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• W1996900425 abstract "Limited modern data exists on management of in-field failures after thoracic radiation. The need to offer patients loco-regional control and prevent distant progression must be balanced against the potential risk of increased toxicity. Specifically, the role of re-irradiation with SBRT as an initial or second course of treatment is poorly defined. We review our experience treating patients with thoracic radiation therapy to previously treated high dose regions. Patients (pts) were treated as part of a thoracic oncology program with 3D conformal RT; SBRT dose 20-60 Gy (5-22.5 Gy/fraction (fx)), and external beam radiation therapy (XRT) dose 45-80.5 Gy (1.5-5 Gy/fx). 4D CT was used to define the ITV with 5 mm PTV expansions beginning in 2007. Otherwise a 10 mm PTV was applied. 8 patients prior to 2006 were treated using homogeneous tissue density for dose calculation. Pt failures were scored regarding local (at the site treated), regional (nodal disease in the hilum /mediastinum), or distant. Central versus peripheral was defined per RTOG 0813 criteria, and toxicity per NCI CTCAE v4.0. Kaplan Meier estimates were performed for local control (LC), regional (RF), distant failure (DF), and overall survival (OS). All event times were based on date of retreatment. Twenty-eight pts were treated with repeat thoracic radiation therapy (2001-2011) and SBRT as a component of care. Median follow-up was 13 months (m) (1-52 m). Pts were included if re-irradiation was in the prior 30 Gy isodose line and intent was definitive control. Twenty pts had XRT followed by SBRT, 6 pts SBRT then SBRT, 2 pts SBRT then XRT. The median re-irradiation dose and fraction was 50 Gy and 5 fx (Range 20-70.2 Gy, 1-35 fx). The median interval between courses was 18 m. Average patient age was 63 years (45-80) with a median ECOG PS of 1. Thoracic only disease was treated in 22 pts while 6 pts had metastatic disease at retreatment; 25 pts with lung cancer (4 SCLC), and 3 pts metastatic carcinoma. Average tumor size was 2.4 cm (0.9-5.4). Median OS was 22 m, with 2 year LC at 62% (95% CI 38.1-87.3). 4 pts had RF (1 isolated). Of 22 pts with chest only disease, 2 year distant metastatic free survival was 50.9%. Ten0 pts suffered chronic grade 2-3 toxicity (6 chest wall pain, 3 dyspnea, 1 esophagitis), and 1 pt suffered grade 5 toxicity with an aorta-esophageal fistula 6 m after 54Gy in 3 fx for a central tumor after 74 Gy XRT 1 year prior. Median time to toxicity was 6 m (2-20 m). In field failures after thoracic radiation present a unique challenge. This analysis suggests reasonable loco-regional control and freedom from distant metastases can be established with re-irradiation using SBRT or delivering fractionated XRT in the high dose region of prior SBRT. Chronic and high grade toxicity occurred in nearly 1/3 of patients." @default.
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• W1996900425 date "2012-11-01" @default.
• W1996900425 modified "2023-09-27" @default.
• W1996900425 title "Thoracic Reirradiation in Patients With Stereotactic Body Radiation Therapy (SBRT) as First or Second Course of Treatment" @default.
• W1996900425 doi "https://doi.org/10.1016/j.ijrobp.2012.07.1610" @default.
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