Is surgical resection indicated for a solitary non–small

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cell lung cancer recurrence?

http://jtcs.ctsnetjournals.org/cgi/cont ... /131/4/838

Tomoyuki Hishida, MD a , * , Kanji Nagai, MD a , Junji Yoshida, MD a , Mitsuyo Nishimura, MD a , Gen-ichiro Ishii, MD b , Motoki Iwasaki, MD c , Yutaka Nishiwaki, MD a

a Department of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan

b Pathology Division, National Cancer Center Research Institute East, Chiba, Japan

c Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan

Received for publication September 8, 2005; revisions received November 20, 2005; accepted for publication November 28, 2005.

* Address for reprints: Tomoyuki Hishida, MD, Department of Thoracic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577 Japan (Email: thishida@nifty.com).

OBJECTIVES: Some investigators have reported long-term survival after surgical resection of a solitary non–small cell lung cancer recurrence in various sites. However, the role and indications of the second operation remain unclear.

METHODS: We reviewed 28 patients with a solitary recurrence after successful initial resection of primary non–small cell lung cancer who underwent resection of the recurrent lesion. The clinicopathologic factors associated with outcome were analyzed.

RESULTS: There were 17 men and 11 women. Recurrence resection was performed for the following sites: 16 in the lung, 5 in the brain, 2 in the adrenal gland, and 1 each in the chest wall, stomach, skin, pelvic lymph node, and malar bone. The median survival time was 25 months, and the 1-, 2-, and 5-year survival rates after recurrence were 89%, 59%, and 32%, respectively. Advanced p-stage (p-stage II and III, n = 14) of the primary tumor was the significant negative prognostic factor. Patients with p-stage II or III had survival equivalent to that of those who had multiple recurrences or were unfit for further surgical intervention.

CONCLUSIONS: Resection of a solitary non–small cell lung cancer recurrence might provide long-term survival in highly selected patients. However, surgical resection might be contraindicated if the primary tumor is stage II or III.

Abbreviations and Acronyms FDG = 18F fluorodeoxyglucose; NSCLC = non–small cell lung cancer; PET = positron emission tomography; RFI = recurrence-free interval