Salvage resection may benefit patients with non-small cell lung cancer (NSCLC) who have residual or recurrent disease after immunotherapy, according to research presented at the American Association for Thoracic Surgery (AATS) Annual Meeting.
Salvage resection was associated with high rates of complete resection, short hospital stays, and low 30-day mortality and unplanned readmission rates, according to researchers.
The researchers studied patients from the National Cancer Database who were diagnosed with NSCLC from 2013 to 2020. The patients were divided into 2 groups — those who received immunotherapy (n=164) and those who received chemoradiation (n=445).
The proportion of patients with adenocarcinoma was 70% in the immunotherapy group and 47% in the chemoradiation group. Patients had stage I (9.8% vs 5.5%), stage II (10.4% vs 22.7%), stage III (39.6% vs 68.1%), or stage IV (34.2% vs 3.6%) disease.
Salvage surgery occurred more than 5 months from the start of immunotherapy or chemoradiation. The most common surgical procedure in both groups was lobectomy (73.8% in the immunotherapy group and 73.9% in the chemoradiation group). Patients also underwent wedge resection (11.6% vs 4.6%), pneumonectomy (9.2% vs 16.7%), and segmentectomy (5.5% vs 2.6%).
Complete resection was achieved in 89.0% of patients in the immunotherapy group and 89.7% of patients in the chemoradiation group.
The median length of stay was 4 days for the immunotherapy group and 5 days for the chemoradiation group. The 30-day mortality rate was 0.6% for the immunotherapy group and 3.8% for the chemoradiation group. The 30-day readmission rate was 4.9% and 4.0%, respectively.
Based on these results, the researchers concluded that salvage resection after immunotherapy is feasible and safe, but prospective studies are needed confirm the efficacy and determine optimal timing.
Nemeth A, Canavan ME, Zhan P, et al. Salvage lung resection after immunotherapy in lung cancer is feasible and safe. AATS 2023. May 6-9, 2023. Abstract 50.