Postoperative Surveillance for Non-Small Cell Lung Cancer Resected With Curative Intent: Developing a Patient-Centered Approach
2013; Elsevier BV; Volume: 95; Issue: 3 Linguagem: Inglês
10.1016/j.athoracsur.2012.09.075
ISSN1552-6259
AutoresNathan M. Mollberg, Mark K. Ferguson,
Tópico(s)Esophageal Cancer Research and Treatment
ResumoLocal recurrence or the development of metachronous cancer after surgical therapy for early-stage non-small cell lung cancer (NSCLC) is not uncommon, and these conditions are often amenable to curative therapy. Predictors of recurrence based on surgical, patient, and pathologic factors are well known. A literature search was performed for articles regarding identification or treatment with curative intent of early local recurrence or metachronous cancer after resection of NSCLC. A patient-centered algorithm for surveillance after resection can be developed based on both risk of recurrence and potential benefit from further treatment to optimize individual follow-up algorithms. Local recurrence or the development of metachronous cancer after surgical therapy for early-stage non-small cell lung cancer (NSCLC) is not uncommon, and these conditions are often amenable to curative therapy. Predictors of recurrence based on surgical, patient, and pathologic factors are well known. A literature search was performed for articles regarding identification or treatment with curative intent of early local recurrence or metachronous cancer after resection of NSCLC. A patient-centered algorithm for surveillance after resection can be developed based on both risk of recurrence and potential benefit from further treatment to optimize individual follow-up algorithms. Non-small cell lung cancer (NSCLC) accounts for the most cancer deaths in the United States, as most patients present with locally advanced or metastatic disease [1Altekruse S.F. Kosary C.L. Krapcho M. et al.SEER Cancer Statistics Review 1975–2007.http://seer.cancer.gov/csr/1975_2007Google Scholar]. This is in part due to the lack of an effective screening tool. Although the National Lung Screening Trial demonstrated that screening high-risk patients with low-dose computed tomography (CT) can reduce lung cancer deaths, the incidence of lung cancers discovered was less than 1% per patient-year [2Aberle D.R. Adams A.M. Berg C.D. et al.National Lung Screening Trial Research TeamReduced lung-cancer mortality with low-dose computed tomographic screening.N Engl J Med. 2011; 365: 395-409Crossref PubMed Scopus (7310) Google Scholar]. However the yield from surveillance is potentially 2 to 10 times higher in patients who have undergone resection of early-stage NSCLC; these patients have a 1% to 2% per year risk of metachronous lung cancer developing [3Haraguchi S. Koizumi K. Hirata T. et al.Surgical treatment of metachronous nonsmall cell lung cancer.Ann Thorac Cardiovasc Surg. 2010; 16: 319-325PubMed Google Scholar, 13Van Meerbeeck J. Weyler J. Thibaut A. et al.Second primary lung cancer in Flanders: frequency, clinical presentation, treatment and prognosis.Lung Cancer. 1996; 15: 281-295Abstract Full Text PDF PubMed Scopus (26) Google Scholar] and a 10% to 15% incidence of local recurrence of their original cancer [14Pepek J.M. Chino J.P. Marks L.B. et al.How well does the new lung cancer staging system predict for local/regional recurrence after surgery? A comparison of the TNM 6 and 7 systems.J Thorac Oncol. 