Reirradiation for locoregionally recurrent non-small cell lung cancer

Abstract

Locoregional failure in non-small cell lung cancer (NSCLC) remains high, and the management for recurrent disease in the setting of prior radiotherapy is difficult. Retreatment options such as surgery or systemic therapy are typically limited or frequently result in suboptimal outcomes. Reirradiation (reRT) of thoracic malignancies may be an optimal strategy for providing definitive local control and offering a new chance of cure. Yet, retreatment with radiation therapy can be challenging for fear of excessive toxicities and the inability to safely deliver definitive (≥60 Gy) doses of reRT. However, with recent improvements in radiation delivery techniques and image-guidance, dose-escalation with reRT is possible and outcomes are encouraging. Here, we present a review of various radiation techniques, clinical outcomes and associated toxicities in patients with locoregionally recurrent NSCLC treated primarily with reRT.

Pattern-of-failure and salvage treatment analysis after chemoradiotherapy for inoperable stage III non-small cell lung cancer

“…In contrast, for patients with OFR, local ablative treatment is more reasonable and should be considered. Our study confirmed the previously described role of ablative salvage treatment in patients with OFR [29,[36][37][38][39][40][41][42][43][44].…”

“…Salvage treatment for stage III NSCLC treated with definitive CRT has dramatically changed in the last decade. Development of image-guided, high precision reirradiation protocols, especially particle re-irradiation as well as introduction of immune check-point inhibition and chemoimmunotherapy have led to continuous improvement of post-recurrence survival [28][29][30][31][32]. Intensive aftercare imaging programs have also significantly influenced post-progression patient outcome [33].…”

The Impact of Radiotherapy on the Incidence of Secondary Malignancies: A Pan-Cancer Study in the US SEER Cancer Registries

“…Actually, patients with combined surgery and radiotherapy can achieve a higher local tumor control rate and better long-term survival. Surgery and radiotherapy were often performed simultaneously in many types of tumors [ 20 , 21 , 22 , 23 ]. In other words, most of the patients without surgery also had not received radiotherapy, thus, we cannot yield a reasonable effect of radiotherapy based on the sparse data (few patients received radiotherapy) in the no surgery subgroup in some types of tumor ( Supplementary Table S2 ).…”

Advances in proton therapy in lung cancer

“…The physical properties of proton therapy allow for dose escalation and hypofractionation that can potentially improve LC and survival, 20 , 77 , 78 while minimizing dose to normal structures, especially in the setting of concurrent chemotherapy, trimodality therapy with surgery for locally advanced disease, and for reirradiation. 79 There have been a number of recently published institutional experiences using proton therapy as a means to deliver definitive, high doses of reirradiation therapy to patients with recurrent NSCLC, providing them a second chance of cure. 23 , 80 – 82 …”