Relapse pattern and second-line treatment following multimodality treatment for XXXX   .

@entity1 @entity5 @entity2615 @entity3620 @entity1349
OBJECTIVES: To analyse the relapse pattern and influence of second-line treatment after recurrence of @entity3620 ( @entity3620 ) in @entity1 who had previously undergone multimodality treatment. METHODS: Between September 1999 and December 2013, 136 @entity1 underwent macroscopic complete resection (MCR) by extrapleural pneumonectomy after induction chemotherapy for @entity3620 . We analysed 106 @entity1 who presented with recurrent disease until October 2014. Data were retrieved from our @entity2615 database, with additional information regarding precise localization gathered by reviewing the imaging and medical records. RESULTS: The overall recurrence rate was 78% (106/136 @entity1 ). The median freedom from recurrence was 9 months after surgery [95% confidence interval (95% CI) 7-10]. Local recurrence only was observed in 33 @entity1 (31%), distant metastases only in 27 @entity1 (26%) and simultaneous distant and local recurrence in 46 @entity1 (43%). Local recurrence was observed significantly less frequently in @entity1 having received adjuvant radiotherapy (19 vs 47%, P = 0.003), but there was no significant impact on overall survival (OS) [radiation: 22 months (95% CI 19-24); no-radiation: 23 months (95% CI 18-27), P = 0.6]. The median OS was 22 months (95% CI 21-24), median @entity1349 ( @entity1349 ) was 7 months (95% CI 5-9) and @entity1 with local recurrence only survived significantly longer (12 months, 95% CI 8-16) compared with @entity1 with distant recurrence only (5 months, 95% CI 2-8) or distant plus local relapse (6 months, 95% CI 3-9; P = 0.04). A total of 78 @entity1 received a second-line therapy after @entity5 recurrence: chemotherapy (n = 48), local radiotherapy (n = 9), surgery (n = 10) or a combination thereof (n = 11). @entity1 undergoing second-line treatment survived significantly longer compared with @entity1 not receiving therapy (P < 0.0005). The median @entity1349 after surgery was significantly longer than that of @entity1 receiving chemo-, radio- or chemo-radiotherapy (P = 0.04). CONCLUSIONS: Local recurrence of @entity3620 remains the most frequent type of relapse even after multimodality treatment including MCR. In the present cohort, active treatment seems beneficial to the @entity1 since surgical excision of local @entity5 relapse has good long-term outcome in selected @entity1 . Thus, second-line treatment may prolong @entity1349 ; however, these results need to be confirmed in a prospective manner.
