Optimal Therapy for Postoperative Recurrence: Does Salvage Radiation Work for Locoregional Recurrence?

Abstract

Background/aim: Survival outcomes in patients with successfully resected non-small-cell lung cancer (NSCLC) are not well understood. Furthermore, the best treatment strategy for postoperative locoregional recurrence has not been established.

Patients and methods: Patients who underwent R0 resection of NSCLC between 2013 and 2022 were retrospectively reviewed. The survival after recurrence was analyzed by categorizing patients into locoregional and distant recurrence groups. Moreover, the efficacy of salvage local therapy including radiotherapy (RT) and concurrent chemoradiotherapy (cCRT) was evaluated in terms of progression-free-survival (PFS), overall survival (OS), and safety.

Results: Of the 694 patients who underwent R0 surgery, 150 were diagnosed with post-operative recurrence consisting of 54 cases of locoregional and 96 of distant recurrence. The median OS was 55.9 and 22.3 months in the locoregional and distant recurrence groups, respectively [hazard ratio (HR)=0.52; 95% confidence interval (CI)=0.32-0.84; p<0.001]. In the multivariate analysis, distant recurrence, negative oncogenic driver-mutation, and male sex were identified as independent predictors of a poor prognosis. Of the 54 patients with locoregional recurrence, local therapy was administered to 48 comprising 30 cases of cCRT and 18 of RT alone. The median PFS and OS were 13.3 and 60.4 months, respectively. Regarding adverse events, two cases (4.2%) of grade ≥3 radiation pneumonitis occurred.

Conclusion: The OS of patients with locoregional recurrence of NSCLC was significantly better than that of patients with distant recurrence. Salvage local therapy, including cCRT and RT, may be an effective option for the treatment of locoregional recurrence due to its superior PFS, OS, and tolerability.

Keywords: EGFR; Locoregional recurrence; concurrent chemoradiotherapy; salvage local therapy.