61O - Outcome of surgical salvage for local failures following stereotactic ablative radiotherapy (SABR)

Date 16 April 2015
Event ELCC 2015
Session New treatment avenues
Topics Non-Small-Cell Lung Cancer, Early Stage
Surgery and/or Radiotherapy of Cancer
Presenter Naomi Verstegen
Citation Annals of Oncology (2015) 26 (suppl_1): 18-23. 10.1093/annonc/mdv048
Authors N. Verstegen1, F.J. Lagerwaard1, M.A. Paul2, E.F. Smit3, M.I.M. Versteegh4, J.J.A. Joosten5, B.J. Slotman1, S. Senan1
  • 1Dept Of Radiation Oncology, Vrije University Medical Centre (VUMC), 1007MB - Amsterdam/NL
  • 2Dept Of Cardiothoracic Surgery, Vrije University Medical Centre (VUMC), Amsterdam/NL
  • 3Dept. Of Pulmonary Diseases, Vrije University Medical Centre (VUMC), 1081 HV - Amsterdam/NL
  • 4Dept Of Thoracic Surgery, Leiden University Medical Center (LUMC), Leiden/NL
  • 5Dept Of Surgery, Westfriesgasthuis, Hoorn/NL

Abstract

Aim/Background

The literature on surgical salvage for local recurrences (LR) following SABR is limited to three case reports describing a total of 16 patients (Z. Allibhai 2012, F. Chen 2010, S. Neri 2010). We describe our experience with salvage surgery in seven patients who developed a LR after SABR.

Methods

Seven patients who underwent surgical salvage for a LR following SABR for peripheral pulmonary lesions were identified from a prospective database of all patients treated at the VUmc (N = 1208). Post-operative complications were graded using the Clavien-Dindo classification (D. Dindo 2004).

Results

Median time to LR was 27.6 months. Recurrences were diagnosed based on CT- and FDG-PET-scans, with two patients also having a pathological diagnosis of recurrence before surgery. All patients had peripheral tumors. One patient had extensive adhesions and it was unclear if this was due to tumor progression or previous radiotherapy as pleural metastases were found intra-operatively. A second patient had limited adhesions. All patients had viable tumor cells in the resection specimen. One patient had a persistent air leakage treated with a thoracic tube (grade IIIa) and there were two grade II complications. The median length of hospital stay was 9 days with a 30-day mortality of 0%. Lymph node dissection revealed mediastinal metastases in three patients, all of whom received adjuvant therapy. Median follow-up after surgery was 29 months, with a median overall survival of 35 months (mean 34 months, 95% CI 24–44 months). During follow-up, one patient developed disease progression manifesting as in regional nodes 29 months post-surgery.

Pt nr Primary disease Procedure pTNM Complications
1 NSCLC Wedge resection pT1bN0, R0 Grade II
2 NSCLC Lobectomy pT1aN0, R0 No
3 NSCLC Lobectomy pT2aN2, R0 Grade II
4 NSCLC Sleeve-lobectomy pT1aN2, R0 Grade IIIa
5 NSCLC Pneumonectomy because of extensive adhesions pT3N0, R2 No
6 M1 colonca Lobectomy M1, R0 No
7 NSCLC Lobectomy pT3N2, R0 No

Conclusions

Our experience with surgical salvage for LR post-SABR reveals only a single grade IIIa and a 30-day mortality of 0%, suggesting that salvage surgery can be safely performed in selected patients.

Disclosure

F.J. Lagerwaard, B.J. Slotman and S. Senan: have received speaker honoraria from Varian Medical systems. Dept of Radiation Oncology has a research agreement with Varian Medical Systems.

All other authors have declared no conflicts of interest.