The Role of Salvage Surgery After Definitive Radiation for Non-small-cell Lung Cancer.

Abstract

BACKGROUND: To evaluate outcomes of patients who undergo extended delay to surgery after definitive radiation for non-small-cell lung cancer (NSCLC).METHODS: Perioperative outcomes and five-year overall survival of patients with NSCLC who underwent definitive radiation followed by surgery from 2004-2020 in the National Cancer Database were evaluated. Patients who underwent surgery >180 days following initiation of radiation therapy (including any external beam therapy at a total dose of >60 g.y) were included in the analysis. Subgroup analyses were conducted by operation type and pathologic nodal status.RESULTS: From 2004-2020, 293 patients had an extended delay to surgery after definitive radiation. The clinical stage distribution was stage I-II in 53 (18.1%), stage IIIA in 111 (37.9%), stage IIIB in 106 (36.2%), stage IIIC in 13 (4.4%), and stage IV in 10 (3.4%) patients. Median dose of radiation received was 64.8 (60.0-66.6) g.y. Median days from radiation to surgery was 221.0 (193.0, 287.0). Lobectomy (64.5%) was the most common operation, followed by pneumonectomy (17.1%) and wedge resection (7.5%). For wedge resection, lobectomy, and pneumonectomy, the thirty-day readmission rate was 4.8%, 4.8%, and 8.3%, the thirty-day mortality rate was 0%, 3.4%, and 6.4%, and the ninety-day mortality rate was 0%, 6.2%, and 12.8% respectively. Five-year overall survival for patients with pN0, pN1, and pN2 disease was 38.6% (95% CI:30.0-47.2), 43.3% (95% CI:16.3-67.9), and 24.0% (95% CI:9.8-41.7), respectively.CONCLUSIONS: In this national analysis, extended delay to surgery after definitive radiation was associated with acceptable perioperative outcomes among a highly selected patient cohort.

View details for DOI 10.1016/j.athoracsur.2023.07.035

View details for PubMedID 37544397