Re-Irradiation of Locoregional NSCLC Recurrence Using Robotic Stereotactic Body Radiotherapy

Ceylan, Cemile; Hamacı, Andaç; Ayata, H.; Berberoğlu, Kezban; Kilic, Ayhan; Güden, Metin; Engin, K.

doi:10.1159/000457129

Cited by 18 publications

(5 citation statements)

References 32 publications

(39 reference statements)

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“…However, such doses cannot be maintained for re-irradiation treatment due to the dose limits to the prior-irradiated critical organs ( 59 ) and hence it is no surprise that prior local irradiation was a significant predictor for worse LC, remaining a borderline significant factor in multivariate analysis ( p = 0.05). Re-treatment of local or regional recurrences after SBRT is also more and more frequently performed ( 60 – 62 ) and in our study, 42.9% of the non-pre-SBRT-irradiated local recurrences ( n = 6) were re-treated with robotic SBRT.…”

Section: Discussionsupporting

confidence: 51%

Clinical Results of Mean GTV Dose Optimized Robotic-Guided Stereotactic Body Radiation Therapy for Lung Tumors

et al. 2018

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IntroductionWe retrospectively evaluated the efficacy and toxicity of gross tumor volume (GTV) mean dose optimized stereotactic body radiation therapy (SBRT) for primary and secondary lung tumors with and without robotic real-time motion compensation.Materials and methodsBetween 2011 and 2017, 208 patients were treated with SBRT for 111 primary lung tumors and 163 lung metastases with a median GTV of 8.2 cc (0.3–174.0 cc). Monte Carlo dose optimization was performed prioritizing GTV mean dose at the potential cost of planning target volume (PTV) coverage reduction while adhering to safe normal tissue constraints. The median GTV mean biological effective dose (BED)10 was 162.0 Gy10 (34.2–253.6 Gy10) and the prescribed PTV BED10 ranged 23.6–151.2 Gy10 (median, 100.8 Gy10). Motion compensation was realized through direct tracking (44.9%), fiducial tracking (4.4%), and internal target volume (ITV) concepts with small (≤5 mm, 33.2%) or large (>5 mm, 17.5%) motion. The local control (LC), progression-free survival (PFS), overall survival (OS), and toxicity were analyzed.ResultsMedian follow-up was 14.5 months (1–72 months). The 2-year actuarial LC, PFS, and OS rates were 93.1, 43.2, and 62.4%, and the median PFS and OS were 18.0 and 39.8 months, respectively. In univariate analysis, prior local irradiation (hazard ratio (HR) 0.18, confidence interval (CI) 0.05–0.63, p = 0.01), GTV/PTV (HR 1.01–1.02, CI 1.01–1.04, p < 0.02), and PTV prescription, mean GTV, and maximum plan BED10 (HR 0.97–0.99, CI 0.96–0.99, p < 0.01) were predictive for LC while the tracking method was not (p = 0.97). For PFS and OS, multivariate analysis showed Karnofsky Index (p < 0.01) and tumor stage (p ≤ 0.02) to be significant factors for outcome prediction. Late radiation pneumonitis or chronic rip fractures grade 1–2 were observed in 5.3% of the patients. Grade ≥3 side effects did not occur.ConclusionRobotic SBRT is a safe and effective treatment for lung tumors. Reducing the PTV prescription and keeping high GTV mean doses allowed the reduction of toxicity while maintaining high local tumor control. The use of real-time motion compensation is strongly advised, however, well-performed ITV motion compensation may be used alternatively when direct tracking is not feasible.

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Section: Discussionsupporting

confidence: 51%

Clinical Results of Mean GTV Dose Optimized Robotic-Guided Stereotactic Body Radiation Therapy for Lung Tumors

et al. 2018

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“…Higher dose was also associated with longer OS. A Turkish study of 28 patients with 34 targets from recurrent NSCLC showed that PFS and OS were not significantly impacted by the interval between prior radiation (conventionally fractionated in all but 1) and salvage SBRT (23).…”

Section: Tumor Control and Survival Outcome-sbrt After Prior Conventimentioning

confidence: 99%

Stereotactic body radiotherapy as salvage treatment for recurrence of non-small cell lung cancer after prior surgery or radiotherapy