2011; 6: 757-761Crossref PubMed Scopus (42) Google Scholar]. Unfortunately, generic strategies for surveillance have largely been unsuccessful, as only 1% to 4% of all patients who have undergone previous lung cancer resection have had repeated resection for recurrence or metachronous tumors [3Haraguchi S. Koizumi K. Hirata T. et al.Surgical treatment of metachronous nonsmall cell lung cancer.Ann Thorac Cardiovasc Surg. 2010; 16: 319-325PubMed Google Scholar, 4Lee B.E. Port J.L. Stiles B.M. et al.TNM stage is the most important determinant of survival in metachronous lung cancer.Ann Thorac Surg. 2009; 88: 1100-1105Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 5Battafarano R.J. Force S.D. Meyers B.F. et al.Benefits of resection for metachronous lung cancer.J Thorac Cardiovasc Surg. 2004; 127: 836-842Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar, 6Tsunezuka Y. Matsumoto I. Tamura M. et al.The results of therapy for bilateral multiple primary lung cancers: 30 years experience in a single centre.Eur J Surg Oncol. 2004; 30: 781-785Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar, 7Rice D. Kim H.W. Sabichi A. et al.The risk of second primary tumors after resection of stage I non small cell lung cancer.Ann Thorac Surg. 2003; 76: 1001-1007Abstract Full Text Full Text PDF PubMed Scopus (111) Google Scholar, 8Aziz T.M. Saad R.A. Glasser J. Jilaihawi A.N. Prakash D. The management of second primary lung cancers A single centre experience in 15 years.Eur J Cardiothorac Surg. 2002; 21: 527-533Crossref PubMed Scopus (98) Google Scholar, 9Egermann U. Jaeggi K. Habicht J.M. Perruchoud A.P. Dalquen P. Solèr M. Regular follow-up after curative resection of nonsmall cell lung cancer: a real benefit for patients?.Eur Respir J. 2002; 19: 464-468Crossref PubMed Scopus (51) Google Scholar, 10Lamont J.P. Kakuda J.T. Smith D. Wagman L.D. Grannis Jr, F.W. Systematic postoperative radiologic follow-up in patients with non-small cell lung cancer for detecting second primary lung cancer in stage IA.Arch Surg. 2002; 137: 935-938Crossref PubMed Scopus (56) Google Scholar, 11Rea F. Zuin A. Callegaro D. Bortolotti L. Guanella G. Sartori F. Surgical results for multiple primary lung cancers.Eur J Cardiothorac Surg. 2001; 20: 489-495Crossref PubMed Scopus (62) Google Scholar, 12Doddoli C. Thomas P. Ghez O. Giudicelli R. Fuentes P. Surgical management of metachronous bronchial carcinoma.Eur J Cardiothorac Surg. 2001; 19: 899-903Crossref PubMed Scopus (29) Google Scholar, 13Van Meerbeeck J. Weyler J. Thibaut A. et al.Second primary lung cancer in Flanders: frequency, clinical presentation, treatment and prognosis.Lung Cancer. 1996; 15: 281-295Abstract Full Text PDF PubMed Scopus (26) Google Scholar, 15Endo C. Sakurada A. Notsuda H. et al.Results of long-term follow-up of patients with completely resected non-small cell lung cancer.Ann Thorac Surg. 2012; 93: 1061-1068Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar, 16Hung J.J. Hsu W.H. Hsieh C.C. et al.Post-recurrence survival in completely resected stage I non-small cell lung cancer with local recurrence.Thorax. 2009; 64: 192-196Crossref PubMed Scopus (121) Google Scholar, 17Okubo K. Bando T. Miyahara R. et al.Resection of pulmonary metastasis of non-small cell lung cancer.J Thorac Oncol. 2009; 4: 203-207Crossref PubMed Scopus (30) Google Scholar, 18Nakagawa T. Okumura N. Ohata K. Igai H. Matsuoka T. Kameyama K. Postrecurrence survival in patients with stage I non-small cell lung cancer.Eur J Cardiothorac Surg. 2008; 34: 499-504Crossref PubMed Scopus (60) Google Scholar, 19Sugimura H. Nichols F.C. Yang P. et al.Survival after recurrent nonsmall-cell lung cancer after complete pulmonary resection.Ann Thorac Surg. 2007; 83: 409-417Abstract Full Text Full Text PDF PubMed Scopus (247) Google Scholar, 20Kim HS H.S. Choi Y.S. Kim K. Shim Y.M. Kim J. Surgical resection of recurrent lung cancer in patients following curative resection.J Korean Med Sci. 2006; 21 (I H): 224-228Crossref PubMed Scopus (10) Google Scholar, 21Hishida T. Nagai