Radiation Therapy for Intrathoracic Recurrence of Non-Small Cell Lung Cancer

Abstract

Fifty-two of 2,315 patients (2.4%) with non-small cell lung cancer (NSLC) treated with radiation therapy at the Mallinckrodt Institute of Radiology and St. Luke's Hospital between 1975 and 1988 presented with local recurrence after definitive surgery. No patient received radiation therapy after surgery as part of initial treatment and none had evidence of distant metastases at the time of local recurrence. The median time to first recurrence was 14 months. At recurrence, patients presented with disease in the bronchial stump (eight patients), ipsilateral lung parenchyma (10), chest wall (six), regional lymph nodes (five), or some combination thereof (23). Sixty-five percent of patients had histologic evidence of recurrence. Radiation therapy consisted of > 5,000 cGy in conventional fractionation to areas of gross disease in 35 of 52 patients. Of 15 patients receiving > 6,000 cGy, 13 had a favorable--complete (CR) or partial (PR) response--tumor response to radiation therapy. Among these patients, local control was achieved in 70% of patients with marginal recurrences (i.e., stump, parenchyma, or chest wall) and in 50% with nodal recurrences. The median survival after radiation therapy for all patients was 8.5 months. The best indicators for long-term survival were the interval from initial surgery to first recurrence and tumor response to radiation therapy.

Comparative Survival in Patients With Postresection Recurrent Versus Newly Diagnosed Non–Small-Cell Lung Cancer Treated With Radiotherapy

“…The 5-year and median OS results for those with recurrence in our study appeared to be better than those reported by others, which have ranged from 4% to 12.5% and 8.1 to 14.0 months, respectively (9)(10)(11)(12)(13)(14)(15)(16)(17), and the survival of the newly diagnosed patients was comparable to those reported for 1996-2004 in the 17 Surveillance, Epidemiology, and End Results geographic areas (5-year survival rate, 15.2%; available from: http://seer.cancer.gov/statfacts/html/lungb. html).…”

“…The prognostic factors for survival of postresection recurrent NSCLC patients have been studied by other investigators. Emami et al (12) reported the best indicators for longterm survival in 52 postresection recurrent patients were the interval from initial surgery to the first recurrence (p <.001) and the tumor response to RT (p = .014). Jeremic et al (14) found that in 61 postresection recurrent NSCLC patients, those treated with high-dose RT (radical intent) had better survival than patients treated with low-dose RT (palliative intent; p <.001); women had better survival than men (p = .02); and the stage and location of the recurrence were also significant prognostic factors (p = .0016 and p = .0011, respectively).…”

“…The data on treatment outcomes after RT are limited for postresection recurrent NSCLC (9)(10)(11)(12)(13)(14)(15)(16)(17), especially relative to the survival outcomes of newly diagnosed NSCLC patients treated with RT-based regimens (10,11). The purpose of the present study was to evaluate the utility of salvage RT for recurrent NSCLC after surgical resection and to compare the survival statistics of these patients with those of newly diagnosed NSCLC patients.…”

Prognosis of recurrent non-small cell lung cancer following complete resection

“…Walsh et al (23) characterized disease-free interval as an “indirect measure of a patient’s tumor biology and aggressiveness”. Thus, longer disease-free interval has been reported to be associated with prolonged survival following recurrence in several studies (24–27). …”

Non-small cell lung cancer: radiation therapy for locoregional recurrence after complete resection

“…2-5 For locoregional recurrence, radiation therapy is the treatment of choice, and several reports have shown that 2-and 5-year survival is comparable to those for radiation therapy alone in patients with primary stage III non-small cell lung cancer. [6][7][8] Therefore, we have treated these patients with radical radiation therapy when possible.…”