TY - JOUR
T1 - Salvage surgery for local recurrences after stereotactic ablative radiotherapy of colorectal pulmonary metastases
AU - van Dorp, Martijn
AU - Ünal, Semih
AU - Gooijer, Simone
AU - Dickhoff, Chris
AU - van den Broek, Frank Jozef Christiaan
AU - Kazemier, Geert
AU - Schreurs, Wilhelmina Hendrika
AU - Schneiders, Famke Lorelei
AU - Dahele, Max
AU - Heineman, David Jonathan
N1 - Funding Information: Max Dahele declares honoraria and research grants from Varian Medical Systems outside the scope of this work. The remaining authors declare no conflict of interest. Publisher Copyright: © 2023 The Authors. Journal of Surgical Oncology published by Wiley Periodicals LLC.
PY - 2023/12
Y1 - 2023/12
N2 - Introduction: Local control following stereotactic ablative radiotherapy (SABR) for patients with colorectal pulmonary metastases is reportedly lower than for metastases from other tumors. Such recurrences may still be amenable to salvage therapy. We describe our experience with salvage surgery in 17 patients. Methods: Patients who underwent salvage metastasectomy for a local recurrence following SABR for colorectal pulmonary metastases were identified from the surgical institutional databases of three Dutch major referral hospitals. Kaplan–Meier survival analysis was performed to determine survival. Results: Seventeen patients underwent 20 salvage resections for local recurrence of colorectal pulmonary metastases. All patients had a progressive lesion on consecutive CT scans, with local uptake on 18fluorodeoxyglucose-positron emission tomography computed tomography (FDG-PET CT), and were discussed in a thoracic oncology tumor board. Median time to local recurrence following SABR was 20 months (interquartile range [IQR]: 13−29). Fourteen procedures were performed minimally invasively. Extensive adhesions were observed during three procedures. A Clavien–Dindo grade III–IV complication occurred after four resections (20%). The 90-day mortality was 0%. The estimated median overall survival and progression-free survival following salvage resection were 71 months (confidence intervals [CI]: 50–92) and 39 months (CI: 19–58), respectively. Salvage resections were significantly more extensive, compared to the potential resection assessed on pre-SABR imaging. Conclusions: Our experience with 20 salvage pulmonary metastasectomy procedures for local recurrences following SABR in colorectal cancer patients demonstrates that salvage resection is a feasible option with acceptable morbidity and good oncological outcome in a highly selected cohort.
AB - Introduction: Local control following stereotactic ablative radiotherapy (SABR) for patients with colorectal pulmonary metastases is reportedly lower than for metastases from other tumors. Such recurrences may still be amenable to salvage therapy. We describe our experience with salvage surgery in 17 patients. Methods: Patients who underwent salvage metastasectomy for a local recurrence following SABR for colorectal pulmonary metastases were identified from the surgical institutional databases of three Dutch major referral hospitals. Kaplan–Meier survival analysis was performed to determine survival. Results: Seventeen patients underwent 20 salvage resections for local recurrence of colorectal pulmonary metastases. All patients had a progressive lesion on consecutive CT scans, with local uptake on 18fluorodeoxyglucose-positron emission tomography computed tomography (FDG-PET CT), and were discussed in a thoracic oncology tumor board. Median time to local recurrence following SABR was 20 months (interquartile range [IQR]: 13−29). Fourteen procedures were performed minimally invasively. Extensive adhesions were observed during three procedures. A Clavien–Dindo grade III–IV complication occurred after four resections (20%). The 90-day mortality was 0%. The estimated median overall survival and progression-free survival following salvage resection were 71 months (confidence intervals [CI]: 50–92) and 39 months (CI: 19–58), respectively. Salvage resections were significantly more extensive, compared to the potential resection assessed on pre-SABR imaging. Conclusions: Our experience with 20 salvage pulmonary metastasectomy procedures for local recurrences following SABR in colorectal cancer patients demonstrates that salvage resection is a feasible option with acceptable morbidity and good oncological outcome in a highly selected cohort.
KW - SABR
KW - colorectal pulmonary metastases
KW - lung metastases
KW - pulmonary metastasectomy
KW - salvage metastasectomy
KW - salvage surgery
UR - http://www.scopus.com/inward/record.url?scp=85165503876&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/jso.27404
DO - https://doi.org/10.1002/jso.27404
M3 - Article
C2 - 37477423
SN - 0022-4790
VL - 128
SP - 1114
EP - 1120
JO - Journal of surgical oncology
JF - Journal of surgical oncology
IS - 7
ER -