day mortality was 0%. The estimated median overall survival and progression-free survival following salvage resection were 71 months (confidence intervals [CI]: 50-92) and 39 months (CI: 19-58), respectively. Salvage resections were significantly more extensive, compared to the potential resection assessed on pre-SABR imaging. CONCLUSIONS Our experience with 20 salvage pulmonary metastasectomy procedures for local recurrences following SABR in colorectal cancer patients demonstrates that salvage resection is a feasible option with acceptable morbidity and good oncological outcome in a highly selected cohort.
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Affiliation(s)
- Martijn van Dorp
- Department of Cardiothoracic Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Semih Ünal
- Department of Cardiothoracic Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Simone Gooijer
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | | | - Geert Kazemier
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Famke Lorelei Schneiders
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Max Dahele
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - David Jonathan Heineman
- Department of Cardiothoracic Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
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Wang YH, Tsai SCS, Lin FCF. Reduction of Blood Loss by Means of the Cavitron Ultrasonic Surgical Aspirator for Thoracoscopic Salvage Anatomic Lung Resections. Cancers (Basel) 2023; 15:4069. [PMID: 37627096 PMCID: PMC10452171 DOI: 10.3390/cancers15164069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
In centrally located lung tumors, salvage pulmonary resections pose challenges due to adhesions between the pulmonary parenchyma, chest wall, and hilum. This study aimed to investigate the surgical outcomes associated with Cavitron Ultrasonic Surgical Aspirator (CUSA) usage in thoracoscopic salvage pulmonary resections. Patients with centrally located advanced-stage lung tumors who underwent salvage anatomic resections following systemic or radiotherapy were included. They were categorized into CUSA and non-CUSA groups, and perioperative parameters and surgical outcomes were analyzed. Results: The study included 7 patients in the CUSA group and 15 in the non-CUSA group. Despite a longer median surgical time in the CUSA group (3.8 h vs. 6.0 h, p = 0.021), there was a significant reduction in blood loss (100 mL vs. 250 mL, p = 0.014). Multivariate analyses revealed that the use of CUSA and radiotherapy had opposing effects on blood loss (β: -296.7, 95% CI: -24.8 to -568.6, p = 0.034 and β: 282.9, 95% CI: 19.7 to 546.3, p = 0.037, respectively). In conclusion, while using CUSA in the salvage anatomic resection of centrally located lung cancer may result in a longer surgical time, it is crucial in minimizing blood loss during the procedure.
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Affiliation(s)
- Yu-Hsiang Wang
- Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
| | - Stella Chin-Shaw Tsai
- Superintendent Office, Tungs’ Taichung MetroHarbor Hospital, Taichung 43503, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Frank Cheau-Feng Lin
- Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
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3
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Afshari S, Anker CJ, Kooperkamp HZ, Sprague BL, Lester-Coll NH. Trends and Outcomes of Salvage Lobectomy for Early-stage Non-Small Cell Lung Cancer. Am J Clin Oncol 2023; 46:271-275. [PMID: 36961366 DOI: 10.1097/coc.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
OBJECTIVES There is little data describing the outcomes for patients who develop local recurrences after stereotactic body radiation therapy (SBRT), a standard-of-care treatment for patients with early-stage non-small cell lung cancer. One emerging option is salvage lobectomy. We investigated trends in the use of salvage lobectomy after SBRT and described patient outcomes using a nationally representative sample. METHODS This is a retrospective study using the National Cancer Database of patients with non-small cell lung cancer diagnosed from 2004 to 2017. We used descriptive statistics to describe patients who underwent salvage lobectomy. Kaplan-Meier analysis was used to estimate overall survival (OS). Cox proportional modeling was used to identify factors associated with OS. RESULTS We identified 276 patients who underwent salvage lobectomy. Ninety-day mortality was 0%. The median survival time for the cohort was 50 months (95% CI, 44 to 58). Median follow-up was 65 months (Interquartile Range: 39 to 96). The factors associated with decreased OS include squamous cell histology (hazard ratio (HR)=1.72, P =0.005) and high grade (1.50, P =0.038). Increased OS was associated with lobectomy performed between 3 and 6 months after SBRT (HR=0.53, P =0.021), lobectomy performed >6 months after SBRT (HR=0.59, P =0.015), and female sex (HR=0.56, P =0.004). CONCLUSIONS Salvage lobectomy after local failures of SBRT was associated with no perioperative mortality and favorable long-term outcomes. Our data suggest that lobectomy performed within 3 months of SBRT is associated with worse OS.
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Affiliation(s)
- Sam Afshari
- University of Vermont Larner College of Medicine
| | | | - Hannah Z Kooperkamp
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
| | - Brian L Sprague
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
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Mills AC, Hofstetter WL, Mehran RJ, Rajaram R, Rice DC, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Antonoff MB. Repeated Pulmonary Metastasectomy: Third Operations and Beyond. Ann Thorac Surg 2023; 115:679-685. [PMID: 35926641 DOI: 10.1016/j.athoracsur.2022.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/11/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND For extrathoracic malignant neoplasms that have metastasized to the lungs, previous investigations have demonstrated both oncologic and survival benefits after pulmonary and repeated metastasectomy. Little is known about the feasibility of incrementally increasing numbers of subsequent metastasectomy procedures. METHODS We conducted a retrospective review of patients who underwent ≥3 pulmonary resection procedures for recurrent, metachronous metastatic disease of nonlung primary malignant neoplasms at a single institution between 1992 and 2020. Primary outcomes collected pertained to safety and feasibility, including estimated blood loss (EBL), hospital length of stay, and details of postoperative complications. RESULTS There were 117 patients who met inclusion criteria, having undergone at least 3 metastasectomy operations, with 55 (47.1%) undergoing a fourth operation and 20 (17.1%) undergoing a fifth operation. EBL did not differ between first and second operations (106.6 mL vs 102.5 mL; P = .76). It was, however, significantly greater at third operations (102.5 mL vs 238.7 mL; P = .000016). We noted an increase in wound complications between the second and third operations (0.9% vs 6.8%; P = .02) and incremental increases in likelihood of prolonged air leak with each subsequent operation. The need for reoperation was low for all and similar between operations. Importantly, hospital length of stay was similar for all procedures, as were the frequencies of hospital readmission. CONCLUSIONS Third-time redo pulmonary metastasectomy can be performed safely and feasibly in select patients. Further repeated resection should remain a therapeutic option for patients, although risks for potentially longer operating time, greater EBL, and prolonged air leaks may be anticipated.
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Affiliation(s)
- Alexander C Mills
- Department of General Surgery, Memorial Hermann Hospital, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ravi Rajaram
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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5
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Eisenberg M, Deboever N, Antonoff MB. Salvage surgery in lung cancer following definitive therapies. J Surg Oncol 2023; 127:319-328. [PMID: 36630094 DOI: 10.1002/jso.27155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 01/12/2023]
Abstract
Salvage surgery refers to operative resection of persistent or recurrent disease in patients initially treated with intention-to-cure nonoperative management. In non-small-cell lung cancer, salvage surgery may be effective in treating selected patients with locally progressive tumors, recurrent local or locoregional disease, or local complications after nonoperative therapy. Importantly, those patients who may be candidates for salvage surgery are evolving, in terms of disease stage as well as the types of attempted definitive therapy received.
