Management and survival outcomes of patients with postoperative recurrence of non-small cell lung cancer at isolated ipsilateral hilar or mediastinal lymph node.

Background: Current guidelines recommend chemoradiotherapy or chemotherapy alone in cases of prior radiotherapy for mediastinal lymph node (LN) recurrence after surgery for non-small cell lung cancer (NSCLC). However, data on management and outcomes remain limited. This study investigated treatment approaches and survival outcomes in patients with isolated ipsilateral hilar or mediastinal LN recurrence after surgical resection for NSCLC.

Methods: A retrospective chart review was conducted using a multi-institutional database to identify consecutive patients with isolated ipsilateral hilar or mediastinal LN recurrence after surgical resection for NSCLC between 2014 and 2016 at 10 institutions. Patient characteristics, recurrence treatment, and post-recurrence survival (PRS) were analyzed.

Results: Sixty-seven patients were included, with a median age of 72 years and a median follow-up of 51.5 months. Two- and 5-year PRS rates were 69.2% and 34.2%, respectively. Local radical therapy (LRT) (surgical resection or radiotherapy), chemotherapy, and chemoradiotherapy were administered in 16 (24%), 30 (45%), and 21 (31%) patients, respectively. Among those receiving chemotherapy, cytotoxic drugs, tyrosine kinase inhibitor (TKI), and immune checkpoint inhibitor (ICI) with or without cytotoxic drugs were administered in 12, 11, and 7 patients, respectively. Five-year PRS rates in patients receiving LRT, chemotherapy, and chemoradiotherapy were 32.9%, 12.6%, and 55.0%, respectively.

Conclusions: Our data suggest that various treatments are administered for postoperative recurrence at isolated ipsilateral hilar or mediastinal LN, differing from current guideline recommendations, which is associated with acceptable survival outcomes. Multidisciplinary discussions are essential for optimizing management.