K. Yoshida J. et al.Is surgical resection indicated for a solitary non-small cell lung cancer recurrence?.J Thorac Cardiovasc Surg. 2006; 131: 838-842Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar, 22Voltolini L. Paladini P. Luzzi L. Ghiribelli C. Di Bisceglie M. Gotti G. Iterative surgical resections for local recurrent and second primary bronchogenic carcinoma.Eur J Cardiothorac Surg. 2000; 18: 529-534Crossref PubMed Scopus (54) Google Scholar]. As a result, a survival benefit from postoperative surveillance programs has not been demonstrated [23Westeel V. Choma D. Clement F. Relevance of an intensive postoperative follow-up after surgery for non-small lung cancer.Ann Thorac Surg. 2000; 70: 1185-1190Abstract Full Text Full Text PDF PubMed Scopus (158) Google Scholar, 24Younes R.N. Gross J.L. Deheinzelin D. Follow-up in lung cancer: how often and for what purpose?.Chest. 1999; 115: 1494-1499Crossref PubMed Scopus (120) Google Scholar, 25Walsh G.L. O'Connor M. Willis K.M. et al.Is follow-up of lung cancer patients after resection medically indicated and cost-effective?.Ann Thorac Surg. 1995; 60 (discussion 1570–2): 1563-1570Abstract Full Text PDF PubMed Scopus (179) Google Scholar, 26Virgo K.S. McKirgan L.W. Caputo M.C. et al.Post-treatment management options for patients with lung cancer.Ann Surg. 1995; 222: 700-710Crossref PubMed Scopus (79) Google Scholar, 27Benamore R. Shepherd F.A. Leighl N. et al.Does intensive follow-up alter outcome in patients with advanced lung cancer?.J Thorac Oncol. 2007; 2: 273-281Crossref PubMed Scopus (48) Google Scholar]. However no attempt has been made to tailor surveillance strategies to subgroups that potentially could benefit from surveillance. A patient-centered approach to surveillance could stratify individual risk for isolated local recurrence or metachronous disease and identify patients who are more likely to benefit from early identification of new or locally recurrent cancer. Individual risk profiles could be modeled statistically to optimize follow-up intervals to capture events amenable to curative treatment [28Ataman O.U. Barrett A. Filleron T. Kramar A. ESTRO-REACT GroupOptimization of follow-up timing from study of patterns of first failure after primary treatment An example from patients with NSCLC: a study of the REACT working group of ESTRO.Radiother Oncol. 2006; 78: 95-100Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar]. This review focuses on clinicopathologic factors that are predictive of recurrent lung cancer in the context of surveillance strategies. The most widely used criteria for distinguishing between a new second primary lung cancer and a recurrence of the primary cancer were described by Martini and Melamed [29Martini N. Melamed M.R. Multiple primary lung cancers.J Thorac Cardiovasc Surg. 1975; 70: 606-611PubMed Google Scholar] in 1975. Criteria for a metachronous tumor include a different histologic type or the same histologic type if (1) there is a disease-free interval of at least 2 years, (2) the origin is from carcinoma in situ, or (3) the location is in a different lobe or lung, with no carcinoma in lymphatic vessels common to both and no extrapulmonary metastases at the time of diagnosis. These criteria were later modified to include DNA ploidy [30Antakli T. Schaefer R.F. Rutherford J.E. Read R.C. Second primary lung cancer.Ann Thorac Surg. 1995; 59: 863-867Abstract Full Text PDF PubMed Scopus (175) Google Scholar]. The proportion of patients in whom isolated locoregional recurrence of NSCLC after curative resection will develop ranges from 4.6% to 24% [14Pepek J.M. Chino J.P. Marks L.B. et al.How well does the new lung cancer staging system predict for local/regional recurrence after surgery? A comparison of the TNM 6 and 7 systems.J Thorac Oncol. 