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Affiliation(s)
- Michael Eisenberg
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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6
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Hino H, Utsumi T, Maru N, Matsui H, Taniguchi Y, Saito T, Tsuta K, Murakawa T. Results of emergency salvage lung resection after chemo- and/or radiotherapy among patients with lung cancer. Interact Cardiovasc Thorac Surg 2022; 35:ivac043. [PMID: 35253874 PMCID: PMC9714598 DOI: 10.1093/icvts/ivac043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/07/2022] [Accepted: 01/31/2022] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVES This study aimed to elucidate the outcomes of emergency salvage surgery following life-threatening events (serious haemorrhage and/or infections) among patients with lung cancer who had undergone chemo- and/or radiotherapy. MATERIALS AND METHODS We analysed the data of patient from 2015 to 2020, retrospectively. The clinical characteristics, including preoperative treatment, perioperative outcomes and survival time, were analysed. RESULTS Of the 862 patients who underwent primary lung cancer surgeries, 10 (1.2%) underwent emergency surgeries. The preoperative clinical characteristics were: median age, 63.7 years [interquartile range (IQR) 55-70.5]; sex (male/female), 9/1; clinical staging before initial treatment (I/II/III/IV), 1/1/3/5; initial treatment (chemoradiotherapy/chemotherapy/proton beam therapy), 5/4/1; and indications for emergency surgery (lung abscess/lung abscess with haemoptysis/haemoptysis/empyema), 5/3/1/1. The selected procedures and results were as follows: lobectomy/bilobectomy/pneumonectomy, 8/1/1 (all open thoracotomies); median operation time, 191.0 min (IQR 151-279); median blood loss, 1071.5 ml (IQR 540-1691.5); postoperative severe complications, 3 (30%); hospital mortality, none; median postoperative hospital stay, 37 days (12-125); control of infection and/or haemoptysis, all the cases; final outcome (alive/dead), 3/7 (all the cancer deaths); median postoperative survival, 9.4 months (IQR 4.3-20.4); and median survival from initial treatment, 19.4 months (IQR 8.0-66.9). CONCLUSIONS Emergency salvage lung resection is a technically challenging procedure; however, the results were feasible and acceptable when the surgical indication, procedure and optimal timing were considered carefully by a multidisciplinary team. Although the aim was palliation, some patients who received additional chemotherapy afterwards and, thus, had additional survival time.
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Affiliation(s)
- Haruaki Hino
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Takahiro Utsumi
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Natsumi Maru
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Hiroshi Matsui
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Yohei Taniguchi
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Tomohito Saito
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Koji Tsuta
- Department of Pathology, Kansai Medical University, Osaka, Japan
| | - Tomohiro Murakawa
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
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7
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Eriguchi T, Tsukamoto N, Kumabe A, Ogata T, Inoue Y, Sugawara A. Suitability of Metastatic Lung Tumors for Stereotactic Body Radiotherapy. Cancer Invest 2021; 40:378-386. [PMID: 34894945 DOI: 10.1080/07357907.2021.2017950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We investigated factors influencing local control of lung metastases treated with stereotactic body radiotherapy (SBRT) and determined the type of lesions for which SBRT is more suitable. Ninety-six patients and 196 tumors were included. Median follow-up duration was 32.0 months (range 4.7-95.8). The two-year local recurrence rate was 15.2% (95% confidence interval: 10.2-21.3). Multivariate analysis revealed biological effective dose, ultracentral tumor location, reirradiation, and prior chemotherapy as significant factors. SBRT is suitable for lung metastases, especially for peripheral tumors and those located in the inner lung parenchyma. For ultracentral lesions and recurrent lesions after SBRT, metastasectomy is recommended.
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Affiliation(s)
- Takahisa Eriguchi
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan.,Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan.,Department of Radiation Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Nobuhiro Tsukamoto
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Atsuhiro Kumabe
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Takeru Ogata
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Yoshimasa Inoue
- Department of Thoracic Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Akitomo Sugawara
- Department of Radiation Oncology, Tokai University School of Medicine, Isehara, Japan
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Shimizu K. Can Salvage Surgery Cause a Paradigm Shift in Lung Cancer Treatment? Ann Thorac Surg 2021; 114:1518-1519. [PMID: 34785245 DOI: 10.1016/j.athoracsur.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Kimihiro Shimizu
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
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Mitchell KG, Antonoff MB. Pulmonary Resection Remains a Salvage Option Following Local Failure of Definitive Radiotherapy. Ann Thorac Surg 2021; 114:1518. [PMID: 34740585 DOI: 10.1016/j.athoracsur.2021.09.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1489, Houston, TX 77030
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1489, Houston, TX 77030.
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10
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Seo YS, Park WY, Kim SW, Kim D, Min BJ, Kim WD. Virtual randomized study comparing lobectomy and particle beam therapy for clinical stage IA non-small cell lung cancer in operable patients. JOURNAL OF RADIATION RESEARCH 2021; 62:884-893. [PMID: 34218277 PMCID: PMC8438263 DOI: 10.1093/jrr/rrab060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/30/2021] [Indexed: 06/13/2023]
Abstract
To the best of our knowledge there have been no randomized controlled trials comparing lobectomy-a standard treatment for patients with early-stage non-small cell lung cancer (NSCLC)-and particle beam therapy (PBT), the best performing existing radiotherapy. We conducted a virtual randomized trial in medically operable patients with stage IA NSCLC to compare lobectomy and PBT effectiveness. A Markov model was developed to predict life expectancy after lobectomy and PBT in a cohort of patients with stage IA NSCLC. Ten thousand virtual patients were randomly assigned to each group. Sensitivity analyses were performed as model variables and scenarios changed to determine which treatment strategy was best for improving life expectancy. All estimated model parameters were determined using variables extracted from a systematic literature review of previously published articles. The preferred strategy differed depending on patient age. In young patients, lobectomy showed better life expectancy than that of PBT. The difference in life expectancy between lobectomy and PBT was statistically insignificant in older patients. Our model predicted lobectomy as the preferred strategy when operative mortality was under 5%. However, the preferred strategy changed to PBT if operative mortality post lobectomy was over 5%. For medically operable patients with stage IA NSCLC, our Markov model revealed the preferred strategy of lobectomy or PBT regarding operative mortality changed with varying age and comorbidity. Until randomized controlled trial results become available, we hope the current results will provide a rationale background for clinicians to decide treatment modalities for patients with stage IA NSCLC.
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Affiliation(s)
- Young-Seok Seo
- Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea
| | - Woo-Yoon Park
- Department of Radiation Oncology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Si-Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Dohun Kim
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Byung Jun Min
- Corresponding authors: Byung Jun Min, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea. Phone: +82-43-269-6213, Fax: +82-43-269-6208, E-mail: ; Won-Dong Kim, MD, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea. Phone: +82-43-269-6212, Fax: +82-43-269-6208, E-mail:
| | - Won-Dong Kim
- Corresponding authors: Byung Jun Min, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Korea. Phone: +82-43-269-6213, Fax: +82-43-269-6208, E-mail: ; Won-Dong Kim, MD, PhD, Department of Radiation Oncology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju 28644, Korea. Phone: +82-43-269-6212, Fax: +82-43-269-6208, E-mail:
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11
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Yamanashi K, Hamaji M, Matsuo Y, Kishi N, Chen-Yoshikawa TF, Mizowaki T, Date H. Updated long-term outcomes of salvage surgery after stereotactic body radiotherapy for early-stage non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2021; 31:892-894. [PMID: 32974674 DOI: 10.1093/icvts/ivaa194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 02/02/2023] Open
Abstract
There is dearth of data regarding the long-term survival outcomes of salvage surgery after stereotactic body radiotherapy for early-stage non-small-cell lung cancer, as previous studies have included a short follow-up period. There is also scarce information on the management of re-relapse in previous studies. This study examined the long-term survival outcomes of patients who underwent salvage surgery for isolated local relapse (LR). We reviewed consecutive patients who underwent salvage surgery for isolated LR after stereotactic body radiotherapy for early-stage non-small-cell lung cancer between 1999 and 2015. All patients were followed up until death or at least 5 years from salvage surgery. Twelve patients were included for analysis. The median follow-up from isolated LR was 62.4 (range: 14.3-152.1) months. The 5-year overall survival rate was 58.3%, updated from 79.5% in our previous report. During the interim, new re-relapses did not occur, whereas there were 5 additional deaths. The median survival after re-relapse was 32.6 months. Our follow-up report confirmed that our patient selection for salvage surgery appeared to be appropriate and that long-term follow-up is required to assess the outcomes of patients undergoing salvage surgery. Long-term follow-up would provide detailed information on late re-relapses, treatment and outcomes of re-relapses and mortality from any causes.
