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. 2019 Apr;51(2):769-776.
doi: 10.4143/crt.2018.366. Epub 2018 Sep 11.

Salvage Concurrent Chemo-radiation Therapy for Loco-regional Recurrence Following Curative Surgery of Non-small Cell Lung Cancer

Kyung Hwa Lee  1 , Yong Chan Ahn  1 , Hongryull Pyo  1 , Jae Myoung Noh  1 , Seung Gyu Park  1 , Tae Gyu Kim  2 , Eonju Lee  2 , Heerim Nam  3 , Hyebin Lee  3 , Jong-Mu Sun  4 , Jin Seok Ahn  4 , Myung-Ju Ahn  4 , Keunchil Park  4
Affiliations

Salvage Concurrent Chemo-radiation Therapy for Loco-regional Recurrence Following Curative Surgery of Non-small Cell Lung Cancer

Kyung Hwa Lee et al. Cancer Res Treat. 2019 Apr.

Abstract

Purpose: This study is to report clinical outcomes of salvage concurrent chemo-radiation therapy (CCRT) in treating patients with loco-regional recurrence (LRR) following initial complete resection of non-small cell lung cancer.

Materials and methods: Between February 2004 and December 2016, 127 patients underwent salvage CCRT for LRR. The median radiation therapy (RT) dose was 66 Gy and clinical target volume was to cover recurrent lesion with margin without elective inclusion of regional lymphatics. Majority of patients (94.5%) received weekly platinum-based doublet chemotherapy during RT course.

Results: The median follow-up time from the start of CCRT was 25 months. The median survival duration was 49 months, and overall survival (OS) rates at 2 and 5 years were 72.9% and 43.9%. The 2- and 5-year rates of in-field failure-free survival, distant metastasis free survival, and progression free survival were 82.4% and 73.8%, 50.4% and 39.9%, and 34.6% and 22.3%, respectively. Grade ≥ 3 radiation-related esophagitis and pneumonitis occurred in 14 (11.0%) and six patients (4.7%), respectively. On both univariate and multivariate analysis, higher biologically equivalent dose (BED10) (≥ 79.2 Gy10 vs. < 79.2 Gy10; hazard ratio [HR], 0.431), smaller CTV (≤ 80 cm3 vs. > 80 cm3; HR, 0.403), and longer disease-free interval (> 1 year vs. ≤ 1 year; HR, 0.489) were significantly favorable factors for OS.

Conclusion: The current study has demonstrated that high dose salvage CCRT focused to the involved lesion only was highly effective and safe. In particular, higher BED10, smaller CTV, and longer disease-free interval were favorable factors for improved survival.

Keywords: Loco-regional recurrence; Non-small cell lung carcinoma; Salvage concurrent chemo-radiation therapy.

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Conflict of interest statement

Conflict of interest relevant to this article was not reported.

Figures

Fig. 1.
Fig. 1.
Kaplan-Meier plots of overall survival (A) and progression free survival (B).
Fig. 2.
Fig. 2.
Failure patterns in relation to radiation therapy target volume.
See this image and copyright information in PMC

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