Abstract 115P
Background
In patients with stage IIIB, IIIC and IV non-small cell lung cancer (NSCLC), current guidelines recommend systemic therapy with or without radiotherapy. Despite this treatment, complete response in these stages is rare and median overall survival (mOS) ranges between 6 and 48 months. However, in a selected group of patients with either residual disease after partial response to first-line systemic treatment, or oligo-recurrence, surgical resection within a salvage concept is under evaluation as an additional treatment option. Currently, clinical data on the outcome of this approach are scarce and candidate selection remains challenging. We therefore aimed to assess short- and long-term outcomes of salvage surgery in advanced NSCLC.
Methods
We retrospectively identified 35 patients with initial stage IIIB, IIIC, or IV NSCLC who underwent anatomical lung resection to treat local relapse or residual disease between 2001–2023. All patients had initially received systemic treatment with or without radiotherapy. Patients were only included if surgical resection had not been part of the first-line treatment approach.
Results
Among 35 patients (54% male, mean age 60.2 ± 10.9 years), the initial clinical UICC NSCLC stage was IIIB in 4, IIIC in 4, IVA in 22, and IVB in 5 cases. 17 patients (48.6%) were treated with curative intent and had received radiochemotherapy. The indication for salvage resection was residual disease after first-line treatment in 21 cases (60%) and local relapse in 14 cases (40%). Lung resections included 22 lobectomies (6 sleeve-resections), 11 pneumonectomies, 1 bilobectomy and 1 segmentectomy. R0-resection was achieved in 94.3% and pathological complete response was found in 22.9% of all resections. 30 and 90-day mortality were 0% and 11.4%, respectively. mOS and progression-free survival (calculated from the date of salvage surgery) were 69 months [95% CI 37–101 months] and 22 months [95% CI: 0–45months] respectively.
Conclusions
In selected patients with advanced stage NSCLC presenting with local relapse or residual disease after systemic treatment, anatomical salvage lung resections are associated with a favorable short- and long-term outcome. However, further prospective evaluation of this treatment approach is required.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
I. Opitz: Financial Interests, Institutional, Advisory Board: AstraZeneca; Financial Interests, Institutional, Research Grant: Medtronic, Roche; Financial Interests, Institutional, Invited Speaker: Roche. All other authors have declared no conflicts of interest.