96. A National Analysis of the Perioperative and Long-term Outcomes of Salvage Surgery after Definitive Radiation for Non-Small-Cell Lung Cancer

Objective: The safety and feasibility of salvage surgery after definitive radiation for non-small-cell lung cancer (NSCLC) has only been explored in single-institution studies. The objective of this study is to evaluate the outcomes of patients who undergo extended delay to surgery after definitive radiation in a national clinical database.

Methods: Perioperative outcomes and five-year overall survival of patients with NSCLC who underwent definitive radiation, with or without chemotherapy, followed by surgery from 2004-2018 in the National Cancer Database were evaluated. Radiation included any external beam therapy at a total dose of >60 g.y. Patients who underwent surgery at least 180 days following initiation of radiation therapy were included in the analysis. Subgroup analyses were conducted by operation type, surgical approach, and pathologic nodal status.

Results: From 2004-2018, 267 patients had an extended delay to surgery after definitive radiation. The clinical stage distribution was stage I-II in 47 (17.6%), stage IIIA in 96 (36.0%), stage IIIB in 102 (38.2%), stage IIIC in 12 (4.5%), and stage IV in 10 (3.8%) patients. Median dose of radiation received was 64.8 g.y (61.0-66.6). Median days from radiation to surgery was 219 (193-276). Lobectomy (65.5%) was the most common operation, followed by pneumonectomy (17.6%) and wedge resection (6.7%). Of all operations, 67.7% and 32.4% were performed via thoracotomy and thoracoscopic techniques respectively. For wedge resection, lobectomy, and pneumonectomy, the 30-day readmission rate was 0%, 3.5%, and 6.5%, the 30-day mortality rate was 0%, 3.0%, and 8.9%, and the 90-day mortality rate was 0%, 5.5%, and 13.6% respectively. Five-year survival by pathologic N status was 46.0% (95% CI: 36.5-55.1) for pN0, 46.2% (95% CI: 19.2-69.6) for pN1, and 29.4% (95% CI: 12.5-48.6) for pN2.

Conclusion: In this national analysis, extended delay to surgery after definitive radiation was found to be feasible and associated with reasonable overall survival, even among patients with residual nodal disease. These findings suggest that, in carefully selected patients, salvage surgery can be considered in the setting of recurrent or persistent locoregional disease after definitive radiation.

Alexandra Potter (1), Allison Rosenstein (1), Max Pan (1), Vignesh Raman (2), Ashok Muniappan (1), Mark Berry (3), Chi-Fu Yang (1), (1) Massachusetts General Hospital, Boston, MA, (2) Duke University Medical Center, DURHAM, NC, (3) Stanford, Stanford, CA

Allison Rosenstein

Abstract Presenter

Allie Rosenstein is a lung cancer researcher and the President of the Harvard Chapter of the American Lung Cancer Screening Initiative.

Specialties: Thoracic, Anatomy and Conditions, Lung--Cancer, Treatment/Procedure/Operation/Surgery, Lung--Cancer