A Systematic Literature Review on Salvage Radiotherapy for Local or Regional Recurrence After Previous Stereotactic Body Radiotherapy for Lung Cancer

Matsuo, Yukinori

doi:10.1177/1533033818798633

Cited by 9 publications

(7 citation statements)

References 31 publications

(83 reference statements)

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“…An early diagnosis of lung cancer relapse is essential, as in some cases, a curative intended treatment might be feasible [ 1 ]. In this study, relapsed lesions within HDV had higher FDG-SUV peak and larger MTV, than the relapsed lesions outside of HDV.…”

Section: Discussionmentioning

confidence: 99%

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Impact of [18F]FDG-PET and [18F]FLT-PET-Parameters in Patients with Suspected Relapse of Irradiated Lung Cancer

et al. 2021

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Radiation-induced changes may cause a non-malignant high 2-deoxy-2-[18F]fluoro-D-glucose (FDG)-uptake. The 3′-deoxy-3′-[18F]fluorothymidine (FLT)-PET/CT performs better in the differential diagnosis of inflammatory changes and lung lesions with a higher specificity than FDG-PET/CT. We investigated the association between post-radiotherapy FDG-PET-parameters, FLT-PET-parameters, and outcome. Sixty-one patients suspected for having a relapse after definitive radiotherapy for lung cancer were included. All the patients had FDG-PET/CT and FLT-PET/CT. FDG-PET- and FLT-PET-parameters were collected from within the irradiated high-dose volume (HDV) and from recurrent pulmonary lesions. For associations between PET-parameters and relapse status, respectively, the overall survival was analyzed. Thirty patients had a relapse, of these, 16 patients had a relapse within the HDV. FDG-SUVmax and FLT-SUVmax were higher in relapsed HDVs compared with non-relapsed HDVs (median FDG-SUVmax: 12.8 vs. 4.2; p < 0.001; median FLT-SUVmax 3.9 vs. 2.2; p < 0.001). A relapse within HDV had higher FDG-SUVpeak (median FDG-SUVpeak: 7.1 vs. 3.5; p = 0.014) and was larger (median metabolic tumor volume (MTV50%): 2.5 vs. 0.7; 0.014) than the relapsed lesions outside of HDV. The proliferative tumor volume (PTV50%) was prognostic for the overall survival (hazard ratio: 1.07 pr cm3 [1.01–1.13]; p = 0.014) in the univariate analysis, but not in the multivariate analysis. FDG-SUVmax and FLT-SUVmax may be helpful tools for differentiating the relapse from radiation-induced changes, however, they should not be used definitively for relapse detection.

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Section: Discussionmentioning

confidence: 99%

“…The early and precise diagnosis in patients suspected for lung cancer relapse is essential, as a curative intended treatment might be feasible [ 1 ]. The 2-deoxy-2-[ 18 F]fluoro- d -glucose (FDG)-PET/CT is recommended in patients with a clinical suspicion of recurrence of lung cancer after treatment [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of [18F]FDG-PET and [18F]FLT-PET-Parameters in Patients with Suspected Relapse of Irradiated Lung Cancer

et al. 2021

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“…Re-RT can be instilled in almost all in-field local recurrent tumors, such as the brain [ 8 , 9 ], head and neck [ 10 , 11 ], lungs [ 12 ], breast [ 13 ], abdomen [ 14 ], pelvis, prostate and gynecological regions [ 15–18 ], bone [ 19 ] or secondary primary cancers [ 10 ]. We know that the patterns of disease progression and prognosis are largely dependent on the site and cancer histopathology.…”

Section: Discussionmentioning

confidence: 99%

A surveillance study of patterns of reirradiation practice using external beam radiotherapy in Japan

