Salvage Surgery for Locally Advanced Non-small Cell Lung Cancer After Chemotherapy: a Case Report

Background. There are no definitive guidelines regarding the use of salvage surgery for treating non-small cell lung cancer. We herein report a case of salvage surgery for locally advanced pulmonary adenocarcinoma in which the patient had initially not been a candidate for surgery and was treated with chemotherapy. Case. A 71-year-old female was diagnosed with primary pulmonary adenocarcinoma, stage cT1bN3M0 (IIIB). She received chemotherapy consisting of six cycles of cisplatin and docetaxel as the first-line treatment and chemotherapy consisting of six cycles of carboplatin and pemetrexed as the second-line treatment, which resulted in a partial response. Although chemotherapy consisting of six cycles of pemetrexed alone was added due to relapse of the primary pulmonary lesion, the treatment had no effect. Because PET demonstrated no abnormal accumulation, except in the primary pulmonary lesion, we performed left upper lobectomy with plasty of the pulmonary artery under a stage of ycT1aN0M0 (IA). The patient received additional radiation therapy consisting of 50 Gy because the pathological stage was ypT1aN2M0 (IIIA). Currently, at one year after the salvage surgery, she shows no signs or symptoms of recurrence. Conclusion. Although a watchful wait-and-see approach is needed in the present case, the results suggest that salvage surgery has the potential to be used for local management in some inoperable locally advanced lung cancer patients. However, the indication for surgery must be determined taking into account the balance between curability and operative stress in each case.