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Affiliation(s)
- Keiji Yamanashi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriko Kishi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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12
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Andruska N, Stowe HB, Crockett C, Liu W, Palma D, Faivre-Finn C, Badiyan SN. Stereotactic Radiation for Lung Cancer: A Practical Approach to Challenging Scenarios. J Thorac Oncol 2021; 16:1075-1085. [PMID: 33901637 DOI: 10.1016/j.jtho.2021.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 12/18/2022]
Abstract
Stereotactic body radiation therapy (SBRT) is an effective and well-tolerated treatment for medically inoperable patients with early stage NSCLC. SBRT is a noninvasive treatment involving the delivery of ablative radiation doses with high precision in the course of a few treatments. Relative to conventionally fractionated radiation, SBRT achieves superior local control and survival. SBRT use has increased dramatically in the past 15 years and is currently considered the standard of care in cases of inoperable early stage NSCLC. It is being increasingly applied to more complex patient populations at higher risk of treatment-related toxicity. In these more complex patients, there is an increasing need to balance patient and treatment factors in selecting the optimal patients for SBRT. Here, we review several challenging clinical scenarios often encountered in thoracic multidisciplinary tumor boards.
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Affiliation(s)
- Neal Andruska
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Hayley B Stowe
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Cathryn Crockett
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Wei Liu
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - David Palma
- Division of Radiation Oncology, Western University, London, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Shahed N Badiyan
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, Missouri.
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13
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Hino H, Nakahama K, Ogata M, Kibata K, Miyasaka C, Utsumi T, Maru N, Matsui H, Taniguchi Y, Saito T, Tsuta K, Murakawa T. Emergent salvage surgery for massive hemoptysis after proton beam therapy for lung cancer: a case report. Surg Case Rep 2021; 7:98. [PMID: 33877476 PMCID: PMC8058119 DOI: 10.1186/s40792-021-01177-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/07/2021] [Indexed: 12/25/2022] Open
Abstract
Background Salvage surgery is an effective therapeutic option for patients experiencing relapses after chemoradiotherapy for advanced-stage lung cancer or after high-dose radiotherapy for early-stage lung cancer. We report a case involving an emergent salvage surgery for a patient with massive hemoptysis who developed lung cancer recurrence after undergoing proton beam therapy 7 years prior to presentation. Case presentation A 70-year-old male patient was emergently admitted due to massive hemoptysis. He had undergone proton beam therapy for a stage I adenocarcinoma of the left upper lobe 7 years ago, and was receiving chemotherapy for local recurrence. We performed an emergent salvage pulmonary resection to achieve hemostasis. During the operation, we confirmed the presence of a left broncho-pulmonary arterial fistula, which was considered as the origin of the massive hemoptysis. We repaired the fistula between the pulmonary artery and left upper bronchus without incident; an orifice of the fistula at the left pulmonary artery was sutured using a non-absorbable monofilament, and the central portion of the orifice of the fistula at the left upper bronchus was closed with a mechanical stapling device. The postoperative diagnosis was of an adenocarcinoma—ypT3(pm1) N0M1a (dissemination)-IVA, ef1b. The patient has survived for over a year with the cancer in almost complete remission following the administration of an epidermal growth factor receptor tyrosine kinase inhibitor. Conclusions Emergent salvage surgery demands high skill levels with optimal timing and correct patient selection. Our case suggested that the procedure played an important role in controlling serious bleeding and/or infectious conditions. Consequently, he could receive chemotherapy again and survive for over a year. Supplementary Information The online version contains supplementary material available at 10.1186/s40792-021-01177-9.
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Affiliation(s)
- Haruaki Hino
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan.
| | - Kahori Nakahama
- First Department of Internal Medicine, Division of Thoracic Oncology, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Makoto Ogata
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Kayoko Kibata
- First Department of Internal Medicine, Division of Thoracic Oncology, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Chika Miyasaka
- Department of Pathology and Laboratory Medicine, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Takahiro Utsumi
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Natsumi Maru
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Hiroshi Matsui
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Yohei Taniguchi
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Tomohito Saito
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Koji Tsuta
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
| | - Tomohiro Murakawa
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shinmachi Hirakata-shi, Osaka, 573-1191, Japan
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Vlaskou Badra E, Baumgartl M, Fabiano S, Jongen A, Guckenberger M. Stereotactic radiotherapy for early stage non-small cell lung cancer: current standards and ongoing research. Transl Lung Cancer Res 2021; 10:1930-1949. [PMID: 34012804 PMCID: PMC8107760 DOI: 10.21037/tlcr-20-860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiation therapy (SBRT) allows for the non-invasive and precise delivery of ablative radiation dose. The use and availability of SBRT has increased rapidly over the past decades. SBRT has been proven to be a safe, effective and efficient treatment for early stage non-small cell lung cancer (NSCLC) and is presently considered the standard of care in the treatment of medically or functionally inoperable patients. Evidence from prospective randomized trials on the optimal treatment of patients deemed medically operable remains owing, as three trials comparing SBRT to surgery in this cohort were terminated prematurely due to poor accrual. Yet, SBRT in early stage NSCLC is associated with favorable toxicity profiles and excellent rates of local control, prompting discussion in regard of the treatment of medically operable patients, where the standard of care currently remains surgical resection. Although local control in early stage NSCLC after SBRT is high, distant failure remains an issue, prompting research interest to the combination of SBRT and systemic treatment. Evolving advances in SBRT technology further facilitate the safe treatment of patients with medically or anatomically challenging situations. In this review article, we discuss international guidelines and the current standard of care, ongoing clinical challenges and future directions from the clinical and technical point of view.
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Affiliation(s)
- Eugenia Vlaskou Badra
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Baumgartl
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvia Fabiano
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Aurélien Jongen
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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15
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Shimizu K, Ohtaki Y, Suzuki K, Date H, Yamashita M, Iizasa T, Ito H, Yoshimura K, Okada M, Chida M. Salvage Surgery for Non-Small Cell Lung Cancer After Definitive Radiotherapy. Ann Thorac Surg 2020; 112:862-873. [PMID: 33248992 DOI: 10.1016/j.athoracsur.2020.10.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/23/2020] [Accepted: 10/12/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The aim of this study was to describe the characteristics and outcomes of patients with non-small cell lung cancer undergoing salvage surgery after chemoradiotherapy, conventional external beam, stereotactic body radiotherapy, and ion beam radiotherapy. METHODS We retrospectively evaluated patients who underwent salvage surgery between 2010 and 2016. Data on perioperative morbidity and mortality and patient outcomes were analyzed. RESULTS In total, 156 patients were included; of those, 110 were categorized into category 1, chemoradiotherapy or conventional external beam; and 46 into category 2, stereotactic body radiotherapy or ion beam radiotherapy. Three-year overall survival (OS) and recurrence-free survival (RFS) in category 1 were 67.3% and 49.8%, respectively. In category 1, pathological nodal stage was an independent prognosticator of both OS (hazard ratio [HR] = 3.53, 95% confidence interval [CI], 1.05-11.83) and RFS (HR = 4.32, 95% CI, 1.32-14.14). In category 2, 3-year OS and RFS were 57.7% and 46.4%, respectively. Age 70 years and greater at initial treatment was the only independent prognosticator of OS (HR = 5.61; 95% CI, 1.44-21.87), whereas age at initial treatment (HR = 6.13; 95% CI, 1.38-27.12) and pathological nodal metastasis (HR = 3.84; 95% CI, 1.40-10.57) were independent prognosticators for RFS. Overall 30- and 90-day mortality were 0% and 0.9% in category 1 and 0% and 4.3% in category 2, respectively. CONCLUSIONS Patients who undergo salvage surgery can have reasonable outcomes, and salvage surgery can be considered in selected patients.
