title: Eight cases of salvage pulmonary resection for residual disease or isolated local recurrence detected after definitive chemoradiotherapy for N2 Stage-IIIA lung cancer.
abstract: OBJECTIVE
  The concept of salvage pulmonary resection after definitive chemoradiotherapy (dCRT) is not yet commonly accepted in lung cancer treatment. We report our experience of eight patients in whom we performed salvage pulmonary resection for residual disease or isolated locoregional recurrence detected after dCRT.
  
  
  METHODS
  Between 2005 and 2014, we performed salvage pulmonary resection for eight patients with N2 Stage-IIIA non-small cell lung cancer. The patients had initially received dCRT (radiation ≤ 60 Gy), but eventually underwent pulmonary resection with curative intent for residual disease or isolated locoregional recurrence. The postoperative complications, incidence of recurrence, and survival parameters were evaluated.
  
  
  RESULTS
  Salvage pulmonary resection was performed in four patients with residual disease and four patients with locoregional recurrence. Complete resection was successfully performed in all eight patients. Postoperative complications were observed in three patients, however, there were no postoperative mortalities. One patient developed local recurrence in a mediastinal lymph node and two patients died. Of the two fatalities, one was related to lung cancer. The estimated 5-year survival rate of the eight patients was 75.0%.
  
  
  CONCLUSIONS
  We report our experience of salvage pulmonary resection performed for residual disease or isolated locoregional recurrence diagnosed after dCRT in eight patients with locally advanced lung cancer. Although the postoperative complication rate was high, the survival data were favorable. A larger study is needed to confirm the safety and feasibility of salvage pulmonary resection after dCRT.
authors.affiliation: Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan. Electronic address: ssawada@shikoku-cc.go.jp.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Sawada
authors.affiliation: Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Suehisa
authors.affiliation: Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ueno
authors.affiliation: Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Yamashita
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018365:Neoplasm, Residual / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy / Q000379:methods*; D012494:Sampling Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: chemotherapy; lung cancer; outcomes; radiation; salvage resection; surgery