Cancer Res Treat.  2019 Jul;51(3):1156-1166. 10.4143/crt.2018.472.

High-Dose Thoracic Re-irradiation of Lung Cancer Using Highly Conformal Radiotherapy Is Effective with Acceptable Toxicity

• Hong JH
• Kim YS
• Lee SW
• Lee SJ
• Kang JH
• Hong SH
• Hong JY
• Cheon G

• KMID: 2454307
• DOI: http://doi.org/10.4143/crt.2018.472

Abstract

PURPOSE
Thoracic re-irradiation (re-RT) of lung cancer has been challenged by the tolerance doses of normal tissues. We retrospectively analyzed local control, overall survival (OS) and toxicity after thoracic re-RT using highly conformal radiotherapy, such as intensity modulated radiotherapy and stereotactic body radiotherapy.
MATERIALS AND METHODS
Thirty-one patients who received high-dose thoracic re-RT were analyzed. Doses were recalculated to determine biologically equivalent doses. The median interval to re-RT was 15.1 months (range, 4.4 to 56.3 months), the median initial dose was 79.2 Gy₁₀ (range, 51.75 to 150 Gy₁₀), and the median re-RT dose was 68.8 Gy₁₀ (range, 43.2 to 132 Gy₁₀).
RESULTS
Eighteen (58.1%) and eleven (35.5%) patients showed loco-regional recurrence and distant metastasis, respectively, after 17.4 months of median follow-up. The 1-year and 2-year local control rates were 60.2% and 43.7%, respectively. The median loco-regional recurrence-free-survival (LRFS) was 15.4 months, and the median OS was 20.4 months. The cumulative and re-RT biologically equivalent dose for α/β=10 (BED₁₀) doses were the most significant prognostic factors. Cumulative BED₁₀≥145 Gy₁₀ and re-RT BED₁₀≥68.7 Gy₁₀ were significantly associated with longer OS (p=0.029 and p=0.012, respectively) and LRFS (p=0.003 and p=0.000, respectively). The most frequent acute toxicity was grade 1-2 pulmonary toxicity (41.9%). No acute grade 3 or higher toxicities occurred.
CONCLUSION
Our results show that high-dose thoracic re-RT of lung cancer can be safely delivered using highly conformal radiotherapy with favorable survival and acceptable toxicity. An optimal strategy to select patients who would benefit from re-RT is crucial in extending the indications and improving the efficacy with a sufficiently high dose.

Keyword

Lung neoplasms; Re-irradiation; Intensity modulated radiotherapy; Radiosurgery

MeSH Terms

Follow-Up Studies
Humans
Lung Neoplasms*
Lung*
Neoplasm Metastasis
Radiosurgery
Radiotherapy
Radiotherapy, Conformal*
Re-Irradiation*
Recurrence
Retrospective Studies

Figure

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  Fig. 1. Kaplan-Meier curve of local recurrence-free survival for all patients.

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  Fig. 2. Kaplan-Meier curve of overall survival for all patients.

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  Fig. 3. The initial irradiation (RT) plan (A), re-RT plan (B), and disease progression after re-RT (C) for patient 1 who experienced bleeding in locally progressive disease after high dose re-RT.

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  Fig. 4. The initial irradiation (RT) plan (A), re-RT plan (B), and disease progression after re-RT (C) for patient 2 who experienced bleeding in locally progressive disease after high dose re-RT.

Reference

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