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World J Clin Oncol. Dec 10, 2014; 5(5): 1048-1054
Published online Dec 10, 2014. doi: 10.5306/wjco.v5.i5.1048
Therapeutic strategy for postoperative recurrence in patients with non-small cell lung cancer
Tokujiro Yano, Tatsuro Okamoto, Seiichi Fukuyama, Yoshihiko Maehara
Tokujiro Yano, Seiichi Fukuyama, Department of Thoracic Surgery, National Hospital Organization Beppu Medical Center, Beppu 874-0011, Japan
Tatsuro Okamoto, Yoshihiko Maehara, Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8581, Japan
Author contributions: Each author contributed to this paper equally.
Correspondence to: Tokujiro Yano, MD, PhD, Department of Thoracic Surgery, National Hospital Organization Beppu Medical Center, 1473 Uchikamado, Beppu 874-0011, Japan. tokujiro@beppu.hosp.go.jp
Telephone: +81-977-671111 Fax: +81-977-675766
Received: December 25, 2013
Revised: January 23, 2014
Accepted: June 18, 2014
Published online: December 10, 2014
Processing time: 351 Days and 4.1 Hours
Abstract

Postoperative recurrence occurs in approximately half of patients with non-small cell lung cancer (NSCLC), even after complete resection. Disease recurrence after surgical resection reduces the patient’s life expectancy sharply. The prognosis after postoperative recurrence is considered to largely depend on both the mode of first recurrence (distant, locoregional or combined) and the treatment modality: (1) The majority of cases of postoperative recurrence involve distant metastasis with or without locoregional recurrence. Platinum-based systemic chemotherapy is practically accepted as the treatment for these diseases on the basis of evidence for original stage IV disease. The advent of both pemetrexed and molecular-targeted drugs has improved the survival of nonsquamous NSCLC and changed the chemotherapeutic algorithm for NSCLC; (2) Among patients with distant metastatic recurrence without locoregional recurrence at the primary tumor site, the metastasis is often limited in both organ and number. Such metastases are referred to as oligometastases. Local therapy, such as surgical resection and radiotherapy, has been suggested to be the first-line treatment of choice for oligometastatic recurrence; and (3) While locoregional recurrence is likely to cause troublesome symptoms, it is a potentially limited disease. Therefore, providing local control is important, and radiation is usually beneficial for treating local recurrence. In order to obtain better control of the disease and provide treatment with curative intent in patients with limited disease, the administration of concurrent platinum-based chemoradiotherapy is recommended according to the results of originally nonresectable stage IIIA and IIIB disease.

Keywords: Non-small cell lung cancer; Postoperative recurrence; Distant metastasis; Oligometastases; Local treatment; Locoregional recurrence

Core tip: The postrecurrence survival in non-small cell lung cancer (NSCLC) is considered to largely depend on both the mode of first recurrence (distant, locoregional or combined) and the treatment modality. Therefore, the therapeutic strategy for treating postoperative recurrence in patients with NSCLC should be considered according to the mode of first recurrence. In this way, proper treatment specific to the mode of recurrence will be developed and improvements of the postrecurrence survival can be obtained.