2011; 6: 757-761Crossref PubMed Scopus (42) Google Scholar, 31Martini N. Bains M.S. Burt M.E. Incidence of local recurrence and second primary tumors in resected stage I lung cancer.J Thorac Cardiovasc Surg. 1995; 109: 120-129Abstract Full Text Full Text PDF PubMed Scopus (873) Google Scholar, 32Yano T. Yokoyama H. Inoue T. et al.The first site of recurrence after complete resection in non-small-cell carcinoma of the lung Comparison between pN0 disease and pN2 disease.J Thorac Cardiovasc Surg. 1994; 108: 680-683PubMed Google Scholar]. Overall 5-year locoregional recurrence rates of 15.0% to 38.5% are reported, depending on stage [14Pepek J.M. Chino J.P. Marks L.B. et al.How well does the new lung cancer staging system predict for local/regional recurrence after surgery? A comparison of the TNM 6 and 7 systems.J Thorac Oncol. 2011; 6: 757-761Crossref PubMed Scopus (42) Google Scholar, 15Endo C. Sakurada A. Notsuda H. et al.Results of long-term follow-up of patients with completely resected non-small cell lung cancer.Ann Thorac Surg. 2012; 93: 1061-1068Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar, 33Kelsey C.R. Marks L.B. Hollis D. et al.Local recurrence after surgery for early stage lung cancer: an 11-year experience with 975 patients.Cancer. 2009; 115: 5218-5227Crossref PubMed Scopus (238) Google Scholar, 34Varlotto J.M. Recht A. Flickinger J.C. Medford-Davis L.N. Dyer A.M. DeCamp M.M. Varying recurrence rates and risk factors associated with different definitions of local recurrence in patients with surgically resected, stage I non small cell lung cancer.Cancer. 2010; 116: 2390-2400PubMed Google Scholar]. The risk of local recurrence increases monotonically from stage IA to stage IIA. Local recurrence rates, however, vary greatly depending on the anatomic definition used for “local,” and vary less based on histologic criteria such as those described by Martini and Melamed [34Varlotto J.M. Recht A. Flickinger J.C. Medford-Davis L.N. Dyer A.M. DeCamp M.M. Varying recurrence rates and risk factors associated with different definitions of local recurrence in patients with surgically resected, stage I non small cell lung cancer.Cancer. 2010; 116: 2390-2400PubMed Google Scholar]. Mean disease-free intervals of 14.1 to 19.8 months for locoregional recurrences are similar to those reported for distant metastasis formation [33Kelsey C.R. Marks L.B. Hollis D. et al.Local recurrence after surgery for early stage lung cancer: an 11-year experience with 975 patients.Cancer. 2009; 115: 5218-5227Crossref PubMed Scopus (238) Google Scholar, 35al-Kattan K. Sepsas E. Fountain S.W. Townsend E.R. Disease recurrence after resection for stage I lung cancer.Eur J Cardiothorac Surg. 1997; 12: 380-384Crossref PubMed Scopus (127) Google Scholar]. Nearly 80% of local recurrences occur in the first 2 years [16Hung J.J. Hsu W.H. Hsieh C.C. et al.Post-recurrence survival in completely resected stage I non-small cell lung cancer with local recurrence.Thorax. 2009; 64: 192-196Crossref PubMed Scopus (121) Google Scholar]. However distinct recurrence peaks occur at around 9 and 50 months after treatment, with a smaller peak occurring around 30 months after treatment [36Demicheli R. Fornili M. Ambrogi F. et al.Recurrence dynamics for non-small-cell lung cancer: effect of surgery on the development of metastases.J Thorac Oncol. 2012; 7: 723-730Crossref PubMed Scopus (123) Google Scholar]. The extent of parenchymal resection for early-stage lung cancer may have an impact on lung cancer recurrence. Performing parenchyma-sparing operations in patients with adequate cardiopulmonary function can theoretically reduce any benefit of “collateral treatment” from removing at-risk tissue for recurrence or metachronous tumor development. An early study of sublobar resection for NSCLC demonstrated survival rates equivalent to those achieved after lobectomy [37Ginsberg R.J. Rubinstein L.V. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer.Ann Thorac Surg. 1995; 60: 615-623Abstract Full Text PDF PubMed Scopus (2414) Google Scholar]. However locoregional recurrence rates were higher, possibly as a result of a large percentage of nonanatomic (wedge) resections rather than segmentectomies, and/or a substantial proportion of large tumors. Nonrandomized trials demonstrate lower locoregional recurrence rates with segmentectomy compared with wedge resection for tumors less than or equal to 2 cm [38Koike T. Yamato Y. Yoshiya K. et al.Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer.J Thorac Cardiovasc Surg. 2003; 125: 924-928Abstract Full Text Full Text PDF PubMed Scopus (291) Google Scholar, 39Okada M. Yoshikawa K. Hatta T. et al.Is segmentectomy with lymph node assessment an alternative to lobectomy for non-small cell lung cancer of 2 cm or smaller?.Ann Thorac Surg. 2001; 71: 956-961Abstract Full Text Full Text PDF PubMed Scopus (271) Google Scholar].There is currently a multicenter randomized controlled trial comparing lobectomy to sublobar resection for patients with small peripheral stage IA NSCLC (Cancer and Leukemia Group B 140503), as well as a trial comparing sublobar resection with brachytherapy versus sublobar resection alone (ACOSOG-Z4032). The results of these trials will provide further evidence as to the efficacy of sublobar resection with regard to local control for stage IA tumors. For patients with centrally located tumors amenable to curative resection, treatment can involve either pneumonectomy or sleeve lobectomy. Although long-term survival between the 2 techniques is comparable, an increased incidence of local recurrence after sleeve lobectomy is reported [40Ferguson M.K. Lehman A.G. Sleeve lobectomy or pneumonectomy: optimal management strategy using decision analysis techniques.Ann Thorac Surg. 2003; 76: 1782-1788Abstract Full Text Full Text PDF PubMed Scopus (161) Google Scholar]. However the stage of disease rather than the type of surgical resection is most important when considering risk of local recurrence [41Deslauriers J. Gregoire J. Jacques L.F. et al.Sleeve lobectomy versus pneumonectomy for lung cancer: a comparative analysis of survival and sites or recurrences.Ann Thorac Surg. 2004; 77: 1152-1156Abstract Full Text Full Text PDF PubMed Scopus (238) Google Scholar]. Residual microscopic disease (R1) at the bronchial margins predicts decreased survival as a result of local failure, depending on the pattern of margin involvement. There is little evidence that bronchial margins involved with carcinoma in situ negatively impact overall survival or local failure for patients with squamous histologic type [42Vallières E. Van Houtte P. Travis W.D. Rami-Porta R. Goldstraw P. International Association for the Study of Lung Cancer (IASLC) International Staging CommitteeCarcinoma in situ at the bronchial resection margin: a review.J Thorac Oncol. 2011; 6: 1617-1623Crossref PubMed Scopus (14) Google Scholar]. Evidence of lymphatic permeation, extension of invasive cancer to the mucosa, and peribronchial residual disease are associated with poor rates of local control and overall survival because this is associated with mediastinal lymph node metastasis [42Vallières E. Van Houtte P. Travis W.D. Rami-Porta R. Goldstraw P. International Association for the Study of Lung Cancer (IASLC) International Staging CommitteeCarcinoma in situ at the bronchial resection margin: a review.J Thorac Oncol. 