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Affiliation(s)
- Kimihiro Shimizu
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan; Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Yoichi Ohtaki
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University, Kyoto, Kyoto, Japan
| | - Motohiro Yamashita
- Division of General Thoracic Surgery, Shikoku Cancer Center, Matsuyama, Ehime, Japan
| | - Toshihiko Iizasa
- Division of General Thoracic Surgery, Chiba Cancer Center, Chiba, Chiba, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
| | - Kenichi Yoshimura
- Innovative Clinical Research Center, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Biostatistics, Hiroshima University Hospital, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
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16
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Koizumi T, Aoki T, Saito M, Yamato Y, Furuyashiki G, Kitahara A, Hashimoto T, Watanabe T, Tsuchida M. Salvage surgery to treat tumor regrowth after stereotactic body radiotherapy in primary non-small cell lung cancer. J Thorac Dis 2020; 12:5289-5298. [PMID: 33209363 PMCID: PMC7656326 DOI: 10.21037/jtd-20-2253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Stereotactic body radiotherapy (SBRT) is considered to be an effective and safe treatment in patients with primary lung cancer. If local recurrence is confirmed following SBRT, surgical treatment is a possibility. The present study aimed to clarify the safety and survival outcomes of salvage surgery in primary lung cancer patients with local recurrence following SBRT. Methods All subjects were patients with primary lung cancer who underwent surgical treatment for local recurrence following SBRT during the period from July 2005 to July 2015. We evaluated the reason for SBRT selection, the surgical procedure, postoperative complications, and prognosis. Results Of 932 patients underwent SBRT as treatment for primary lung cancer, 48 patients (5.2%) had local recurrence alone and 19 patients (2.0%) underwent salvage surgery. SBRT was selected in eight medically operable patients who refused surgery, and in 11 patients considered medically inoperable by their pulmonologist. Lobectomy was performed in 15 patients. Postoperative complications were documented in 4 patients (21.1%). Incomplete resection was performed in 2 patients. Stage progression was confirmed in 7 patients (36.8%). The 5-year overall survival (OS) was 72.5% and the 5-year disease-free survival (DFS) was 65.2%. Conclusions We evaluated patients who underwent salvage surgery due to local recurrence of lung cancer following SBRT. We found that salvage surgery could be performed safely without affecting SBRT outcomes. We further infer that cases of complete resection are likely to be associated with good prognosis, and that SBRT should be selected only after careful consideration because complete resection is not possible in all cases.
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Affiliation(s)
- Takahisa Koizumi
- Department of Thoracic Surgery, National Hospital Organization Nishi-Niigata Chuo National Hospital, Niigata, Japan
| | - Tadashi Aoki
- Division of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Masayuki Saito
- Department of Thoracic Surgery, Niigata Prefectural Central Hospital, Joetsu, Niigata, Japan
| | - Yasushi Yamato
- Department of Thoracic Surgery, Japanese Red Cross Nagaoka Hospital, Nagaoka, Niigata, Japan
| | - Go Furuyashiki
- Department of Thoracic Surgery, Nagaoka Chuo General Hospital, Nagaoka, Niigata, Japan
| | - Akihiko Kitahara
- Department of Thoracic Surgery, Niigata Prefectural Shibata Hospital, Shibata, Niigata, Japan
| | - Takehisa Hashimoto
- Department of Thoracic Surgery, Uonuma Kikan Hospital, Uonuma, Niigata, Japan
| | - Takehiro Watanabe
- Department of Thoracic Surgery, National Hospital Organization Nishi-Niigata Chuo National Hospital, Niigata, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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17
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Elbanna M, Shiue K, Edwards D, Cerra-Franco A, Agrawal N, Hinton J, Mereniuk T, Huang C, Ryan JL, Smith J, Aaron VD, Burney H, Zang Y, Holmes J, Langer M, Zellars R, Lautenschlaeger T. Impact of Lung Parenchymal-Only Failure on Overall Survival in Early-Stage Lung Cancer Patients Treated With Stereotactic Ablative Radiotherapy. Clin Lung Cancer 2020; 22:e342-e359. [PMID: 32736936 DOI: 10.1016/j.cllc.2020.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/28/2020] [Accepted: 05/18/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The impact of lung parenchymal-only failure on patient survival after stereotactic ablative body radiotherapy (SABR) for early-stage non-small-cell lung cancer (NSCLC) remains unclear. PATIENTS AND METHODS The study population included 481 patients with early-stage NSCLC who were treated with 3- to 5-fraction SABR between 2000 and 2016. The primary study objective was to assess the impact of out-of-field lung parenchymal-only failure (OLPF) on overall survival (OS). RESULTS At a median follow-up of 5.9 years, the median OS was 2.7 years for all patients. Patients with OLPF did not have a significantly different OS compared to patients without failure (P = .0952, median OS 4.1 years with failure vs. 2.6 years never failure). Analysis in a 1:1 propensity score-matched cohort for Karnofsky performance status, comorbidity score, and smoking status showed no differences in OS between patients without failure and those with OLPF (P = .8). In subgroup analyses exploring the impact of time of failure on OS, patients with OLPF 6 months or more after diagnosis did not have significantly different OS compared to those without failure, when accounting for immortal time bias (P = .3, median OS 4.3 years vs. 3.5 years never failure). Only 7 patients in our data set experienced failure within 6 months of treatment, of which only 4 were confirmed to be true failures; therefore, limited data are available in our cohort on the impact of OLPF for ≤ 6 months on OS. CONCLUSION OLPF after SABR for early-stage NSCLC does not appear to adversely affect OS, especially if occurring at least 6 months after SABR. More studies are needed to understand if OLPF within 6 months of SABR is associated with adverse OS. These data are useful when discussing prognosis of lung parenchymal failures after initial SABR.
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Affiliation(s)
- May Elbanna
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Kevin Shiue
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Donna Edwards
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Alberto Cerra-Franco
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Namita Agrawal
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Jason Hinton
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Todd Mereniuk
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Christina Huang
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Joshua L Ryan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - Jessica Smith
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - Vasantha D Aaron
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - Heather Burney
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Yong Zang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Jordan Holmes
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Mark Langer
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard Zellars
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Tim Lautenschlaeger
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN.
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18
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Kobayashi AK, Horinouchi H, Nakayama Y, Ohe Y, Yotsukura M, Uchida S, Asakura K, Yoshida Y, Nakagawa K, Watanabe SI. Salvage surgery after chemotherapy and/or radiotherapy including SBRT and proton therapy: A consecutive analysis of 38 patients. Lung Cancer 2020; 145:105-110. [PMID: 32422344 DOI: 10.1016/j.lungcan.2020.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/02/2020] [Accepted: 04/14/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Local recurrence after definitive chemoradiation therapy, chemotherapy or radiotherapy with curative intent is often seen in patients with advanced non-small cell lung cancer. We evaluated the feasibility of salvage pulmonary resection after definitive non-surgical treatments and the postoperative morbidity and mortality rates. METHODS We retrospectively analyzed the characteristics and medical courses of patients who had undergone salvage pulmonary resections after local relapse or progression between January 2000 and March 2018 at the National Cancer Centre Hospital, Tokyo, Japan. All the candidates were evaluated, and curability by surgical resection was assessed by a multidisciplinary tumor board. RESULTS A total of 38 patient received salvage surgery: 26 of the patients were men, and the median age was 64.5 years (range, 20-78 years). Among these 38 patients, salvage lung resection was performed after chemoradiotherapy in 23 patients, after chemotherapy in 9 patients, and after radiotherapy with curative intent in 6 patients. The surgical resection methods were as follows: 26 lobectomies (2 bilobectomy, 15 right upper, 5 right lower, 1 right middle, 2 left lower and 1 left upper), 8 pneumonectomies (5 left and 3 right), and 4 segmentectomies. A complete resection (R0 resection) was achieved in 35 cases (92.1 %). Postoperative complications were observed in 3 patients (prolonged air leakage, bronchopleural fistula and surgical site infection in 1 patient each). No postoperative deaths occurred within 30 days after surgery. CONCLUSION Along with better outcomes after definitive chemoradiotherapy, chemotherapy, and radiotherapy, the frequency of salvage surgery has been increasing in recent years. Salvage pulmonary resections after definitive non-surgical treatments with curative intent are feasible with an acceptable morbidity rate and oncological outcomes in thoroughly assessed patients.