Yamazaki

Suzuki

Aibe

et al. 2020

Journal of Radiation Research

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The aim of this study was to survey the present status and patterns of reirradiation (Re-RT) practice using external beam radiotherapy in Japan. We distributed an e-mail questionnaire to the Japanese Society for Radiation Oncology partner institutions, which consisted of part 1 (number of Re-RT cases in 2008–2012 and 2013–2018) and part 2 (indications and treatment planning for Re-RT and eight case scenarios). Of the 85 institutions that replied to part 1, 75 (88%) performed Re-RTs. However, 59 of these 75 institutions (79%) reported difficulty in obtaining Re-RT case information from their databases. The responses from 37 institutions included the number of Re-RT cases, which totaled 508 in the period from 2009 to 2013 (institution median 3; 0–235), and an increase to 762 cases in the period from 2014 to 2018 (12.5; 0–295). A total of 47 physicians responded to part 2 of the survey. Important indications for Re-RT that were considered were age, performance status, life expectancy, absence of distant metastases and time interval since previous radiotherapy. In addition to clinical decision-making factors, previous total radiation dose, volume of irradiated tissue and the biologically equivalent dose were considered during Re-RT planning. From the eight site-specific scenarios presented to the respondents, >60% of radiation oncologists agreed to perform Re-RT. Re-RT cases have increased in number, and interest in Re-RT among radiation oncologists has increased recently due to advances in technology. However, several problems exist that emphasize the need for consensus building and the establishment of guidelines for practice and prospective evaluation.

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“…For centrally located lung tumors or nodal recurrences after previous irradiation, some authors have discouraged the use of SABR because of the perceived high risks of toxicity. 16,17 In other studies that included central lesions without prior radiotherapy, a higher rate of grade 5 toxicities was often reported. [16][17][18] In an analysis of 32 lesions (11 central) that were previously irradiated, Peulen et al reported that treatment of central lung lesions and lesions with larger volumes resulted in higher toxicity; 9 of 29 patients had grade 3 or higher toxicity, including 3 cases of fatal hemoptysis.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 In other studies that included central lesions without prior radiotherapy, a higher rate of grade 5 toxicities was often reported. [16][17][18] In an analysis of 32 lesions (11 central) that were previously irradiated, Peulen et al reported that treatment of central lung lesions and lesions with larger volumes resulted in higher toxicity; 9 of 29 patients had grade 3 or higher toxicity, including 3 cases of fatal hemoptysis. 17 Another prospective trial studying salvage SABR in NSCLC did not include any central lesions in their reirradiation series.…”

Section: Discussionmentioning

confidence: 99%

Long-term toxicity and survival outcomes after stereotactic ablative radiotherapy for patients with centrally located thoracic tumors

Atalar

Mustafayev

Sio

et al. 2020

Radiology and Oncology

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AbstractBackgroundStereotactic ablative radiotherapy (SABR) is effective for thoracic cancer and metastases; however, adverse effects are greater for central tumors. We evaluated factors affecting outcomes and toxicities after SABR for patients with primary lung and oligometastatic tumors.Patients and methodsWe retrospectively identified consecutive patients with centrally located lung tumors that were treated at our hospital from 2009-2016. The effects of patient, disease, and treatment-related parameters on local control (LC), overall survival (OS), and toxicity-free survival (TFS) were evaluated with multivariate analyses.ResultsAmong 65 consecutive patients identified with 70 centrally located tumors, 20 tumors (28%) were reirradiated. Median (range) total dose for all tumors was 55 (30–60) Gy in 5 (3–10) fractions. Radiographic complete response was obtained in 43 lesions (61%). None of the analyzed factors were correlated with complete response. After a median follow-up of 57 (95% CI, 48–65) months, 10 tumors (14%) relapsed and 37 patients (57%) died; the actuarial 2- and 5-year OS rates were 52% and 28%, respectively. Median OS was significantly lower in patients with grade 3 or higher toxicity vs. lower toxicity (5 vs. 39 months; P < 0.001). Among 17 severe toxicities, 5 were grade 5, and 3 of them were reirradiated to the same field. Grade 3 to 5 TFS was lower with vs. without reirradiation (2-year TFS, 63% vs. 96%; P = 0.02).ConclusionsOur study showed that modern SABR is effective for central lung tumors, and toxicities are acceptable. SABR for reirradiated central lung lesions and possibly for lesions abutting the tracheobronchial tree may result in higher risk of serious toxicities.

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A Systematic Literature Review on Salvage Radiotherapy for Local or Regional Recurrence After Previous Stereotactic Body Radiotherapy for Lung Cancer

Cited by 9 publications

References 31 publications

Impact of [18F]FDG-PET and [18F]FLT-PET-Parameters in Patients with Suspected Relapse of Irradiated Lung Cancer

Impact of [18F]FDG-PET and [18F]FLT-PET-Parameters in Patients with Suspected Relapse of Irradiated Lung Cancer

A surveillance study of patterns of reirradiation practice using external beam radiotherapy in Japan

Long-term toxicity and survival outcomes after stereotactic ablative radiotherapy for patients with centrally located thoracic tumors

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