Salvage Lung Resection for Non-small Cell Lung Cancer After Stereotactic Body Radiotherapy in Initially Operable Patients

Background: Stereotactic body radiotherapy (SBRT) has emerged as a curative treatment for medically inoperable patients with early-stage non-small cell lung cancer (NSCLC). Since NSCLC recurs locally in 10% of the patients treated with SBRT, salvage lung resection after SBRT may be considered in these cases. To further understand the indications for salvage surgery and the pathogenesis of tumor recurrence in these patients, we retrospectively reviewed cases treated at our institution. Methods: SBRT has been performed in patients with early-stage NSCLC at Kyoto University Hospital. We encountered 5 patients who underwent salvage lung resection for NSCLC after SBRT. Results: All the patients were initially operable, but they chose SBRT. After SBRT, the tumors shrank initially in all patients, but increased in size within 18 months of SBRT in the case of 4 patients. During surgical extirpation, we did not find any significant SBRT-related adhesions in any of the patients. Conclusions: We have successfully treated 5 patients who underwent salvage lung resection for early-stage NSCLC after SBRT. We found that surgical resection was feasible after SBRT.