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Affiliation(s)
- Aki K Kobayashi
- Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Masaya Yotsukura
- Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shinsuke Uchida
- Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Keisuke Asakura
- Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yukihiro Yoshida
- Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Mitchell KG, Farooqi A, Ludmir EB, Corsini EM, Sepesi B, Gomez DR, Antonoff MB. Pulmonary resection is associated with long-term survival and should remain a therapeutic option in oligometastatic lung cancer. J Thorac Cardiovasc Surg 2020; 161:1497-1504.e2. [PMID: 32331820 DOI: 10.1016/j.jtcvs.2020.02.134] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Comprehensive local consolidative therapy led to improved overall survival in oligometastatic non-small cell lung cancer in a recent phase II trial, yet the role of pulmonary resection in ongoing oligometastatic trials is a matter of controversy. We sought to examine outcomes after pulmonary resection with radiotherapy used as a benchmark comparator. METHODS Patients treated at a single institution (2000-2017) with cT1-3N0-2M1 non-small cell lung cancer, 3 or less synchronous metastases, and performance status 0 to 1, and who received comprehensive local consolidative therapy were analyzed according to local consolidative therapy modality for the primary lesion. Progression was analyzed with death as a competing risk. RESULTS Of 88 patients meeting inclusion criteria, 63 (71.6%) received radiotherapy for local consolidative therapy modality for the primary lesion and 25 (28.4%) underwent surgery (lobectomy 20/25 [80.0%], pneumonectomy 3/25 [12.0%], sublobar 2/25 [8.0%]). Time from diagnosis to local consolidative therapy modality for the primary lesion was similar. Surgical patients were younger and had lower intrathoracic disease burden. Ninety-day post-treatment mortality was low (surgery 0/25 [0.0%], radiotherapy 1/63 [1.6%]). Median postoperative survival time was 55.2 months (95% confidence interval, 20.1 to not reached), with 1- and 5-year overall survivals of 95.7% and 48.0%, respectively. After radiotherapy, median postoperative survival time was 23.4 months (confidence interval, 17.2-35.9); 1- and 5-year overall survivals were 74.3% and 24.2%, respectively. No differences were observed between modalities in site of first failure, cumulative incidence of locoregional failure (P = .635), or systemic progression (P = .747). CONCLUSIONS Pulmonary resection is feasible and associated with long-term survival in selected patients with synchronous oligometastatic non-small cell lung cancer. Surgery should remain a local consolidative therapeutic option for patients with operable oligometastatic non-small cell lung cancer enrolled in ongoing and future randomized clinical trials.
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Affiliation(s)
- Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ahsan Farooqi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Erin M Corsini
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Daniel R Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
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20
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Brooks ED, Verma V, Senan S, De Baere T, Lu S, Brunelli A, Chang JY. Salvage Therapy for Locoregional Recurrence After Stereotactic Ablative Radiotherapy for Early-Stage NSCLC. J Thorac Oncol 2020; 15:176-189. [PMID: 31712134 PMCID: PMC7058490 DOI: 10.1016/j.jtho.2019.10.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/20/2019] [Accepted: 10/21/2019] [Indexed: 12/25/2022]
Abstract
Although isolated local (LRs) and regional recurrences (RRs) constitute a minority of post-stereotactic ablative radiotherapy (SABR) relapses, their management is becoming increasingly important as the use of SABR continues to expand. However, few evidence-based strategies are available to guide treatment of these potentially curable recurrences. On behalf of the Advanced Radiation Technology Committee of the International Association for the Study of Lung Cancer, this article was written to address management of recurrent disease. Topics discussed include diagnosis and workup, including the roles of volumetric and functional imaging as well as histopathologic methods; clinical outcomes after salvage therapy; patterns of recurrence after salvage therapy; and management options. Our main conclusions are that survival for patients with adequately salvaged LRs is similar to that for patients after primary SABR without recurrence, and survival for those with salvaged RRs (regardless of nodal burden or location) is similar to that of patients with de novo stage III disease. Although more than half of patients who undergo salvage do not develop a second relapse, the predominant pattern of second failure is distant, especially for RRs. Management requires rigorous multidisciplinary coordination. Isolated LRs can be managed with resection and nodal dissection, repeat SABR, thermal ablation, or systemic therapies. RRs can be treated with combined chemoradiotherapy, radiation or chemotherapy alone, or supportive services. Finally, regular and structured follow-up is recommended after post-SABR salvage therapy.
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Affiliation(s)
- Eric D Brooks
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Thierry De Baere
- Département d'imagerie, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Shun Lu
- Department of Medical Oncology, Shanghai Chest Hospital, Shanghai Jiao University, Shanghai, China
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Kennedy WR, Gabani P, Nikitas J, Robinson CG, Bradley JD, Roach MC. Repeat stereotactic body radiation therapy (SBRT) for salvage of isolated local recurrence after definitive lung SBRT. Radiother Oncol 2020; 142:230-235. [PMID: 31481272 PMCID: PMC7655115 DOI: 10.1016/j.radonc.2019.08.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Optimal management of isolated local recurrences after stereotactic body radiation therapy (SBRT) for early non-small cell lung cancer (NSCLC) is unknown and literature describing repeat SBRT for in-field recurrences after initial SBRT are sparse. We investigate the safety and efficacy of salvage SBRT for isolated local failures after initial SBRT for NSCLC. METHODS/MATERIALS Patients receiving SBRT for isolated local recurrence after initial SBRT for early NSCLC were identified using a prospective registry. Both courses were 3-5 fractions with a biologically effective dose (BED10) of ≥100 Gy. Local failure was defined as within 1 cm of the initial planning target volume (PTV) or an overlap of the ≥25% isodose lines of the first and second treatments. Failures >1 cm beyond the PTV and without ≥25% overlap, or with additional recurrence sites were excluded. Kaplan-Meier analysis was used to estimate survival. RESULTS A total 21 patients receiving salvage SBRT from 2008 to 2017 were identified. Median interval from initial SBRT to salvage SBRT was 23 months (7-52). Six patients (29%) had central tumors. Median follow-up time from salvage SBRT was 24 months (3-60). Median overall survival after salvage was 39 months. After reirradiation, two-year primary tumor control was 81%, regional nodal control was 89%, distant control was 75% and overall survival was 68%. Grade 2 pneumonitis occurred in 2 patients (10%) and grade 2 chest wall toxicity in 4 patients (19%). No grade 3+ toxicity was observed. CONCLUSIONS Salvage SBRT for isolated local failures after initial SBRT appears safe, with low treatment-related toxicity and encouraging rates of tumor control.
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Affiliation(s)
- William R Kennedy
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, United States
| | - Prashant Gabani
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, United States
| | - John Nikitas
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, United States
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, United States
| | - Jeffrey D Bradley
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, United States
| | - Michael C Roach
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, United States.