Milano

Kong

Movsas

2018

Transl. Lung Cancer Res

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Treatment options for thoracic recurrences of non-small cell lung cancer (NSCLC) are limited. Stereotactic body radiation therapy (SBRT) is an emerging, potentially effective technology to manage recurrent NSCLC, although with limited prospective studies. This work reviews the outcomes of patients undergoing salvage SBRT for pulmonary recurrences after prior resection or prior radiotherapy for NSCLC. Following salvage SBRT, after prior external beam radiation (SBRT or conventionally fractionated), the 2-year overall survival (OS) ranged from 37% to 79% in 11 of the studies (397 patients) reviewed here, while the 2-year local control (LC) ranged from 37% to 90% in 6 studies that reported that outcome. Toxicity risks are acceptable albeit with appreciable risks of severe to potentially fatal toxicity, necessitating the need to weigh risks vs. benefits in the re-irradiation setting. There were fewer studies on the use of SBRT after prior resection. Following salvage SBRT, after prior resection, the 2-year OS ranged from 56% to 68% in 4 studies (131 patients) reviewed here, while the 2-year LC ranged from 83% to 100% in 3 of these studies. SBRT in the salvage setting after prior resection appeared to be well-tolerated, with toxicity risks comparable to historical patients treated with SBRT alone (i.e., SBRT without prior resection, which is not reviewed here). The data are limited due to the retrospective nature of published studies (all but 4 with <40 patients), with various clinical scenarios (i.e., original NSCLC stage, prior treatment, location of target amenable to salvage SBRT) and a range of SBRT dosing and techniques. More studies are needed to better understand the tumor control, survival and toxicity of SBRT for salvage therapy of NSCLC patients, as well as the potentially prognostic factors that could affect these outcomes.

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“…The reirradiation resulted in no severe toxicities, and there was an acceptable crude local control rate of 80%. Ceylan et al 25 also reported on SBRT salvage for 28 patients with isolated local recurrence. They found a significant difference in local control between patients treated with BED ≥48 Gy 10 (ECD2, 40 Gy 10 ) and those with BED <48 Gy (median local control, 48 months vs 13 months; P = .007).…”

Section: Resultsmentioning

confidence: 99%

“…Seven articles evaluated salvage RT for patients with local recurrence after previous thoracic irradiation that included not only SBRT but also conventionally fractionated RT (CFRT; Table 3). [19][20][21][22][23][24][25] Prescribed dose and fractionation varied among the articles. Trakul et al 19 assessed treatment outcomes for SBRT reirradiation for in-field recurrences after prior SBRT or CFRT.…”

Section: Salvage Rt For Local Tumor Recurrencementioning

confidence: 99%

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

Matsuo

2018

Technol Cancer Res Treat

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Purpose:The purpose of this review article was to summarize available data on the efficacy and safety of salvage radiotherapy for isolated local or regional recurrence after prior stereotactic body radiotherapy for lung cancer.Methods:Studies were systematically searched on PubMed, following which suitable papers were selected. Reported outcomes and toxicities were qualitatively reviewed.Results:Nineteen papers, which were retrospective studies based on single institution experiences, were selected. Sixteen papers were on salvage radiotherapy for local tumor recurrence, and the remaining 3 papers evaluated radiotherapy for regional failures after stereotactic body radiotherapy for lung cancer. Patient cohorts in the selected papers seemed very frail with 2-year survival of 30% to 40% after the salvage. Local control was reported to be approximately 60% to 70%, which is worse than that after primary stereotactic body radiotherapy. Reported rates of toxicity grade 3 or worse were considered acceptable. Larger target volume and central tumor localization were suggested as risk factors for severe toxicities. Dosimetric data on patients having toxicities were found to help with considering dose constraints for organs at risk.Conclusion:Based on data from a limited number of articles, salvage radiotherapy is a reasonable treatment option for select patients with local or regional tumor recurrence after prior stereotactic body radiotherapy for lung cancer. Optimal patient selection and dose prescription can be clarified with a larger study that include more data on experiences with salvage radiotherapy.

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Re-Irradiation of Locoregional NSCLC Recurrence Using Robotic Stereotactic Body Radiotherapy

Cited by 18 publications

References 32 publications

Clinical Results of Mean GTV Dose Optimized Robotic-Guided Stereotactic Body Radiation Therapy for Lung Tumors

Clinical Results of Mean GTV Dose Optimized Robotic-Guided Stereotactic Body Radiation Therapy for Lung Tumors

Stereotactic body radiotherapy as salvage treatment for recurrence of non-small cell lung cancer after prior surgery or radiotherapy

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

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