early stage NSCLC

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Aug 10, 2016 - Aim: The literature on surgical salvage for local recurrences (LR) following SABR is limited to three case reports describing a total of 16 patients ...
Annals of Oncology 26 (Supplement 1): i18–i23, 2015 doi:10.1093/annonc/mdv048.2

early stage NSCLC 61O

OUTCOME OF SURGICAL SALVAGE FOR LOCAL FAILURES FOLLOWING STEREOTACTIC ABLATIVE RADIOTHERAPY (SABR)

Pt nr Primary disease Procedure

pTNM

Complications

1 2 3 4 5

NSCLC NSCLC NSCLC NSCLC NSCLC

pT1bN0, R0 pT1aN0, R0 pT2aN2, R0 pT1aN2, R0 pT3N0, R2

Grade II No Grade II Grade IIIa No

6 7

M1 colonca NSCLC

M1, R0 pT3N2, R0

No No

Wedge resection Lobectomy Lobectomy Sleeve-lobectomy Pneumonectomy because of extensive adhesions Lobectomy Lobectomy

Conclusions: Our experience with surgical salvage for LR post-SABR reveals only a single grade IIIa and a 30-day mortality of 0%, suggesting that salvage surgery can be safely performed in selected patients. Disclosure: F.J. Lagerwaard, B.J. Slotman and S. Senan: have received speaker honoraria from Varian Medical systems. Dept of Radiation Oncology has a research agreement with Varian Medical Systems. All other authors have declared no conflicts of interest.

abstracts

Aim: The literature on surgical salvage for local recurrences (LR) following SABR is limited to three case reports describing a total of 16 patients (Z. Allibhai 2012, F. Chen 2010, S. Neri 2010). We describe our experience with salvage surgery in seven patients who developed a LR after SABR. Methods: Seven patients who underwent surgical salvage for a LR following SABR for peripheral pulmonary lesions were identified from a prospective database of all patients treated at the VUmc (N = 1208). Post-operative complications were graded using the Clavien-Dindo classification (D. Dindo 2004). Results: Median time to LR was 27.6 months. Recurrences were diagnosed based on CT- and FDG-PET-scans, with two patients also having a pathological diagnosis of recurrence before surgery. All patients had peripheral tumors. One patient had extensive adhesions and it was unclear if this was due to tumor progression or previous

Table: 61O

© European Society for Medical Oncology 2015. Published by Oxford University Press on behalf of the European Lung Cancer Conference (ELCC) 2015 organisers. All rights reserved. For permissions, please email: [email protected].

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N.E. Verstegen1, F.J. Lagerwaard1, M.A. Paul2, E.F. Smit3, M.I.M. Versteegh4, J.J.A. Joosten5, B.J. Slotman1, S. Senan1 1 Dept of Radiation Oncology, Vrije University Medical Centre (VUMC), Amsterdam, Netherlands 2 Dept of Cardiothoracic Surgery, Vrije University Medical Centre (VUMC), Amsterdam, Netherlands 3 Dept. of Pulmonary Diseases, Vrije University Medical Centre (VUMC), Amsterdam, Netherlands 4 Dept of Thoracic Surgery, Leiden University Medical Center (LUMC), Leiden, Netherlands 5 Dept of Surgery, Westfriesgasthuis, Hoorn, Netherlands

radiotherapy as pleural metastases were found intra-operatively. A second patient had limited adhesions. All patients had viable tumor cells in the resection specimen. One patient had a persistent air leakage treated with a thoracic tube (grade IIIa) and there were two grade II complications. The median length of hospital stay was 9 days with a 30-day mortality of 0%. Lymph node dissection revealed mediastinal metastases in three patients, all of whom received adjuvant therapy. Median follow-up after surgery was 29 months, with a median overall survival of 35 months (mean 34 months, 95% CI 24–44 months). During follow-up, one patient developed disease progression manifesting as in regional nodes 29 months post-surgery.