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22
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Mitchell KG, Nelson DB, Corsini EM, Correa AM, Erasmus JJ, Hofstetter WL, Mehran RJ, Roth JA, Swisher SG, Sepesi B, Walsh GL, Vaporciyan AA, Rice DC, Nguyen QN, Antonoff MB. Surveillance After Treatment of Non-Small-Cell Lung Cancer: A Call for Multidisciplinary Standardization. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 15:57-65. [PMID: 31875755 DOI: 10.1177/1556984519886281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Though interest in expansion of the use of less-invasive therapies among operable non-small-cell lung cancer (NSCLC) patients is growing, it is not clear that post-treatment surveillance has been comparable between treatment modalities. We sought to characterize institutional surveillance patterns after NSCLC therapy with stereotactic body radiation therapy (SBRT) and lobectomy. METHODS NSCLC patients treated with lobectomy or SBRT (2005 to 2016) at a single institution were identified. Natural language processing searched data fields within axial surveillance imaging reports for findings suggestive of recurrence. Duration and patterns of institutional surveillance were compared between the 2 groups. RESULTS Three thousand forty-two patients (73.5% lobectomy, 26.5% SBRT) met inclusion criteria. Patients had a longer median duration of surveillance after lobectomy (28.0 months vs SBRT 12.3 months, P < 0.001) and were more likely to undergo histopathological evaluation of clinically suspected relapse (206/274 [75.2%] vs SBRT 54/113 [47.8%], P < 0.001). Patients with clinical suspicion of recurrence had longer durations of institutional surveillance than those who did not among both cohorts (lobectomy 44.4 months vs 25.9, P < 0.001; SBRT 27.9 vs 10.3, P < 0.001). Landmark analyses at 1 and 3 years after therapy identified associations between receipt of lobectomy and ongoing surveillance at each time point (1 year odds ratio [OR] 2.10, P < 0.001; 3 years OR 1.71, P < 0.001) among all patients and those with documented stage I disease. CONCLUSIONS We identified potential heterogeneity in institutional surveillance patterns after treatment of NSCLC with 2 therapeutic modalities. As less-invasive treatment options for operable patients expand, it will be critical to implement rigorous surveillance paradigms across all modalities.
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Affiliation(s)
- Kyle G Mitchell
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David B Nelson
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erin M Corsini
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arlene M Correa
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeremy J Erasmus
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wayne L Hofstetter
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reza J Mehran
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack A Roth
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen G Swisher
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Boris Sepesi
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Garrett L Walsh
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ara A Vaporciyan
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David C Rice
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mara B Antonoff
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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23
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Ohtaki Y, Shimizu K, Saitoh JI, Kamiyoshihara M, Mogi A, Nakazawa S, Ohno T, Shirabe K. Is salvage surgery for patients with lung cancer after carbon ion radiotherapy easy or difficult? Interact Cardiovasc Thorac Surg 2019; 28:953-956. [PMID: 30649311 DOI: 10.1093/icvts/ivy350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/29/2018] [Accepted: 12/04/2018] [Indexed: 11/13/2022] Open
Abstract
Carbon ion radiotherapy (CIRT) shows higher local control rates and minimal damage to normal lung parenchyma compared with conventional radiotherapy; however, some patients experience local recurrence. The efficacy and safety of salvage surgery after CIRT for non-small-cell lung cancer are unclear. We reviewed clinical, surgical, pathological and prognostic data of 6 patients who underwent salvage surgery after CIRT between 2010 and 2015. All patients were men with a smoking history, and their median age was 67 years. The time from CIRT to surgery was 18 (range 12-24) months. All patients underwent at least lobectomy with mediastinal node dissection. Viable tumour cells were confirmed pathologically in all cases. Five patients required combined resection or extra procedure because of strong adhesions and the possibility of tumour extension; however, none of the patients had a tumour invasion to the adjacent organ. None of the patients had severe complications, perioperative death and local recurrence, and 3 patients are alive without recurrence (range 28-84 months). Salvage surgery appears to be safe and effective. Even though the tumours did not invade the adjacent organs, combined resection was required because of severe adhesion.
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Affiliation(s)
- Yoichi Ohtaki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kimihiro Shimizu
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Jun-Ichi Saitoh
- Department of Radiation Oncology, Faculty of Medicine, University of Toyama, Toyama, Japan.,Gunma University Heavy Ion Medical Center, Gunma, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Akira Mogi
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Seshiru Nakazawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Gunma, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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24
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Kumar SS, McGarry RC. Management of local recurrences and regional failure in early stage non-small cell lung cancer after stereotactic body radiation therapy. Transl Lung Cancer Res 2019; 8:S213-S221. [PMID: 31673526 DOI: 10.21037/tlcr.2019.09.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiation therapy (SBRT) is a very effective way to treat early stage non-small cell lung cancer (NSCLC) and small oligometastatic lung lesions with consistently high rates of local control, but both local and regional/distant recurrences still occur. The management of recurrences remains unsettled and may entail repeat SBRT, conventionally fractionated external beam RT (EF-EBRT), chemotherapy or surgery. Most patients with local recurrences [within the initial planning target volume (PTV)] can be salvaged successfully with good cancer specific survival. Nonetheless, proximity of the initial SBRT delivery to organs at risk (ribs, blood vessels, airways) may make retreatment more difficult. With attention to detail and careful patient selection, both surgery and reirradiation can be performed safely and effectively. Strategies for management of regional (nodal) recurrences may require conventional therapies tailored to the patterns of failure. The role of immunotherapy in salvage has not been elucidated as yet. We review here data on the available literature concerning salvage of SBRT lung patients.
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Affiliation(s)
- Sameera S Kumar
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Ronald C McGarry
- Department of Radiation Oncology, University of Kentucky, Lexington, KY, USA
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25
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Seo YS, Kim HJ, Wu HG, Choi SM, Park S. Lobectomy versus stereotactic ablative radiotherapy for medically operable patients with stage IA non-small cell lung cancer: A virtual randomized phase III trial stratified by age. Thorac Cancer 2019; 10:1489-1499. [PMID: 31124275 PMCID: PMC6558457 DOI: 10.1111/1759-7714.13103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although the choice between stereotactic ablative radiotherapy (SABR) and lobectomy for early-stage non-small cell lung cancer (NSCLC) has been debated for years, the two procedures have not yet been directly compared in a randomized trial. We conducted a virtual randomized phase III trial stratified by age to compare the effectiveness of lobectomy and SABR for medically operable patients with stage IA (AJCC eighth) NSCLC using the Markov model analysis. METHODS A Markov model was developed to simulate a cohort of patients aged 45-85 years with stage IA NSCLC who had undergone either lobectomy or SABR and were followed up for their remaining lifetime. Each virtual patient was randomly assigned to undergo lobectomy or SABR, and 10 000 patients were allocated to each group. All estimates of the variables were obtained by a systematic review of published articles. RESULTS The lobectomy group showed a better life expectancy than the SABR group, in patients under 75 years of age. However, no statistically significant difference was seen in patients 75 years or older. The predicted life expectancy was 9.43 and 8.70 years in 75-year-old patients in the lobectomy and SABR groups, respectively. However, the 95%CI for the difference in life expectancy between the two groups was - 0.06-1.50 years (P = 0.0689). CONCLUSIONS The Markov model showed no statistically significant difference in the expected overall survival in stage IA NSCLC patients who were older than 75 years and had undergone SABR or lobectomy.
