Lung cancer: Retreatment of local recurrence after definitive irradiation

Abstract

Aggressive radiation therapy for the management of inoperable lung cancer has increased tumor control and survival. However, approximately 20% of patients continue to experience local recurrence as the sole manifestation of treatment failure. Seven hundred thirty-four patients were initially treated by radiation therapy for inoperable lung cancer, for recurrence after resection, or as adjunct postoperative therapy. Twenty-nine patients were referred for retreatment of cancer that recurred within the original treatment field. Following retreatment, 14 of 29 patients (48%) had a favorable subjective response, and 20 of 27 patients (74%) a favorable objective response. A favorable response was observed for all cell types and over a wide range of retreatment dosages. Symptomatic radiation pneumonitis developed in one patient, rib sclerosis and fracture developed in another. Th median survival after onset of retreatment was five months with a range of one month to 54 months. The clinically determined mechanisms of death were persistent intrathoracic disease in 14 of 25 patients (56%), intrathoracic disease and distant metastasis in 7 of 25 (28%), distant metastasis in 3 of 25 (12%), and unknown in 1 of 25 (4%).

Non-small-cell lung cancer: reirradiation for loco-regional relapse previously treated with radiation therapy

“…[7][8][9] Although the number of patients in the present study was not large in comparison with previous reports, the stages of relapsed non-small-cell lung cancer and the prescribed radiation doses were relatively uniform. [10][11][12][13][14] Several suggestive findings in our study may contribute to the future study of relapsed non-small-cell lung cancer after radiation therapy.…”

Chest Reirradiation With External Beam Radiotherapy for Locally Recurrent Non-Small-Cell Lung Cancer: A Review

“…Eleven studies were identified that specifically reported on clinical results for thoracic reirradiation of locally recurrent NSCLC (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), with publication dates ranging from 1982 to 2009. The majority of these studies are retrospective in nature and are characterized overall by the limited quality and comprehensiveness of the patient, tumor, and treatment data reported and analyzed.…”

“…Few studied provided comprehensive pattern-of-failure documentation. Finally, only four studies attempted to evaluate survival according to potential prognostic factors such as interval between first and second RT, PS, age, size, location, or response (5,7,12,15).…”

Stereotactic Body Radiation Therapy as Salvage for Intrathoracic Recurrence in Patients With Previously Irradiated Locally Advanced Non–Small Cell Lung Cancer

“…Outcome data for reirradiation by traditionally fractionated dosages (180 to 300 cGy) showed overall survival (OS) rates of 26% to 59% at 1 year and 11%to 27% at 2-year follow-up. [7][8][9][10] The same studies had median survival times between 5 and 18 months. These poor outcomes data are further exacerbated by the fact that reirradiation of tissue is associated with greater risk of adverse effects than treatment of radiation-naive lung.…”