2011; 6: 1617-1623Crossref PubMed Scopus (14) Google Scholar, 43Wind J. Smit E.J. Senan S. Eerenberg J.P. Residual disease at the bronchial stump after curative resection for lung cancer.Eur J Cardiothorac Surg. 2007; 32: 29-34Crossref PubMed Scopus (62) Google Scholar]. Inadequate nodal assessment is associated with increased local recurrence rates, presumably based on incomplete staging [44Sawyer T.E. Bonner J.A. Gould P.M. et al.Patients with stage I non-small cell lung carcinoma at postoperative risk for local recurrence, distant metastasis, and death: implications related to the design of clinical trials.Int J Radiat Oncol Biol Phys. 1999; 45: 315-321Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 45Hung J.J. Jeng W.J. Hsu W.H. Chou T.Y. Huang B.S. Wu Y.C. Predictors of death, local recurrence, and distant metastasis in completely resected pathological stage-I non-small-cell lung cancer.J Thorac Oncol. 2012; 7: 1115-1123Crossref PubMed Scopus (90) Google Scholar]. Interestingly, the extent of nodal dissection (systematic sampling versus complete lymphadenectomy) does not affect local recurrence or survival rates for patients undergoing resection of T1-2,N0 or T1-2,N1 (intralobar N1 only) disease [46Darling G.E. Allen M.S. Decker P.A. et al.Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial.J Thorac Cardiovasc Surg. 2011; 141: 662-670Abstract Full Text Full Text PDF PubMed Scopus (568) Google Scholar]. Although lymphovascular invasion has been reported as a predictor of locoregional recurrence [32Yano T. Yokoyama H. Inoue T. et al.The first site of recurrence after complete resection in non-small-cell carcinoma of the lung Comparison between pN0 disease and pN2 disease.J Thorac Cardiovasc Surg. 1994; 108: 680-683PubMed Google Scholar, 33Kelsey C.R. Marks L.B. Hollis D. et al.Local recurrence after surgery for early stage lung cancer: an 11-year experience with 975 patients.Cancer. 2009; 115: 5218-5227Crossref PubMed Scopus (238) Google Scholar, 47Varlotto J.M. Recht A. Flickinger J.C. Medford-Davis L.N. Dyer A.M. Decamp M.M. Factors associated with local and distant recurrence and survival in patients with resected nonsmall cell lung cancer.Cancer. 2009; 115: 1059-1069Crossref PubMed Scopus (91) Google Scholar], recent studies have failed to reproduce these findings [48Koo H.K. Jin S.M. Lee C.H. et al.Factors associated with recurrence in patients with curatively resected stage I-II lung cancer.Lung Cancer. 2011; 73: 222-229Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 49Higgins K.A. Chino J.P. Ready N. et al.Lymphovascular invasion in non-small-cell lung cancer: implications for staging and adjuvant therapy.J Thorac Oncol. 2012; 7: 1141-1147Crossref PubMed Scopus (95) Google Scholar]. Similarly, some studies demonstrate locoregional recurrences to be more common in squamous cell and large cell histologic types [30Antakli T. Schaefer R.F. Rutherford J.E. Read R.C. Second primary lung cancer.Ann Thorac Surg. 1995; 59: 863-867Abstract Full Text PDF PubMed Scopus (175) Google Scholar, 50Jang K.M. Lee K.S. Shim Y.M. et al.The rates and CT patterns of locoregional recurrence after resection surgery of lung cancer: correlation with histopathology and tumor staging.J Thorac Imaging. 2003; 8: 225-230Crossref Scopus (21) Google Scholar], whereas other studies report contradictory results [51Baldini E.H. DeCamp Jr, M.M. Katz M.S. et al.Patterns of recurrence and outcome for patients with clinical stage II nonsmall- cell lung cancer.Am J Clin Oncol. 