Salvage surgery for local recurrences after stereotactic ablative radiotherapy of colorectal pulmonary metastases

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.

TAMOF-1 for capture and separation of the main flue gas components

Experimental screening of Metal Organic Frameworks (MOFs) for separation applications can be costly and time-consuming. Computational methods can provide many benefits in this process, as expensive compounds and a wide range of operating conditions can be tested while crucial mechanistic insights are gained. TAMOF-1, a recently developed MOF, stands out for its exceptional stability, robustness and cost-effective synthesis. Its good CO2 uptake capacity makes it a promising agent for flue gas separation applications. In this work, we combine experiments with simulations at the atomistic and numerical level to investigate the adsorption and separation of CO2 and N2. Using Monte Carlo simulations, we accurately reproduce experimental adsorption isotherms and elucidate the adsorption mechanisms. TAMOF-1 effectively separates CO2 from N2 because of preferential binding sites near Cu2+ atoms. To assess separation performance in equilibrium at different conditions along the entire isotherm pressure range, adsorbed mole fractions, selectivities, and the trade-off between selectivity and uptake (TSN) are calculated. The dynamic separation performance is assessed by breakthrough experiments and numerical simulations, demonstrating efficient dynamic separation of CO2 and N2, with CO2 being retained in the column.