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. 2015;4(1):65-70.
doi: 10.1007/s13566-014-0175-2. Epub 2014 Dec 10.

Stereotactic body radiotherapy for re-irradiation of lung cancer recurrence with lower biological effective doses

Nisha R Patel  1 , Rachelle Lanciano  2 , Karna Sura  1 , Jun Yang  2 , John Lamond  2 , Jing Feng  3 , Michael Good  3 , Ed J Gracely  1 , Lydia Komarnicky  1 , Luther Brady  2
Affiliations

Stereotactic body radiotherapy for re-irradiation of lung cancer recurrence with lower biological effective doses

Nisha R Patel et al. J Radiat Oncol. 2015.

Abstract

Objective: Few studies have evaluated re-irradiation of lung cancer recurrences with stereotactic body radiotherapy (SBRT). This study evaluates outcomes with SBRT re-irradiation for recurrent lung cancer.

Methods: Two hundred and seventy-eight patients treated with SBRT for lung cancer were retrospectively reviewed. Of those, 26 patients with 29 tumors were re-irradiated with SBRT. Ninety percent of tumors received prior external beam irradiation and 10 % received prior SBRT. Previous median radiation dose was 61.2 Gy with a median 8-month interval from previous radiation. The median re-irradiation SBRT dose was 30 Gy (48 Gy10 biological effective dose (BED)). Endpoints evaluated included local control, overall survival, and progression-free survival.

Results: Twenty-five of 29 tumors were evaluable for local control, with 27 tumors (93 %) considered in-field recurrences. In-field crude local control rate was 80 % (20/25) with 1 and 2-year actuarial rates of 78.6 and 65.5 %, respectively. One and 2-year actuarial survival rates were 52.3 and 37.0 %, respectively. One and 2-year actuarial progression-free survival rates were 56.7 and 37.0 %, respectively. Fifty-five percent of patients reported acute/chronic grades 1 and 2 toxicities. No grade 3 or higher toxicities were reported.

Conclusion: Patients with recurrent lung cancer have limited options. SBRT re-irradiation is tolerable even after a median 61.2 Gy to the re-irradiation site. The lower BED used provided acceptable progression-free survival with low toxicity. Given the poor prognosis with current treatment options, new paradigms for re-treatment should include SBRT-re-irradiation as an adjunct to systemic therapy for in-field lung cancer recurrence.

Keywords: Lung cancer; Radiation; Re-irradiation; Recurrence; SBRT.

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Figures

Fig. 1
Fig. 1
Composite plan of a patient who initially received 54 Gy external beam radiation for a left upper lobe adenocarcinoma. She was re-irradiated with SBRT 25 Gy in 5 fractions for an in-field recurrence in left upper lobe and subsequent 50 Gy in 5 fractions for a marginal right hilar recurrence. Note fiducials in each site of re-irradiation SBRT. Patient survived 45 months after initial SBRT re-irradiation
Fig. 2
Fig. 2
Proportion of patients free from progression over time
See this image and copyright information in PMC

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