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Affiliation(s)
- Young-Seok Seo
- Department of Radiation Oncology, ChungBuk National University Hospital, Chungcheongbuk-do, Republic of Korea.,Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiation Oncology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiation Oncology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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26
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Shirai K, Ohno T, Saitoh JI, Okamoto M, Katoh H, Murata K, Kawamura H, Musha A, Abe T, Mizukami T, Akahane K, Nakano T. Prospective Study of Isolated Recurrent Tumor Re-irradiation With Carbon-Ion Beams. Front Oncol 2019; 9:181. [PMID: 30972294 PMCID: PMC6445888 DOI: 10.3389/fonc.2019.00181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 03/04/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose: To perform a prospective study to evaluate the efficacy and safety of isolated recurrent tumor re-irradiation with carbon-ion radiotherapy (RT). Methods and Materials: The inclusion criteria were clinically proven recurrent tumors, measurable by computed tomography or magnetic resonance imaging, patients ≥ 16 years old, performance status scores between 0 and 2, isolated tumor at a previously irradiated site, and a life expectancy > 6 months. The exclusion criteria were tumor invasion into the gastrointestinal tract or a major blood vessel, uncontrolled infection, early recurrence (<3 months), and severe concomitant diseases. The primary end-point was the local control rate, the secondary end-points including the overall survival rate, and adverse events. Results: Between December 2013 and March 2016, 22 patients were enrolled in this prospective study. All patients were re-irradiated with carbon-ion RT with radical intent. Five patients had rectal cancer, 4 had sarcoma, 4 had lung cancer, 3 had hepatic cell carcinoma, and 6 had other tumors. The median follow-up time was 26 months. Eight patients developed local recurrence, and the 1- and 2-year local control rates were 71 and 60%, respectively. Eight patients died of their cancers and 2 died of other diseases. The 1- and 2-year overall survival rates were 76 and 67%, respectively. There were no grade 2 or higher acute adverse events and 4 patients (18%) developed grade 3 late adverse events. The group with the longer interval (>16 months) between the first RT and re-irradiation had significantly better outcomes than the shorter interval group (≤ 16 months). Conclusions: Re-irradiation, using carbon-ion RT with radical intent, had favorable local control and overall survival rates without severe toxicities for selected patients. Re-irradiation has the potential to improve clinical outcomes for isolated, local, recurrent tumors; further investigations are required to confirm the therapeutic efficacy.
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Affiliation(s)
- Katsuyuki Shirai
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Omiya-ku, Japan.,Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | | | | | - Hiroyuki Katoh
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | | | | | - Atsushi Musha
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Takanori Abe
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | | | - Keiko Akahane
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Omiya-ku, Japan
| | - Takashi Nakano
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
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27
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Abstract
PURPOSE OF REVIEW Significant advances have been made in the field of stereotactic ablative radiotherapy (SABR) for the treatment of pulmonary neoplasms in recent years. This review aims to summarize recent salient evidence on SABR for early-stage nonsmall cell lung cancer (ES-NSCLC). RECENT FINDINGS In medically inoperable patients, SABR remains the standard of care. The optimal SABR dosing regimen is being studied. Comparisons with non-SABR radiotherapy regimens with lower doses per fraction revealed benefit of SABR. In operable patients, no prospective clinical trial comparing SABR and surgery has been completed, although multiple trials are currently underway to address this question. SABR is generally cost-effective and safe in most patients, with preserved patient-reported quality of life. However, increased toxicity with SABR is noted in patients with disease close to, or invading the proximal tracheobronchial tree. Significant SABR-related toxicity and mortality is also reported in patients with coexisting interstitial lung disease. Considerations on pathologic confirmation, surveillance and multiple primaries are also addressed. SUMMARY SABR is an effective and safe treatment for inoperable ES-NSCLC. Ongoing trials and comparative effectiveness research will help to clarify SABR's role in various lung cancer indications going forward.
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28
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Matsuo Y. A Systematic Literature Review on Salvage Radiotherapy for Local or Regional Recurrence After Previous Stereotactic Body Radiotherapy for Lung Cancer. Technol Cancer Res Treat 2019; 17:1533033818798633. [PMID: 30198413 PMCID: PMC6131295 DOI: 10.1177/1533033818798633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose: The purpose of this review article was to summarize available data on the efficacy and safety of salvage radiotherapy for isolated local or regional recurrence after prior stereotactic body radiotherapy for lung cancer. Methods: Studies were systematically searched on PubMed, following which suitable papers were selected. Reported outcomes and toxicities were qualitatively reviewed. Results: Nineteen papers, which were retrospective studies based on single institution experiences, were selected. Sixteen papers were on salvage radiotherapy for local tumor recurrence, and the remaining 3 papers evaluated radiotherapy for regional failures after stereotactic body radiotherapy for lung cancer. Patient cohorts in the selected papers seemed very frail with 2-year survival of 30% to 40% after the salvage. Local control was reported to be approximately 60% to 70%, which is worse than that after primary stereotactic body radiotherapy. Reported rates of toxicity grade 3 or worse were considered acceptable. Larger target volume and central tumor localization were suggested as risk factors for severe toxicities. Dosimetric data on patients having toxicities were found to help with considering dose constraints for organs at risk. Conclusion: Based on data from a limited number of articles, salvage radiotherapy is a reasonable treatment option for select patients with local or regional tumor recurrence after prior stereotactic body radiotherapy for lung cancer. Optimal patient selection and dose prescription can be clarified with a larger study that include more data on experiences with salvage radiotherapy.
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Affiliation(s)
- Yukinori Matsuo
- 1 Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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29
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Brooks ED, Sun B, Feng L, Verma V, Zhao L, Gomez DR, Liao Z, Jeter M, O’Reilly M, Welsh JW, Nguyen QN, Erasmus JJ, Eapen G, Ahrar K, Antonoff MB, Hahn SM, Heymach JV, Rice DC, Chang JY. Association of Long-term Outcomes and Survival With Multidisciplinary Salvage Treatment for Local and Regional Recurrence After Stereotactic Ablative Radiotherapy for Early-Stage Lung Cancer. JAMA Netw Open 2018; 1:e181390. [PMID: 30646121 PMCID: PMC6324276 DOI: 10.1001/jamanetworkopen.2018.1390] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/26/2018] [Indexed: 12/19/2022] Open
Abstract
Importance Stereotactic ablative radiotherapy (SABR) is first-line treatment for patients with early-stage non-small cell lung cancer (NSCLC) who cannot undergo surgery. However, up to 1 in 6 such patients will develop isolated local recurrence (iLR) or isolated regional recurrence (iRR). Little is known about outcomes when disease recurs after SABR, or about optimal management strategies for such recurrences. Objective To characterize long-term outcomes for patients with iLR or iRR after SABR for early-stage NSCLC with the aim of informing treatment decision making for these patients with potentially curable disease. Design, Setting, and Participants In this cohort study, a retrospective review was conducted of 912 patients prospectively enrolled in an institutional database at a tertiary cancer center from January 1, 2004, through December 31, 2014. Main Outcomes and Measures Overall survival, progression-free survival, recurrence patterns, demographics, salvage techniques, patterns of salvage failure, and toxic effects. Results Of the 912 patients in the study (456 women and 456 men; median age, 72 years [range, 46-91 years]), 756 (82.9%) had T1 tumors at initial diagnosis; 502 tumors (55.0%) were adenocarcinomas and 309 tumors (33.9%) were squamous cell carcinomas. Of 912 patients with early-stage I to II NSCLC who received definitive SABR (50 Gy in 4 fractions or 70 Gy in 10 fractions), 102 developed isolated recurrence (49 with iLR and 53 with iRR), and 658 had no recurrence. Median times to recurrence after SABR were 14.5 months (range, 1.5-60.8 months) for iLR and 9.0 months (range, 1.9-70.7 months) for iRR; 39 of 49 patients (79.6%) with iLR and 48 of 53 patients (90.6%) with iRR underwent salvage with reirradiation, surgery, thermal ablation, or chemotherapy. Median follow-up times for patients with iLR or iRR were 57.2 months (interquartile range, 37.7-87.6 months) from initial SABR and 38.5 months (interquartile range, 19.9-69.3 months) from recurrence. Rates of overall survival at 5 years from initial SABR were no different between patients with iLR and salvage treatment (57.9%) and patients with no recurrence (54.9%; hazard ratio, 0.89; 95% CI, 0.56-1.43; P = .65) but were lower for patients with iRR and salvage treatment (31.1%; hazard ratio, 1.43; 95% CI, 1.00-2.34; P = .049). Patients receiving salvage treatment had longer overall survival than patients who did not (median, 37 vs 7 months after recurrence; hazard ratio, 0.40; 95% CI, 0.09-0.66; P = .006). Twenty-four of 87 patients (27.6%) who received salvage treatment for iLR or iRR subsequently developed distant metastases. No patient experienced grade 5 toxic effects after salvage treatment. Conclusions and Relevance Life expectancy after salvage treatment for iLR was similar to that for patients without recurrence, but survival after salvage treatment for iRR was similar to that of patients with stage III NSCLC. Patients who received salvage treatment had significantly improved survival. Because salvage treatment for iLR or iRR was based on a consistent multidisciplinary approach, this may help in clinical decision making.
