title: Salvage surgery for local failures after stereotactic ablative radiotherapy for early stage non-small cell lung cancer.
abstract: BACKGROUND
  The literature on surgical salvage, i.e. lung resections in patients who develop a local recurrence following stereotactic ablative radiotherapy (SABR), is limited. We describe our experience with salvage surgery in nine patients who developed a local recurrence following SABR for early stage non-small cell lung cancer (NSCLC).
  
  
  METHODS
  Patients who underwent surgical salvage for a local recurrence following SABR for NSCLC were identified from two Dutch institutional databases. Complications were scored using the Dindo-Clavien-classification.
  
  
  RESULTS
  Nine patients who underwent surgery for a local recurrence were identified. Median time to local recurrence was 22 months. Recurrences were diagnosed with CT- and/or 18FDG-PET-imaging, with four patients also having a pre-surgical pathological diagnosis. Extensive adhesions were observed during two resections, requiring conversion from a thoracoscopic procedure to thoracotomy during one of these procedures. Three patients experienced complications post-surgery; grade 2 (N = 2) and grade 3a (N = 1), respectively. All resection specimens showed viable tumor cells. Median length of hospital stay was 8 days (range 5-15 days) and 30-day mortality was 0 %. Lymph node dissection revealed mediastinal metastases in 3 patients, all of whom received adjuvant therapy.
  
  
  CONCLUSIONS
  Our experience with nine surgical procedures for local recurrences post-SABR revealed two grade IIIa complications, and a 30-day mortality of 0 %, suggesting that salvage surgery can be safely performed after SABR.
authors.affiliation: Department of Radiation Oncology, VU University Medical Center Amsterdam, De Boelelaan 1117, Postbox 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Verstegen
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Alexander P W M
authors.initials: AP
authors.lastname: Maat
authors.affiliation: Department of Radiation Oncology, VU University Medical Center Amsterdam, De Boelelaan 1117, Postbox 7057, 1007 MB, Amsterdam, The Netherlands. FJ.Lagerwaard@vumc.nl.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Lagerwaard
authors.affiliation: Department of Cardiothoracic Surgery, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marinus A
authors.initials: MA
authors.lastname: Paul
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Michel I
authors.initials: MI
authors.lastname: Versteegh
authors.affiliation: Department of Surgery, Westfriesgasthuis Hoorn, Hoorn, The Netherlands.
authors.forename: Joris J
authors.initials: JJ
authors.lastname: Joosten
authors.affiliation: Department of Surgery, Gelre Hospital Apeldoorn, Apeldoorn, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Lastdrager
authors.affiliation: Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Egbert F
authors.initials: EF
authors.lastname: Smit
authors.affiliation: Department of Radiation Oncology, VU University Medical Center Amsterdam, De Boelelaan 1117, Postbox 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Slotman
authors.affiliation: Department of Radiation Oncology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Joost J M E
authors.initials: JJ
authors.lastname: Nuyttens
authors.affiliation: Department of Radiation Oncology, VU University Medical Center Amsterdam, De Boelelaan 1117, Postbox 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Suresh
authors.initials: S
authors.lastname: Senan
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D009367:Neoplasm Staging; D016634:Radiosurgery; D016879:Salvage Therapy