title: Salvage surgery for locoregional recurrence or persistent tumor after high dose chemoradiotherapy for locally advanced non-small cell lung cancer.
abstract: OBJECTIVE
  Curative intent treatment options for locoregional recurrence or persistent tumor after radical chemoradiotherapy for locally-advanced non-small cell lung cancer (NSCLC) are limited. In selected patients, surgery can be technically feasible, although it is widely believed to be hazardous. As data regarding the outcome of this approach is sparse, we evaluated our institutional experience with salvage surgery.
  
  
  METHODS
  Patients with a pulmonary resection for in-field locoregional recurrence or persistent tumor after high dose chemoradiotherapy (≥60 Gy) for the treatment of non-small cell lung cancer, were identified and retrospectively analyzed.
  
  
  RESULTS
  A total of 15 patients treated between January 2007 and August 2015 were eligible for evaluation. In 13 patients (87%), the indication for surgery was a locoregional recurrence, while 2 patients had persistent tumor. The prior median radiotherapy dose was 66 Gy (range 60-70). All patients underwent an anatomical resection, with 8 patients having a pneumonectomy, and all pathological specimens revealed the presence of viable tumor. The in-hospital morbidity rate was 40% (6 patients), and the 90-day mortality rate was 6.7% (1 patient). Median follow-up was 12.1 months. The estimated median overall and event-free survivals were 46 months and 43.6 months, respectively.
  
  
  CONCLUSIONS
  Salvage surgery for locoregional recurrence or persistent tumor after high dose chemoradiotherapy, resulted in acceptable morbidity, mortality and promising outcome. It should be considered as a treatment option for selected patients.
authors.affiliation: Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. Electronic address: chrisdickhoff@yahoo.com.
authors.forename: C
authors.initials: C
authors.lastname: Dickhoff
authors.affiliation: Department of Radiation Oncology VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Dahele
authors.affiliation: Department of Cardiothoracic Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Paul
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: van de Ven
authors.affiliation: Department of Pulmonary Diseases, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: de Langen
authors.affiliation: Department of Radiation Oncology VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Senan
authors.affiliation: Department of Pulmonary Diseases, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands.
authors.forename: E F
authors.initials: EF
authors.lastname: Smit
authors.affiliation: Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands.
authors.forename: K J
authors.initials: KJ
authors.lastname: Hartemink
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016879:Salvage Therapy; D016896:Treatment Outcome
keywords: Chemoradiotherapy; Locoregional recurrence; Non-small cell lung cancer; Salvage surgery; Survival