Salvage pneumonectomy after definitive chemo-radiotherapy

Luca Bertolaccini, Lorenzo Spaggiari

Abstract

Guidelines and recommendations for not small cell lung cancer in stage IIIA include induction chemoradiotherapy followed by surgical resection, induction chemotherapy followed by surgery, and definitive chemoradiotherapy. After definitive high dose chemoradiation, >35% of patients will locally relapse. In a slight proportion of patients, the recurrent disease is isolated local relapse not suitable for curative-intent radiotherapy. Therefore, complete resection (salvage surgery) is the first curative-intent modality of treatment. Salvage surgery is technically feasible in high-volume referral centres when indicated. Even if salvage surgery is a challenging operation, can be performed with adequate morbidity, mortality, and long-term outcomes, even when anatomical resections larger than a lobectomy or extended resections are necessary. The prognostic analyses of salvage surgery could offer a background for further discussion of the factors determinant to undertake this strategy. Strictly multidisciplinary meetings are crucial to deciding on salvage lung resection. Specific attention should be paid to the recurrence location of original cancer. The task remains in identifying patients promptly with persistent tumour after prior treatment and with local failure. This careful selection and the surgical expertise allow for successful salvage pneumonectomy with acceptable morbidity.