Schreiner Waldemar, Dudek Wojciech, Lettmaier Sebastian, Fietkau Rainer, Sirbu Horia
Division for Thoracic Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, University Hospital, Erlangen, Germany.
Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, University Hospital, Erlangen, Germany.
Thorac Cardiovasc Surg. 2018 Mar;66(2):135-141. doi: 10.1055/s-0037-1606597. Epub 2017 Oct 9.
The incidence of local failure and residual tumor after definitive chemoradiation therapy (dCRT) for locally advanced non-small-cell lung cancer remains high, irrespective of applied radiation dose (>59 Gy). So-called salvage surgery has been suggested as a feasible treatment option after failure of definitive chemoradiation for locally advanced non-small cell lung cancer (NSCLC). Experience with salvage lung surgery (SLS) is limited, and long-term survival is rarely reported. Patient selection criteria for surgical lung salvage are not defined. The aim of this study was to assess postoperative survival and perioperative morbidity/mortality to identify prognostic factors and to define patient selection criteria.
Records of 13 consecutive patients with locally advanced NSCLC, who underwent SLS at a single institution between March 2011 and November 2016, were reviewed. Descriptive statistics were applied for patient characteristics and surgical and oncological outcome. Survival rates were calculated using the Kaplan-Meier method and were compared with the long-rank test.
All patients initially received curative-intent definitive chemoradiation with median radiation doses of 66 Gy (range 59.4-72) and concurrent platinum-based chemotherapy. Clinical tumor stage before definitive chemoradiation was IIIA in 9, IIIB in 3, IV in 1 patients. Median interval between definitive chemoradiation and salvage surgery was 6.7 months. Perioperative morbidity and 30-days-mortality was 38% and 7.7%, respectively. The median postoperative survival and estimated 5-year survival rate were 29.7 months and 46%, respectively.
SLS in patients with locally advanced non-small cell lung surgery following dCRT is feasible, prolongs long-term survival and allows local tumor control. Selection criteria remain undefined and patients should be considered surgical candidates during multidisciplinary team conference.
对于局部晚期非小细胞肺癌，无论采用何种放射剂量（>59 Gy），根治性放化疗（dCRT）后局部复发和残留肿瘤的发生率仍然很高。对于局部晚期非小细胞肺癌（NSCLC），在根治性放化疗失败后，所谓的挽救性手术被认为是一种可行的治疗选择。挽救性肺手术（SLS）的经验有限，很少有长期生存的报道。肺挽救手术的患者选择标准尚未明确。本研究的目的是评估术后生存率和围手术期发病率/死亡率，以确定预后因素并明确患者选择标准。
回顾了2011年3月至2016年11月期间在单一机构接受SLS的13例连续局部晚期NSCLC患者的记录。对患者特征、手术和肿瘤学结果进行描述性统计。采用Kaplan-Meier方法计算生存率，并与长秩检验进行比较。
所有患者最初均接受了根治性意图的根治性放化疗，中位放射剂量为66 Gy（范围59.4 - 72），并同时进行铂类化疗。根治性放化疗前临床肿瘤分期为IIIA期9例，IIIB期3例，IV期1例。根治性放化疗与挽救性手术之间的中位间隔时间为6.7个月。围手术期发病率和30天死亡率分别为38%和7.7%。术后中位生存期和估计5年生存率分别为29.7个月和46%。
dCRT后局部晚期非小细胞肺癌患者的SLS是可行的，可延长长期生存并实现局部肿瘤控制。选择标准仍未明确，患者应在多学科团队会议期间被视为手术候选者。
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