Salvage surgery following immuno-chemo-radiotherapy for advanced non-small cell lung cancer

Ayako Nawashiro; Fumihiro Tanaka; Akihiro Taira; Shinji Shinohara; Masaru Takenaka; Koji Kuroda; Shohei Shimajiri

doi:10.1186/s40792-022-01371-3

Salvage surgery following immuno-chemo-radiotherapy for advanced non-small cell lung cancer

Surg Case Rep. 2022 Jan 21;8(1):17. doi: 10.1186/s40792-022-01371-3.

Authors

Ayako Nawashiro¹, Fumihiro Tanaka², Akihiro Taira¹, Shinji Shinohara¹, Masaru Takenaka¹, Koji Kuroda¹, Shohei Shimajiri³

Affiliations

¹ Second Department of Surgery, University of Occupational and Environmental Health, Iseigaoka 1-1, Yahata-nishi, Kitakyushu, 807-8555, Japan.
² Second Department of Surgery, University of Occupational and Environmental Health, Iseigaoka 1-1, Yahata-nishi, Kitakyushu, 807-8555, Japan. ftanaka@med.uoeh-u.ac.jp.
³ Department of Pathology, School of Medicine, University of Occupational and Environmental Health, Iseigaoka 1-1, Yahata-nishi, Kitakyushu, 807-8555, Japan.

Abstract

Background: Salvage surgery following definitive radiotherapy or systemic treatment has become a feasible treatment option in selected patients with advanced initially unresectable non-small cell lung cancer. Recent clinical trials of neoadjuvant treatment have showed that surgery following immuno-chemotherapy is safely performed. Here, we present the first case of salvage surgery following immuno-chemotherapy with concurrent definitive radiotherapy for advanced lung large cell carcinoma.

Case presentation: A 44-year male was admitted to our hospital for salvage surgery. Ten months prior to this administration, he had been diagnosed with unresectable large cell carcinoma with malignant pericardial effusion (clinical stage IVA/T3N2M1A; no driver-gene alteration) originating from the right upper lobe (RUL). Due to rapid intrabronchial tumor growth causing severe dyspnea, emergency bronchial stenting in the right main bronchus using an expandable metallic stent had been performed. Thereafter, he had received immuno-chemotherapy with concurrent definitive radiotherapy. Despite dramatic radiographic response, he had suffered from persistent and refractory Pseudomonas aeruginosa lung infection associated with bronchial stent placement. As pericardial effusion had disappeared and no distant metastasis had developed, he was diagnosed with a potentially curable disease and was referred to our hospital. An extended sleeve resection was successfully performed, and pathological sections revealed that pathologic complete response was achieved with immuno-chemo-radiotherapy. The patient received no subsequent treatment, and is alive without tumor recurrence at 8 months after surgery.

Conclusions: Salvage surgery following immuno-chemotherapy with concurrent definitive radiotherapy for advanced non-small cell lung cancer may be feasible in selected patients, and may be considered as a treatment option to control local disease.

Keywords: Chemotherapy; Immunotherapy; Lung cancer; Radiotherapy; Salvage surgery.