Salvage Surgery After Chemoradiotherapy and Durvalumab: a Case Report

Abstract

Background. Few reports have described salvage surgery for locally recurrent non-small cell lung cancer after chemoradiotherapy and consolidation therapy using immune checkpoint inhibitors. Case. A 65-year-old man received chemoradiotherapy (CRT) followed by consolidation therapy using durvalumab for unresectable cStage IIIA adenocarcinoma of the left upper lung. The tumor regressed at 3 months after chemoradiotherapy, with the disappearance of a mediastinal hot spot observed on fluorodeoxyglucose (FDG)-positron emission tomography. Although tumor regrowth occurred 8 months after CRT, the mediastinal lymph node did not show the uptake of FDG. Therefore, we concluded that the tumor was downstaged to ycStage IB following treatment. At 10 months after chemoradiotherapy, we performed left lung upper lobectomy as salvage surgery. Histopathological evaluation of the resected tumor confirmed the diagnosis of low-grade adenocarcinoma ypStage IA3, with viable cells and lymphocytic infiltration. The scarred lymph nodes did not show any tumor cells. The resectability status was determined to be R0. The patient's postoperative course was uneventful, and he was discharged to home on postoperative day 10. He did not receive adjuvant chemotherapy and no recurrence has been detected in 14 months of postoperative follow-up.