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The Role of Salvage Surgery After Definitive Radiation for Non-small-cell Lung Cancer - PubMed (nih.gov)
Rosenstein AL, Potter AL, Senthil P, Raman V, Kumar A, Muniappan A, Berry M, Jeffrey Yang CF. The Role of Salvage Surgery After Definitive Radiation for Non-small-cell Lung Cancer. Ann Thorac Surg. 2023 Aug 4:S0003-4975(23)00823-8. doi: 10.1016/j.athoracsur.2023.07.035. Epub ahead of print. PMID: 37544397.
Background: To evaluate outcomes of patients who undergo extended delay to surgery after definitive radiation for non-small-cell lung cancer (NSCLC).
根治性放化疗后局部复发率：23-35%
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.
What is Salvage Surgery?
接受治愈性化放疗后仍存在肿瘤，接受手术以减少局部复发。并不是复发了再接受手术。
Higher doses of radiation,coupled with longer periods of time between radiation and surgery, can contribute to increased radiation fibrosis and tissue hypovascularity at the time of salvage surgery.
较高的全肺切除率
The rate of pneumonectomy was 14.6% (n=24), 27.8% (n=5), and 29.6% (n=8) among patients diagnosed with pathologic N0, N1, and N2 disease, respectively.
很多的手术并未得到完整的病理分期
Of the 293 patients in the study cohort, 203 (69.3%) had known pathologic staging.
The high proportion of patients with unknown pathologic N status is possibly explained by the following considerations. For example, radiation—especially at high doses—could lead to obliterated planes and could increase the complexity and difficulty of subsequent mediastinal lymph node dissection.
术后/围术期/90天死亡率
Among the 7 patients with pathologic N2 disease who underwent pneumonectomy and had known ninety-day mortality data, the ninety-day mortality rate was 42.9% compared to 11.1% among patients with pathologic N2 disease who underwent operations other than pneumonectomy.
与PACIFIC这样的模式相比会有优势吗？
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