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Affiliation(s)
- Eric D. Brooks
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Bing Sun
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Lei Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha
| | - Lina Zhao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Daniel R. Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Melenda Jeter
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Michael O’Reilly
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - James W. Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jeremy J. Erasmus
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston
| | - George Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Kamran Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston
| | - Mara B. Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Stephen M. Hahn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - John V. Heymach
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - David C. Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Joe Y. Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
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30
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Ogawa Y, Shibamoto Y, Hashizume C, Kondo T, Iwata H, Tomita N, Ogino H. Repeat stereotactic body radiotherapy (SBRT) for local recurrence of non-small cell lung cancer and lung metastasis after first SBRT. Radiat Oncol 2018; 13:136. [PMID: 30055636 PMCID: PMC6064122 DOI: 10.1186/s13014-018-1080-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/17/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study evaluated the safety and efficacy of repeat SBRT for local recurrence of stage I non-small-cell lung cancer (NSCLC) and solitary lung metastasis. METHODS Thirty-one patients with in-field local relapse of NSCLC (n = 23) or lung metastasis (n = 8) underwent repeat SBRT. All patients had grade 2 or lower radiation pneumonitis after the first SBRT. Local recurrence was diagnosed with CT and FDG-PET in 17 patients and by biopsy in 14. The median interval between the first and second SBRT was 18 months (range, 4-80). The first SBRT dose was mainly 48-52 Gy in 4 fractions (n = 25) according to the institutional protocols. Second SBRT doses were determined based on the tumor size and distance to organs at risk, and were mostly 48-52 Gy in 4 fractions (n = 13) or 60 Gy in 8 fractions (n = 13). RESULTS At 3 years, overall survival and local control rates were 36 and 53%, respectively, for all 31 patients. Four patients showed no further recurrence for > 5 years (63-111 months) after the second SBRT. Radiation pneumonitis after the second SBRT was grade 2 in 4 patients, and no grade 3 pneumonitis was observed. CONCLUSION Repeat SBRT was safe. Local control and survival rates were higher than expected. SBRT should be an important treatment option for local recurrence of NSCLC or lung metastasis after previous local SBRT. TRIAL REGISTRATION This retrospective study was approved by the ethics committee of our institution (September, 2017; approval number: 27-10).
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Affiliation(s)
- Yasutaka Ogawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Chisa Hashizume
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Takuhito Kondo
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Ogino
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan
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31
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Dickhoff C, Rodriguez Schaap PM, Otten RHJ, Heymans MW, Heineman DJ, Dahele M. Salvage surgery for local recurrence after stereotactic body radiotherapy for early stage non-small cell lung cancer: a systematic review. Ther Adv Med Oncol 2018; 10:1758835918787989. [PMID: 30023008 PMCID: PMC6047243 DOI: 10.1177/1758835918787989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/19/2018] [Indexed: 12/25/2022] Open
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).
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Affiliation(s)
- Chris Dickhoff
- Department of Surgery and Cardiothoracic Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | | | - Rene H J Otten
- Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - David J Heineman
- Department of Surgery and Cardiothoracic Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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Progress in Radiotherapy for Regional and Oligometastatic Disease in 2017. J Thorac Oncol 2018; 13:488-496. [PMID: 29452269 DOI: 10.1016/j.jtho.2018.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 12/25/2022]
Abstract
This review highlights key publications and abstracts in the field of radiation oncology for lung cancer in 2017 and attempts to place these in the context of developments for the broader thoracic oncology community.
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33
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Milano MT, Kong FMS, Movsas B. Stereotactic body radiotherapy as salvage treatment for recurrence of non-small cell lung cancer after prior surgery or radiotherapy. Transl Lung Cancer Res 2018; 8:78-87. [PMID: 30788237 DOI: 10.21037/tlcr.2018.08.15] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Treatment options for thoracic recurrences of non-small cell lung cancer (NSCLC) are limited. Stereotactic body radiation therapy (SBRT) is an emerging, potentially effective technology to manage recurrent NSCLC, although with limited prospective studies. This work reviews the outcomes of patients undergoing salvage SBRT for pulmonary recurrences after prior resection or prior radiotherapy for NSCLC. Following salvage SBRT, after prior external beam radiation (SBRT or conventionally fractionated), the 2-year overall survival (OS) ranged from 37% to 79% in 11 of the studies (397 patients) reviewed here, while the 2-year local control (LC) ranged from 37% to 90% in 6 studies that reported that outcome. Toxicity risks are acceptable albeit with appreciable risks of severe to potentially fatal toxicity, necessitating the need to weigh risks vs. benefits in the re-irradiation setting. There were fewer studies on the use of SBRT after prior resection. Following salvage SBRT, after prior resection, the 2-year OS ranged from 56% to 68% in 4 studies (131 patients) reviewed here, while the 2-year LC ranged from 83% to 100% in 3 of these studies. SBRT in the salvage setting after prior resection appeared to be well-tolerated, with toxicity risks comparable to historical patients treated with SBRT alone (i.e., SBRT without prior resection, which is not reviewed here). The data are limited due to the retrospective nature of published studies (all but 4 with <40 patients), with various clinical scenarios (i.e., original NSCLC stage, prior treatment, location of target amenable to salvage SBRT) and a range of SBRT dosing and techniques. More studies are needed to better understand the tumor control, survival and toxicity of SBRT for salvage therapy of NSCLC patients, as well as the potentially prognostic factors that could affect these outcomes.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Feng-Ming Spring Kong
- Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Cancer Institute at Henry Ford Health System, Detroit, MI, USA
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34
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Ronden M, van Sörnsen de Koste J, Johnson C, Slotman B, Spoelstra F, Haasbeek C, Blom G, Bongers E, Warner A, Ward A, Palma D, Senan S. Incidence of High-Risk Radiologic Features in Patients Without Local Recurrence After Stereotactic Ablative Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2018; 100:115-121. [DOI: 10.1016/j.ijrobp.2017.09.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/11/2017] [Accepted: 09/14/2017] [Indexed: 12/25/2022]
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35
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Weder W, Moghanaki D, Stiles B, Siva S, Rocco G. The great debate flashes: surgery versus stereotactic body radiotherapy as the primary treatment of early-stage lung cancer. Eur J Cardiothorac Surg 2017; 53:295-305. [DOI: 10.1093/ejcts/ezx410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/23/2017] [Accepted: 10/28/2017] [Indexed: 12/25/2022] Open
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36
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Wei B. The value of salvage surgery after stereotactic body radiotherapy failure: A sticky conundrum. J Thorac Cardiovasc Surg 2017; 154:700-701. [PMID: 28499594 DOI: 10.1016/j.jtcvs.2017.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Benjamin Wei
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama Birmingham School of Medicine, Birmingham, Ala.
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