Reirradiation for Locoregionally Recurrent Lung Cancer

Kruser, Tim J.; McCabe, Bradley P.; Mehta, Minesh P.; Khuntia, Deepak; Campbell, Toby C.; Geye, Heather M.; Cannon, George M.

doi:10.1097/coc.0b013e31826b9950

Cited by 32 publications

(6 citation statements)

References 17 publications

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“…Kim described 10 patients who underwent re-irradiation for locally recurrent esophageal cancer following definitive radiotherapy, and the 2 patients who had long times to recurrence (17.8 and 36.4 months) had a complete response [17]. This finding has also been reported in many studies of other tumors [14, 16, 21]. However, Hong failed to show the association between survival and time to recurrence [12], probably because the study included patients with mixed patterns of recurrence, including those with regional lymph node recurrence only, local failure or both.…”

Section: Discussionmentioning

confidence: 68%

“…A higher re-RT dose has been recommended for recurrent lung cancer, nasopharyngeal carcinoma and other tumors and has been shown to lead to an increase in local control and survival [14–16]. However, the optimal re-RT dose in patients with recurrent ESCC following definitive radiotherapy remains uncertain, although the importance of re-RT is well known.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating the optimal re-irradiation dose for locally recurrent esophageal squamous cell carcinoma after definitive radiotherapy

Wang

Jiang

et al. 2019

Radiat Oncol

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BackgroundRe-irradiation (re-RT) has the active effect of relieving clinical symptoms and prolonging the survival of patients with recurrent esophageal squamous cell carcinoma (ESCC). However, the optimal re-RT dose is still uncertain. Here, we analyzed the prognostic factors associated with survival and explored the optimal re-RT dose for patients with recurrent ESCC following definitive radiotherapy.Patients and methodsThe data of 47 patients with recurrent ESCC who were retreated between 2010 and 2014 were retrospectively analyzed. All patients received a radiation dose > 50 Gy during the primary treatment. The median time to recurrence after primary radiotherapy was 26 months (range 6–120 months). All patients had in-field recurrence in the esophagus. Recurrence within the local site was observed in 37 patients (78.7%), and recurrence in both the local site and regional nodes were observed in 10 patients (21.3%). All patients received 3D conformal re-RT with a median dose of 58 Gy (range 26–64 Gy). Chemotherapy was sequentially used in 27.7% of the patients. Survival curves were constructed according to the Kaplan-Meier method and were compared by log-rank tests. The factors predictive of survival were identified with univariate and multivariate analyses.ResultsDysphagia relief after re-RT was achieved in 20 of the 35 symptomatic patients (57.1%). The median survival time (MST) of all patients was 17 months, and the 1-, 2-, 3- and 5-year overall survival (OS) rates were 72.3, 25.5, 17.0 and 2.1%, respectively. In the univariate analysis, an Eastern Cooperative Oncology Group Performance Status (ECOG-PS) of 0–1 (P = 0.014), recurrence at the local site (P = 0.048), time to recurrence ≥24 months (P = 0.006) and re-RT dose ≥50 Gy (P < 0.001) were associated with favorable OS. In the multivariate analysis, only re-RT dose was an independent factor for OS (P = 0.007). Severe complications were observed in 7 patients, two of whom received a re-RT dose > 60 Gy.ConclusionOur results demonstrated that patients with recurrent ESCC following definitive radiotherapy had unfavorable OS. Re-RT could be considered a feasible and effective treatment modality. A re-RT dose > 50 Gy could improve the survival outcomes, and a dose > 60 Gy should be administered with caution due to the risk of severe complications.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Evaluating the optimal re-irradiation dose for locally recurrent esophageal squamous cell carcinoma after definitive radiotherapy

Wang

Jiang

et al. 2019

Radiat Oncol

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“…Published data have suggested that either thoracic re-RT with conventional fractionation [ 8 – 10 , 19 , 20 ] or with SBRT [ 5 – 7 , 11 – 14 ] is a reasonable treatment option to consider for relapse or progression. However, there is a lack of prospective evidence detailing outcomes after thoracic re-RT.…”

Section: Discussionmentioning

confidence: 99%

The risk and predictors for severe radiation pneumonitis in lung cancer patients treated with thoracic reirradiation

