4.7 Article

Repeat stereotactic body radiation therapy (SBRT) for salvage of isolated local recurrence after definitive lung SBRT

Journal

RADIOTHERAPY AND ONCOLOGY
Volume 142, Issue -, Pages 230-235

Publisher

ELSEVIER IRELAND LTD
DOI: 10.1016/j.radonc.2019.08.010

Keywords

Lung cancer; Stereotactic body radiation therapy; Local failure; Reirradiation; Salvage

Funding

  1. Clinical and Translational Science Award (CTSA) Grant [UL1 TR000448]
  2. Siteman Comprehensive Cancer Center
  3. NCI Cancer Center Support Grant [P30 CA091842]

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Purpose: Optimal management of isolated local recurrences after stereotactic body radiation therapy (SBRT) for early non-small cell lung cancer (NSCLC) is unknown and literature describing repeat SBRT for in-field recurrences after initial SBRT are sparse. We investigate the safety and efficacy of salvage SBRT for isolated local failures after initial SBRT for NSCLC. Methods/Materials: Patients receiving SBRT for isolated local recurrence after initial SBRT for early NSCLC were identified using a prospective registry. Both courses were 3-5 fractions with a biologically effective dose (BED10) of >= 100 Gy. Local failure was defined as within 1 cm of the initial planning target volume (PTV) or an overlap of the >= 25% isodose lines of the first and second treatments. Failures >1 cm beyond the PTV and without >= 25% overlap, or with additional recurrence sites were excluded. Kaplan-Meier analysis was used to estimate survival. Results: A total 21 patients receiving salvage SBRT from 2008 to 2017 were identified. Median interval from initial SBRT to salvage SBRT was 23 months (7-52). Six patients (29%) had central tumors. Median follow-up time from salvage SBRT was 24 months (3-60). Median overall survival after salvage was 39 months. After reirradiation, two-year primary tumor control was 81%, regional nodal control was 89%, distant control was 75% and overall survival was 68%. Grade 2 pneumonitis occurred in 2 patients (10%) and grade 2 chest wall toxicity in 4 patients (19%). No grade 3+ toxicity was observed. Conclusions: Salvage SBRT for isolated local failures after initial SBRT appears safe, with low treatment-related toxicity and encouraging rates of tumor control. (C) 2019 Elsevier B.V. All rights reserved.

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