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• W2521541971 abstract "High local control rates of 70-90% have been reported for SBRT in stage I NSCLC and solitary lung metastasis, but still local recurrence is one of major patterns of failure after SBRT. In such cases, salvage surgery is difficult. As a salvage treatment of local recurrence after SBRT, we have used repeat SBRT. The purpose of this study was to evaluate the safety and efficacy of stereotactic re-irradiation after local in-field relapse of NSCLC or solitary lung metastasis previously treated with SBRT. From July 2004 to November 2011, 19 patients with local relapse of NSCLC (n=14) or lung metastasis (n=5) were retreated with SBRT. Median patient age at second SBRT was 79 years (range, 58-84), and 12 were men and 7 were women. These patients had grade 1 or 2 radiation pneumonitis after first SBRT. Local recurrence was first suspected on contrast-enhanced CT images showing an increasing mass-like shadow within the area of once consolidated radiation fibrosis. To support the diagnosis of local recurrence, FDG-PET was performed and a standardized uptake ratio was 3 or higher in all cases. Biopsy of the mass was performed whenever possible. The median interval between the first and second SBRT was 18 months (range, 4-80). First SBRT doses were 36 Gy in 2 fractions (fr) or 48, 50, or 52 Gy in 4 fr according to the institutional protocols. Second SBRT doses were 48, 50 or 52 Gy in 4 fr (n=12), 48 or 56 Gy in 6 fr (n=2), 60 Gy in 8 fr (n=3), 55 Gy in 10 fr (n=1), or 52.5 Gy in 15 fr (n=1). The prescribed doses were determined considering the tumor size and the distance between the tumor and organs at risk. One patient with a metastasis from colon cancer underwent SBRT 4 times to the same tumor. Overall survival rates were 83% at 1 year and 70% at 2 years. Local control rates were 72% and 1 year and 29% at 2 years. Five patients have not developed further recurrence until their death or last follow-up (2-100 months after second SBRT). The longest survival was 100 months; he had a histologically-confirmed recurrence and died of aspiration pneumonia with no evidence of further recurrence. The patient receiving SBRT 4 times is alive at 12 months after the fourth SBRT with no complication. All but 3 patients had grade 1 or 2 radiation pneumonitis after second SBRT. Grade 3 radiation pneumonitis occurred in two patients who had severe emphysema; domiciliary oxygen therapy became necessary for them eventually. The other adverse events were rib fracture in two and pain around the treatment volume in one. Repeat SBRT was relatively safe. Local control and survival rates were higher than expected. SBRT should be an important treatment option for local recurrence of NSCLC or lung metastasis in patients who did not have grade 3 or higher radiation pneumonitis after first SBRT." @default.
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• W2521541971 date "2015-11-01" @default.
• W2521541971 modified "2023-10-16" @default.
• W2521541971 title "Safety and Efficacy of Repeat Stereotactic Body Radiation Therapy (SBRT) for Local Recurrence of Non-Small Cell Lung Cancer (NSCLC) and Lung Metastasis" @default.
• W2521541971 doi "https://doi.org/10.1016/j.ijrobp.2015.07.1591" @default.
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