A case of salvage surgery for local recurrence of stage I lung adenocarcinoma following carbon beam radiation

608 Background: Since 1983 through 2005, 2439 clinical stage I or II patients (pts) were treated with lumpectomy and postoperative irradiation. During median follow-up of 75 months, 142 patients experienced local recurrence as first and sole event were judged as candidate for further local therapy. The purpose of this study is to evaluate the outcome of salvage treatment, with specific reference to feasibility of second breast conservation surgery. Methods: Among those with operable local recurrences, 73 pts who requested conservation of their breasts and whose recurrences were judged to be small enough to be locally re-excised with adequate margins underwent second lumpectomy (Re-LMP). 51 pts were treated by mastectomy with or without immediate reconstruction (MAS). Adjuvant systemic therapy of limited duration was given at the discretion of patients and therapists. Survival and local re-recurrence after salvage surgery were estimated by Kaplan-Meier method. Results: Age of patients ranged from 28–69 (mean: 41). Median follow-up length after salvage surgery was 53 months (6–194 months). Patient/Tumor characteristics were similar in Re-LMP and MAS groups. Local re-recurrence: Re-LMP: 31 pts developed in-breast re-recurrence (34% at 3yrs, 49% at 5yrs). MAS: 6 pts experienced chest wall recurrence (11% at 3yrs, 11% at 5yrs, p=0.0005). Independent risk factor for re-recurrence was not identified. Survival: In initial clinical stage I patients, 3 pts treated with Re-LMP died after salvage surgery and all treated with MAS survived (94% and 100% at 5yrs, p=0.2). In clinical stage II patients, 6 in Re-LMP and 8 patients in MAS died (89%, 57% at 5yrs after salvage surgery, p=0.02). Poor prognostic factors for both groups were initial stage and stage at the time of local failure. Conclusions: For an isolated in-breast recurrence, salvage mastectomy with or without immediate reconstruction provides excellent local control. At the present time, mastectomy should be offered as 1st treatment option. Although survival is not jeopardized, Re-LMP alone does not offer adequate local control. Additional local therapy i.e. re-radiotherapy or aggressive systemic therapy may improve this poor result. Prospective studies should be initiated. No significant financial relationships to disclose.

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Spinal laser interstitial thermal therapy: single-center experience and outcomes in the first 120 cases

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine20661 ◽

2020 ◽

pp. 1-10

Author(s):

Dhiego C. A. Bastos ◽

Rafael A. Vega ◽

Jeffrey I. Traylor ◽

Amol J. Ghia ◽

Jing Li ◽

...

Keyword(s):

Local Recurrence ◽

Local Control ◽

Thoracic Spine ◽

Adjuvant Radiotherapy ◽

Neurological Complications ◽

Thermal Therapy ◽

External Beam Radiation ◽

Beam Radiation ◽

Laser Interstitial Thermal Therapy ◽

Hazard Ratios

OBJECTIVEThe objective of this study was to present the results of a consecutive series of 120 cases treated with spinal laser interstitial thermal therapy (sLITT) to manage epidural spinal cord compression (ESCC) from metastatic tumors.METHODSThe electronic records of patients treated from 2013 to 2019 were analyzed retrospectively. Data collected included demographic, pathology, clinical, operative, and imaging findings; degree of epidural compression before and after sLITT; length of hospital stay; complications; and duration before subsequent oncological treatment. Independent-sample t-tests were used to compare means between pre- and post-sLITT treatments. Survival was estimated by the Kaplan-Meier method. Multivariate logistic regression was used to analyze predictive factors for local recurrence and neurological complications.RESULTSThere were 110 patients who underwent 120 sLITT procedures. Spinal levels treated included 5 cervical, 8 lumbar, and 107 thoracic. The pre-sLITT Frankel grades were E (91.7%), D (6.7%), and C (1.7%). The preoperative ESCC grade was 1c or higher in 92% of cases. Metastases were most common from renal cell carcinoma (39%), followed by non–small cell lung carcinoma (10.8%) and other tumors (35%). The most common location of ESCC was in the vertebral body (88.3%), followed by paraspinal/foraminal (7.5%) and posterior elements (4.2%). Adjuvant radiotherapy (spinal stereotactic radiosurgery or conventional external beam radiation therapy) was performed in 87 cases (72.5%), whereas 33 procedures (27.5%) were performed as salvage after radiotherapy options were exhausted. sLITT was performed without need for spinal stabilization in 87 cases (72.5%). Post-sLITT Frankel grades were E (85%), D (10%), C (4.2%), and B (0.8%); treatment was associated with a median decrease of 2 ESCC grades. The local control rate at 1 year was 81.7%. Local control failure occurred in 25 cases (20.8%). The median progression-free survival was not reached, and overall survival was 14 months. Tumor location in the paraspinal region and salvage treatment were independent predictors of local recurrence, with hazard ratios of 6.3 and 3.3, respectively (p = 0.01). Complications were observed in 22 cases (18.3%). sLITT procedures performed in the lumbar and cervical spine had hazard ratios for neurological complications of 15.4 and 17.1 (p < 0.01), respectively, relative to the thoracic spine.CONCLUSIONSsLITT is safe and provides effective local control for high-grade ESCC from vertebral metastases in the thoracic spine, particularly when combined with adjuvant radiotherapy. The authors propose considering sLITT as an alternative to open surgery in selected patients with spinal metastases.

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