1999; 22: 8-14Crossref PubMed Scopus (29) Google Scholar]. For N2 disease, multiple positive N2 nodal stations are an independent predictor of decreased freedom from local recurrence (hazard ratio, 2.17) [52Ichinose Y. Kato H. Koike T. et al.Japan Clinical Oncology GroupOverall survival and local recurrence of 406 completely resected stage IIIa-N2 non-small cell lung cancer patients: questionnaire survey of the Japan Clinical Oncology Group to plan for clinical trials.Lung Cancer. 2001; 34: 29-36Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar]. Diabetes is an independent predictor of decreased freedom from local recurrence (hazard ratio, 1.81) [47Varlotto J.M. Recht A. Flickinger J.C. Medford-Davis L.N. Dyer A.M. Decamp M.M. Factors associated with local and distant recurrence and survival in patients with resected nonsmall cell lung cancer.Cancer. 2009; 115: 1059-1069Crossref PubMed Scopus (91) Google Scholar]. This has been shown to be independent of body mass index, glucose control, or the presence of the metabolic syndrome [47Varlotto J.M. Recht A. Flickinger J.C. Medford-Davis L.N. Dyer A.M. Decamp M.M. Factors associated with local and distant recurrence and survival in patients with resected nonsmall cell lung cancer.Cancer. 2009; 115: 1059-1069Crossref PubMed Scopus (91) Google Scholar, 53Varlotto J. Medford-Davis L.N. Recht A. et al.Confirmation of the role of diabetes in the local recurrence of surgically resected non-small cell lung cancer.Lung Cancer. 2012; 75: 381-390Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar]. Although smoking has been identified as a predictor of decreased disease-free survival, studies evaluating predictors of isolated local recurrence have failed to duplicate these findings [32Yano T. Yokoyama H. Inoue T. et al.The first site of recurrence after complete resection in non-small-cell carcinoma of the lung Comparison between pN0 disease and pN2 disease.J Thorac Cardiovasc Surg. 1994; 108: 680-683PubMed Google Scholar, 33Kelsey C.R. Marks L.B. Hollis D. et al.Local recurrence after surgery for early stage lung cancer: an 11-year experience with 975 patients.Cancer. 2009; 115: 5218-5227Crossref PubMed Scopus (238) Google Scholar]. Only 0.9% to 4.4% of patients undergoing resection with curative intent are candidates for repeated resection of local recurrence (Table 1) [15Endo C. Sakurada A. Notsuda H. et al.Results of long-term follow-up of patients with completely resected non-small cell lung cancer.Ann Thorac Surg. 2012; 93: 1061-1068Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar, 16Hung J.J. Hsu W.H. Hsieh C.C. et al.Post-recurrence survival in completely resected stage I non-small cell lung cancer with local recurrence.Thorax. 2009; 64: 192-196Crossref PubMed Scopus (121) Google Scholar, 17Okubo K. Bando T. Miyahara R. et al.Resection of pulmonary metastasis of non-small cell lung cancer.J Thorac Oncol. 2009; 4: 203-207Crossref PubMed Scopus (30) Google Scholar, 18Nakagawa T. Okumura N. Ohata K. Igai H. Matsuoka T. Kameyama K. Postrecurrence survival in patients with stage I non-small cell lung cancer.Eur J Cardiothorac Surg. 2008; 34: 499-504Crossref PubMed Scopus (60) Google Scholar, 19Sugimura H. Nichols F.C. Yang P. et al.Survival after recurrent nonsmall-cell lung cancer after complete pulmonary resection.Ann Thorac Surg. 2007; 83: 409-417Abstract Full Text Full Text PDF PubMed Scopus (247) Google Scholar, 20Kim HS H.S. Choi Y.S. Kim K. Shim Y.M. Kim J. Surgical resection of recurrent lung cancer in patients following curative resection.J Korean Med Sci. 2006; 21 (I H): 224-228Crossref PubMed Scopus (10) Google Scholar, 21Hishida T. Nagai K. Yoshida J. et al.Is surgical resection indicated for a solitary non-small cell lung cancer recurrence?.J Thorac Cardiovasc Surg. 2006; 131: 838-842Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar, 22Voltolini L. Paladini P. Luzzi L. Ghiribelli C. Di Bisceglie M. Gotti G. Iterative