Characteristics and Treatment Outcomes of Single Recurrence in Patients Who Underwent Curative Resection for Stage I Lung Adenocarcinoma

Abstract

Introduction: Lung cancer is second most commonly diagnosed cancer worldwide with recurrence being the main cause of failure after curative resection. The knowledge of recurrence patterns and modalities used for diagnosis and management of recurrence is necessary for better management of recurrences. Materials and Methods: All patients of pathologic stage I (TNM 8th Edition) lung adenocarcinoma, who underwent curative resection at Seoul National University Bundang Hospital from 2003-2014 were included in the study. Detailed analyses of recurrence characteristics, diagnostic and treatment modalities, and survival among various groups were performed. Results: From the total 967 patients with stage I lung adenocarcinoma who underwent curative resection, 129 (13.34%) presented with recurrence, out of which 54 (41.86%) patients with single recurrence. Intrathoracic recurrences were more common (74.07%) with most recurrences occurring in the first two years post curative resection. Most patients (87.04%) were diagnosed with recurrence during regular follow-up. Computed Tomography (CT) scan (72.22%) was the most commonly performed primary diagnostic. Positron Emission Tomography (PET) scan was able to detect most extrathoracic recurrences. Surgery (40.74%) was the most commonly performed treatment for recurrence and these patients had better post treatment survival (7.4 years) than patients who underwent chemotherapy (3.7 years) or radiotherapy (4.4 years) without surgery. Post treatment survival in patients who did not receive any treatment was 1.2 years. Conclusion: Ipsilateral lung was the most common site of recurrence. Intrathoracic recurrences were more common and had better survival than extrathoracic recurrences. CT and PET scans combined were able to detect almost all of the recurrences (94.44%). Treatment of recurrence significantly prolonged survival. Surgery was the most common treatment modality for recurrence in stage I lung adenocarcinoma patients with better survival than chemotherapy and/or radiotherapy without surgery.