Surgical Treatment of Complications After High-Dose Chemoradiotherapy for Lung Cancer

Background: There are limited published reports on the indications for, and outcomes of, a surgical intervention for complications arising after high-dose chemoradiotherapy (CRT) for locally advanced non-small cell lung cancer (NSCLC). We report on our institutional experience with such cases.

Methods: Patients who underwent operations for any complication after CRT (≥60 Gy) for NSCLC between 2009 and 2015 were identified. All operations were performed at a tertiary referral center.

Results: In the 15 patients identified, the median time between the last day of radiotherapy and first radiologic confirmation of the complication was 8 months (range, 0 to 102 months). Complicated pulmonary cavitation was the most frequent indication for surgical intervention (n = 11 in 9 patients), followed by esophagorespiratory fistula (n = 3), hemorrhage (n = 3), bronchial stenosis (n = 2), esophageal stenosis (n = 1), and bronchiectasis (n = 1). Four patients had more than two complications diagnosed, and 9 patients underwent more than one surgical intervention. Surgical procedures performed included thoracostomy (n = 11 in 9 patients) with seven vascularized muscle flaps used in 6 patients, pulmonary resection (n = 5 in 4 patients) and esophageal resection with gastric tube reconstruction (n = 3). The 30- and 90-day mortality rates were 20% (n = 3) and 27% (n = 4), respectively. Median survival was 19 months (95% confidence interval [CI]: 3.9 to 34.1 months).

Conclusions: An Operation is often the only treatment option when irreversible complications arise after high-dose CRT for NSCLC. It is infrequently performed, technically challenging, and associated with high perioperative risk and even death. Therefore, we suggest that such patients should be managed by a multidisciplinary team, including experienced thoracic surgeons.