title: Salvage surgery for local recurrence after carbon ion radiotherapy for patients with lung cancer.
abstract: OBJECTIVE
  Carbon ion radiotherapy (CIRT) has been expected to be an alternative for surgery for early-stage non-small-cell lung cancer (NSCLC) and adopted as the second-best choice even in operable patients although local recurrence after CIRT is sometimes experienced. The purpose of this study was to investigate the demographic data, perioperative courses and therapeutic outcomes of patients who underwent salvage resection for local recurrence after CIRT.
  
  
  METHODS
  From November 1994 to February 2012, CIRT was applied for 602 c-T1/T2/T3N0M0 NSCLC lesions of 599 patients at the National Institute of Radiological Science. A total of 95 (16%) patients were diagnosed as having local recurrence, of whom 12 underwent salvage surgeries. The medical records were retrospectively reviewed.
  
  
  RESULTS
  There were 7 men and 5 women (mean age, 63 ± 7.4 years). The clinical stages upon initial presentation with NSCLC were as follows: 4 IA, 7 IB and 1 IIB. All the patients were operable, but refused surgery and underwent CIRT. The median progression-free survival time after CIRT was 20 months (range, 7.1-77 months), and salvage surgery was performed at a median of 24 months (range, 9-78 months) after CIRT. All surgeries were successfully performed without any significant CIRT-related adhesions during the surgery, resulting in no mortality or Clavien-Dindo grade 3-4 postoperative complications. However, the distribution of pathological stages was as follows: 4 IA, 3 IB, 2 IIB, 2 IIIA and 1 IV, which included 6 upstages from the clinical stages before CIRT. The Kaplan-Meier estimate of overall survival after the salvage surgery showed that the 3-year survival rate was 82%.
  
  
  CONCLUSIONS
  The dose intensity of CIRT spared the hilum of the lungs and parietal pleura, none of the patients developed adhesions outside of the radiation field, such that the salvage surgeries for local recurrence after CIRT were safe and feasible.
authors.affiliation: Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan Pneumothorax Research Center and Thoracic Surgery Division, Nissan Tamagawa Hospital, Tokyo, Japan tmizobuc@gmail.com.
authors.forename: Teruaki
authors.initials: T
authors.lastname: Mizobuchi
authors.affiliation: Research Center for Charged Particle Therapy, National Institute of Radiological Science, Chiba, Japan.
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Research Center for Charged Particle Therapy, National Institute of Radiological Science, Chiba, Japan.
authors.forename: Mio
authors.initials: M
authors.lastname: Nakajima
authors.affiliation: Research Center for Charged Particle Therapy, National Institute of Radiological Science, Chiba, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Baba
authors.affiliation: Department of Thoracic Surgery, Okayama University Graduate School of Medicine, Okayama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Miyoshi
authors.affiliation: Department of Thoracic Surgery, Kanagawa Cancer Center Hospital, Yokohama, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Nakayama
authors.affiliation: Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Syun-Ichi
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Department of Pulmonology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Katoh
authors.affiliation: Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Tadasu
authors.initials: T
authors.lastname: Kohno
authors.affiliation: Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kamiyoshihara
authors.affiliation: Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Nishio
authors.affiliation: Research Center for Charged Particle Therapy, National Institute of Radiological Science, Chiba, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kamada
authors.affiliation: Research Chiba Foundations for Health Promotion and Disease Prevention Center, Chiba, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Fujisawa
authors.affiliation: Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yoshino
mesh_terms: D000368:Aged; D005260:Female; D063193:Heavy Ion Radiotherapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D012189:Retrospective Studies; D016879:Salvage Therapy
keywords: Carbon ion radiotherapy; Local recurrence; Lung cancer; Pulmonary resection; Salvage surgery