Stereotactic Body Radiation Therapy for Re-irradiation of Persistent or Recurrent Non-Small Cell Lung Cancer

Journal Article · Tue Apr 01 04:00:00 EDT 2014 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2014.01.012· OSTI ID:22416526

Trovo, Marco ^[1]; Minatel, Emilio; Durofil, Elena ^[1]; Polesel, Jerry ^[2]; Avanzo, Michele ^[3]; Baresic, Tania ^[4]; Bearz, Alessandra ^[5]; Del Conte, Alessandro ^[6]; Franchin, Giovanni; Gobitti, Carlo; Rumeileh, Imad Abu; Trovo, Mauro G. ^[1]

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1. Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy)
2. Department of Epidemiology and Biostatistics, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy)
3. Department of Medical Physics, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy)
4. Department of Nuclear Medicine, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy)
5. Department of Medical Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy)
6. Department of Medical Oncology, Pordenone General Hospital, Aviano, Pordenone (Italy)

Purpose: To retrospectively assess toxicity and outcome of re-irradiation with stereotactic body radiation therapy (SBRT) in patients with recurrent or persistent non-small cell lung cancer (NSCLC), who were previously treated with radical radiation therapy (50-60 Gy). The secondary endpoint was to investigate whether there are dosimetric parameter predictors of severe radiation toxicity. Methods and Materials: The analysis was conducted in 17 patients with “in-field” recurrent/persistent centrally located NSCLC, who underwent re-irradiation with SBRT. SBRT consisted of 30 Gy in 5 to 6 fractions; these prescriptions would be equivalent for the tumor to 37.5 to 40 Gy, bringing the total 2-Gy-per-fraction cumulative dose to 87 to 100 Gy, considering the primary radiation therapy treatment. Actuarial analyses and survival were calculated by the Kaplan-Meier method, and P values were estimated by the log-rank test, starting from the date of completion of SBRT. Dosimetric parameters from the subgroups with and without grade ≥3 pulmonary toxicity were compared using a 2-tailed Student t test. Results: The median follow-up was 18 months (range, 4-57 months). Only 2 patients had local failure, corresponding to a local control rate of 86% at 1 year. The Kaplan-Meier estimates of overall survival (OS) rates at 1 and 2 years were 59% and 29%, respectively; the median OS was 19 months. Four patients (23%) experienced grade 3 radiation pneumonitis, and 1 patient developed fatal pneumonitis. One patient died of fatal hemoptysis 2 months after the completion of SBRT. Unexpectedly, heart maximum dose, D5 (minimum dose to at least 5% of the heart volume), and D10 were correlated with risk of radiation pneumonitis (P<.05). Conclusions: Re-irradiation with SBRT for recurrent/persistent centrally located NSCLC achieves excellent results in terms of local control. However, the high rate of severe toxicity reported in our study is of concern.

• OSTI ID: 22416526
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 88; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
COMPARATIVE EVALUATIONS
HAZARDS
HEART
LUNGS
NEOPLASMS
PATIENTS
PNEUMONITIS
RADIOTHERAPY
TOXICITY