Highlights
- •Local recurrences occur in 10–15% of early stage NSCLC after definitive SBRT.
- •Salvage SBRT safety and efficacy for local recurrence after initial SBRT is unknown.
- •Median overall survival after salvage SBRT was 39 months in 21 patients.
- •Primary tumor and distant control at 2 years were 81% and 75% after salvage.
- •We observed no grade 3+ AEs, with grade 1–2 pneumonitis in 10% and CW pain in 19%
Abstract
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.
Keywords
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Article info
Publication history
Published online: August 31, 2019
Accepted:
August 14,
2019
Received in revised form:
August 14,
2019
Received:
December 19,
2018
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