surgical resections for local recurrent and second primary bronchogenic carcinoma.Eur J Cardiothorac Surg. 2000; 18: 529-534Crossref PubMed Scopus (54) Google Scholar, 23Westeel V. Choma D. Clement F. Relevance of an intensive postoperative follow-up after surgery for non-small lung cancer.Ann Thorac Surg. 2000; 70: 1185-1190Abstract Full Text Full Text PDF PubMed Scopus (158) Google Scholar]. Few studies offer their indications for resection of locally recurrent disease, which could bias reported resection rates. However no evidence of other organ metastasis or ability to tolerate operation are commonly mentioned. Median disease-free intervals range from 2.6 to 24 months. Median overall survival ranges from 27 to 40 months, with 5-year actuarial survival rates after repeated resection of 8.3% to 40.0%. The original cancer is overwhelmingly at an early stage in these patients, with 76.2% to 100% being stage IIB or less.Table 1Current Series Reporting on Repeated Excision of Locally Recurrent Lung CancerReferenceYearSurveillance Imaging ModalitySurveillance IntervalDFI (mo)Martini & Melamed CriteriaPatients Amenable to Repeated Surgical Excision % (n)Intrathoracic-Only Recurrence Amenable to Repeated Excision % (n)Lung-only Recurrence Amenable to Repeated Excision % (n)Stage of Index Lung Cancer Amenable to Repeated ExcisionStage I/IIStage III/IVEndo et al15Endo C. Sakurada A. Notsuda H. et al.Results of long-term follow-up of patients with completely resected non-small cell lung cancer.Ann Thorac Surg. 2012; 93: 1061-1068Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar2012CTQ 4 mo for 2 y, then Q 6 mo for y 3–515.7Yes4.4 (14/315)23.0 (14/61)42.4 (14/33)……Hung et al16Hung J.J. Hsu W.H. Hsieh C.C. et al.Post-recurrence survival in completely resected stage I non-small cell lung cancer with local recurrence.Thorax. 2009; 64: 192-196Crossref PubMed Scopus (121) Google Scholar2009…Q 3 mo for 2 y, then Q 6 mo16.8Yes3.5 (10/289)13.5 (10/74)55.6 (10/18)100Okubo et al17Okubo K. Bando T. Miyahara R. et al.Resection of pulmonary metastasis of non-small cell lung cancer.J Thorac Oncol. 2009; 4: 203-207Crossref PubMed Scopus (30) Google Scholar2009……28YesaModified Martini and Melamed criteria;2.6 (42/1638)……3210Nakagawa et al18Nakagawa T. Okumura N. Ohata K. Igai H. Matsuoka T. Kameyama K. Postrecurrence survival in patients with stage I non-small cell lung cancer.Eur J Cardiothorac Surg. 2008; 34: 499-504Crossref PubMed Scopus (60) Google Scholar2008CXR/CTbannual CT with CXR used at interval visits;Q 3 mo for 2 y, Q 3–6 mo for y 2–5, then annually…No11.5 (10/87)……100Sugimura et al19Sugimura H. Nichols F.C. Yang P. et al.Survival after recurrent nonsmall-cell lung cancer after complete pulmonary resection.Ann Thorac Surg. 2007; 83: 409-417Abstract Full Text Full Text PDF PubMed Scopus (247) Google Scholar2007……11.5Yes5.9 (23/390)18.5 (23/124)27.4 (23/84)……Kim et al20Kim HS H.S. Choi Y.S. Kim K. Shim Y.M. Kim J. Surgical resection of recurrent lung cancer in patients following curative resection.J Korean Med Sci. 2006; 21 (I H): 224-228Crossref PubMed Scopus (10) Google Scholar2006CTQ 3 mo for 2 y, Q 3–6 months for y 2–5, then annually8.9Yes2.0 (29/1461)cincludes both locally recurrent and metachronous resected lung cancers;…………Hishida et al21Hishida T. Nagai K. Yoshida J. et al.Is surgical resection indicated for a solitary non-small cell lung cancer recurrence?.J Thorac Cardiovasc Surg. 2006; 131: 838-842Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar2006CXRQ 3–6 mo for 3 y, then Q 6–12 mo thereafter2.6Yes2.7 (16/592)…………Voltolini et al22Voltolini L. Paladini P. Luzzi L. Ghiribelli C. Di Bisceglie M. Gotti G. Iterati
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