Ren

Liu

et al. 2018

Radiat Oncol

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BackgroundThoracic reirradiation (re-RT) is increasingly administered. However, radiation pneumonitis (RP) remains to be the most common side effect from retreatment. This study aimed to determine the risk and predictors for severe RP in patients receiving thoracic re-RT.MethodsSixty seven patients with lung cancer received thoracic re-RT for recurrent or metastatic disease. Three-dimensional conformal radiotherapy (3D-CRT)/intensity modulated radiotherapy (IMRT) was used for 60 patients, and stereotactic body radiation therapy (SBRT) was used in 7 patients. Deformable image registration (DIR) was performed to create a composite plan. Severe (grade ≥ 3) RP was graded according to Common Terminology Criteria for Adverse Events version 4.0.ResultsEighteen patients (26.9%) developed grade ≥ 3 RP (17 of grade 3, and 1 of grade 4). In univariate analyses, V5 and mean lung dose (MLD) of initial RT or re-RT plans, V5 and V20 of composite plans, and the overlap between V5 of initial RT and V5 of re-RT plans/V5 of re-RT plans (overlap-V5/re-V5) were significantly associated with grade ≥ 3 RP (P < 0.05 for each comparison). Multivariate analysis revealed that MLD of the initial RT plans (HR = 14.515, 95%CI:1.778–118.494, P = 0.013), V5 of the composite plans (HR = 7.398, 95%CI:1.319–41.495, P = 0.023), and overlap-V5/re-V5 (P = 0.041) were independent predictors for grade ≥ 3 RP. Out-of-field failures with medium overlap-V5/re-V5 of 0.4–0.8 was associated with higher risk of grade ≥ 3 RP compared with in-field failures (18.3% vs. 50%, P = 0.014).ConclusionsThe risk of grade ≥ 3 RP could be predicted not only by dose-volume variables from re-RT plan, but also by some from initial-RT and composite plans. Out-of-field failures was associated with higher risk of severe RP compared with in-field failures in some cases.

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“…The longer interval group (≥16 months) had a better prognosis than the shorter interval group (< 16 months). In studies of re-irradiation for lung cancer, it has been reported that a longer interval between the first RT and re-irradiation was associated with better survival (26, 27). A multi-institutional cohort study of re-irradiation for head and neck tumors indicated that more than a 2-year interval from the first RT to re-irradiation is a factor indicating better prognosis (28).…”

Section: Discussionmentioning

confidence: 99%

Prospective Study of Isolated Recurrent Tumor Re-irradiation With Carbon-Ion Beams

et al. 2019

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Purpose: To perform a prospective study to evaluate the efficacy and safety of isolated recurrent tumor re-irradiation with carbon-ion radiotherapy (RT). Methods and Materials: The inclusion criteria were clinically proven recurrent tumors, measurable by computed tomography or magnetic resonance imaging, patients ≥ 16 years old, performance status scores between 0 and 2, isolated tumor at a previously irradiated site, and a life expectancy > 6 months. The exclusion criteria were tumor invasion into the gastrointestinal tract or a major blood vessel, uncontrolled infection, early recurrence (<3 months), and severe concomitant diseases. The primary end-point was the local control rate, the secondary end-points including the overall survival rate, and adverse events. Results: Between December 2013 and March 2016, 22 patients were enrolled in this prospective study. All patients were re-irradiated with carbon-ion RT with radical intent. Five patients had rectal cancer, 4 had sarcoma, 4 had lung cancer, 3 had hepatic cell carcinoma, and 6 had other tumors. The median follow-up time was 26 months. Eight patients developed local recurrence, and the 1- and 2-year local control rates were 71 and 60%, respectively. Eight patients died of their cancers and 2 died of other diseases. The 1- and 2-year overall survival rates were 76 and 67%, respectively. There were no grade 2 or higher acute adverse events and 4 patients (18%) developed grade 3 late adverse events. The group with the longer interval (>16 months) between the first RT and re-irradiation had significantly better outcomes than the shorter interval group (≤ 16 months). Conclusions: Re-irradiation, using carbon-ion RT with radical intent, had favorable local control and overall survival rates without severe toxicities for selected patients. Re-irradiation has the potential to improve clinical outcomes for isolated, local, recurrent tumors; further investigations are required to confirm the therapeutic efficacy.

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Reirradiation for Locoregionally Recurrent Lung Cancer

Cited by 32 publications

References 17 publications

Evaluating the optimal re-irradiation dose for locally recurrent esophageal squamous cell carcinoma after definitive radiotherapy

Evaluating the optimal re-irradiation dose for locally recurrent esophageal squamous cell carcinoma after definitive radiotherapy

The risk and predictors for severe radiation pneumonitis in lung cancer patients treated with thoracic reirradiation

Prospective Study of Isolated Recurrent Tumor Re-irradiation With Carbon-Ion Beams

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