The Role of Salvage Resection After Definitive Radiation Therapy for Non-small Cell Lung Cancer

Allison L Rosenstein; Alexandra L Potter; Priyanka Senthil; Vignesh Raman; Arvind Kumar; Ashok Muniappan; Mark F Berry; Chi-Fu Jeffrey Yang

doi:10.1016/j.athoracsur.2023.07.035

The Role of Salvage Resection After Definitive Radiation Therapy for Non-small Cell Lung Cancer

Ann Thorac Surg. 2023 Nov;116(5):997-1003. doi: 10.1016/j.athoracsur.2023.07.035. Epub 2023 Aug 6.

Authors

Allison L Rosenstein¹, Alexandra L Potter¹, Priyanka Senthil¹, Vignesh Raman², Arvind Kumar³, Ashok Muniappan¹, Mark F Berry⁴, Chi-Fu Jeffrey Yang⁵

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
² Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
³ Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
⁴ Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California.
⁵ Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: cjyang@mgh.harvard.edu.

PMID: 37544397
DOI: 10.1016/j.athoracsur.2023.07.035

Abstract

Background: This study evaluated outcomes of patients who undergo extended delay to resection after definitive radiation therapy for non-small cell lung cancer (NSCLC).

Methods: Perioperative outcomes and 5-year overall survival of patients with NSCLC who underwent definitive radiation therapy, followed by resection, from 2004 to 2020 in the National Cancer Database were evaluated. Patients who underwent resection >180 days after the initiation of radiation therapy (including any external beam therapy at a total dose of >60 Gy) were included in the analysis. Subgroup analyses were conducted by operation type and pathologic nodal status.

Results: From 2004 to 2020, 293 patients had an extended delay to resection after definitive radiation therapy. The clinical stage distribution was stage I to II in 53 patients (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%). Median dose of radiation therapy received was 64.8 Gy (interquartile range, 60.0-66.6 Gy). Median days from radiation therapy to resection were 221.0 (interquartile range, 193.0-287.0) days. 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 30-day readmission rate was 4.8%, 4.8%, and 8.3%, the 30-day mortality rate was 0%, 3.4%, and 6.4%, and the 90-day mortality rate was 0%, 6.2%, and 12.8%, respectively. Overall survival at 5 years 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 resection after definitive radiation therapy was associated with acceptable perioperative outcomes among a highly selected patient cohort.