Table 1.

Selected studies of surgery as salvage after initial stereotactic ablative radiotherapy

Study and Reference	No. of Patients	Population	Techniques	Median time, SABR to surgery (mo)	Median follow-up time, mo	Significant Findings	Outcomes	Toxic Effects/Complications
Neri et al, 2010 [48]	2	iLR in initially inoperable cases	VATS lobectomy, segmentectomy	14	17	Complete resection in both patients	Both alive and disease-free at 2 and 32 months after resection	Postoperative pulmonary fistula (n=1) treated with surgery and pleurodesis
Chen et al, 2010 [45]	5	iLR in initially operable cases	Lobectomy	17	27	No significant fibrosis/adhesions impairing dissection	All patients alive at last follow-up	None
Allibhai et al, 2012 [38]	4	iLR in initially inoperable cases	Lobectomy	15	31	Adhesions in all cases; required conversion to open procedure and partial chest wall resection (n=1 each)	All patients alive and disease-free at last follow-up	None
Taira et al, 2014 [49]	2	iLR in patients initially operable or inoperable	Wedge resection	37	--	Neither case had viable tumor cells in resection specimen	Not reported	Not reported
Hamaji et al, 2015 [50]	12	iLR in patients initially operable (9/12) and inoperable (3/12)	Open lobectomy (n=6), VATS lobectomy (n=3), VATS segmentectomy (n=2), open wedge resection (n=1)	15	55	Nodal dissection done in 11 patients, two of which were positive and offered adjuvant chemotherapy	Median CSS and OS from salvage surgery were 83 months	Intraoperative bleeding (n=1) requiring conversion to open lobectomy; prolonged air leak (n=3)
Verstegen et al, 2016 [39]	9	iLR (n=7) in initially operable cases; remainder with regional (n=1) or single distant metastasis (n=1)	Open lobectomy (n=5), VATS lobectomy (n=1), sleeve lobectomy (n=1), wedge resection (n=1), pneumonectomy (n=1)	22	19	Adhesions limited (n=3) or extensive (n=2), one of which required conversion to pneumonectomy; complete resection in all but one patient	Median OS 26 months; two patients failed (one with regional/distant, the other distant alone)	Grade 2 infection (n=2), grade 3 air leak requiring new chest tube (n=1); no 30-day mortality and 11% (n=1) 90-day mortality
Antonoff et al, 2017 [47]	21*	iLR in initially inoperable (18/21) cases	Open lobectomy (n=8), robot/VATS lobectomy (n=2), wedge resection (n=3), segmentectomy (n=1), pneumonectomy (n=1)	16	17	Complete resection in all; nodal dissection in all patients (n=2 pN1, n=1 pN2, n=1 pM1)	Median OS 14 months	Of all patients, any complication (n=6) and ICU admission (n=2). Prolonged air leak (n=2), atrial arrhythmia (n=3), pulmonary artery thrombosis requiring pneumonectomy (n=1); 30- and 90-day mortality 5%
Brooks et al, 2018 [12]	10	iLR in initially inoperable cases	Lobectomy (n=6), sublobar (n=4)	--	39	Complete resection in all patients	100% local control and 90% regional control	40% with grade 3+ toxicities, including respiratory distress (n=1), pleural effusion (n=1), atrial fibrillation (n=1); no 90- day mortality

^*15 with non-metastatic disease

Abbreviations: SABR, stereotactic ablative radiotherapy; iLR, isolated local recurrence; VATS, video-assisted thoracoscopic surgery; CSS, cancer-specific survival; OS, overall survival