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Re-Irradiation for Locally Recurrent Lung Cancer: A Single Center Retrospective Analysis

The treatment of locally recurrent lung cancer is a major challenge for radiation-oncologists, especially with data on high-dose reirradiation being limited to small retrospective studies. The aim of the present study is to assess overall survival (OS) for patients with locally recurrent lung cancer...

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Autores principales: Grambozov, Brane, Nussdorfer, Evelyn, Kaiser, Julia, Gerum, Sabine, Fastner, Gerd, Stana, Markus, Gaisberger, Christoph, Wass, Romana, Studnicka, Michael, Sedlmayer, Felix, Zehentmayr, Franz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161822/
https://www.ncbi.nlm.nih.gov/pubmed/34068043
http://dx.doi.org/10.3390/curroncol28030170
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author Grambozov, Brane
Nussdorfer, Evelyn
Kaiser, Julia
Gerum, Sabine
Fastner, Gerd
Stana, Markus
Gaisberger, Christoph
Wass, Romana
Studnicka, Michael
Sedlmayer, Felix
Zehentmayr, Franz
author_facet Grambozov, Brane
Nussdorfer, Evelyn
Kaiser, Julia
Gerum, Sabine
Fastner, Gerd
Stana, Markus
Gaisberger, Christoph
Wass, Romana
Studnicka, Michael
Sedlmayer, Felix
Zehentmayr, Franz
author_sort Grambozov, Brane
collection PubMed
description The treatment of locally recurrent lung cancer is a major challenge for radiation-oncologists, especially with data on high-dose reirradiation being limited to small retrospective studies. The aim of the present study is to assess overall survival (OS) for patients with locally recurrent lung cancer after high-dose thoracic reirradiation. Thirty-nine patients who were re-irradiated for lung cancer relapse between October 2013 and February 2019 were eligible for the current retrospective analysis. All patients were re-irradiated with curative intent for in-field tumor recurrence. The diagnostic work-up included a mandatory (18)F-FDG-PET-CT scan and—if possible—histological verification. The ECOG was ≤2, and the interval between initial and second radiation was at least nine months. Thirty patients (77%) had non-small cell lung cancer (NSCLC), eight (20%) had small cell lung cancer (SCLC), and in one patient (3%) histological confirmation could not be obtained. More than half of the patients (20/39, 51%) received re-treatment with dose differentiated accelerated re-irradiation (DART) at a median interval of 20.5 months (range: 6–145.3 months) after the initial radiation course. A cumulative EQD(2) of 131 Gy (range: 77–211 Gy) in a median PTV of 46 mL (range: 4–541 mL) was delivered. Patients with SCLC had a 3 mL larger median re-irradiation volume (48 mL, range: 9–541) compared to NSCLC patients (45 mL, range: 4–239). The median cumulative EQD2 delivered in SCLC patients was 84 Gy (range: 77–193 Gy), while NSCLC patients received a median cumulative EQD2 of 135 Gy (range: 98–211 Gy). The median OS was 18.4 months (range: 0.6–64 months), with tumor volume being the only predictor (p < 0.000; HR 1.007; 95%-CI: 1.003–1.012). In terms of toxicity, 17.9% acute and 2.6% late side effects were observed, with a toxicity grade >3 occurring in only one patient. Thoracic high dose reirradiation plays a significant role in prolonging survival, especially in patients with small tumor volume at recurrence.
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spelling pubmed-81618222021-05-29 Re-Irradiation for Locally Recurrent Lung Cancer: A Single Center Retrospective Analysis Grambozov, Brane Nussdorfer, Evelyn Kaiser, Julia Gerum, Sabine Fastner, Gerd Stana, Markus Gaisberger, Christoph Wass, Romana Studnicka, Michael Sedlmayer, Felix Zehentmayr, Franz Curr Oncol Article The treatment of locally recurrent lung cancer is a major challenge for radiation-oncologists, especially with data on high-dose reirradiation being limited to small retrospective studies. The aim of the present study is to assess overall survival (OS) for patients with locally recurrent lung cancer after high-dose thoracic reirradiation. Thirty-nine patients who were re-irradiated for lung cancer relapse between October 2013 and February 2019 were eligible for the current retrospective analysis. All patients were re-irradiated with curative intent for in-field tumor recurrence. The diagnostic work-up included a mandatory (18)F-FDG-PET-CT scan and—if possible—histological verification. The ECOG was ≤2, and the interval between initial and second radiation was at least nine months. Thirty patients (77%) had non-small cell lung cancer (NSCLC), eight (20%) had small cell lung cancer (SCLC), and in one patient (3%) histological confirmation could not be obtained. More than half of the patients (20/39, 51%) received re-treatment with dose differentiated accelerated re-irradiation (DART) at a median interval of 20.5 months (range: 6–145.3 months) after the initial radiation course. A cumulative EQD(2) of 131 Gy (range: 77–211 Gy) in a median PTV of 46 mL (range: 4–541 mL) was delivered. Patients with SCLC had a 3 mL larger median re-irradiation volume (48 mL, range: 9–541) compared to NSCLC patients (45 mL, range: 4–239). The median cumulative EQD2 delivered in SCLC patients was 84 Gy (range: 77–193 Gy), while NSCLC patients received a median cumulative EQD2 of 135 Gy (range: 98–211 Gy). The median OS was 18.4 months (range: 0.6–64 months), with tumor volume being the only predictor (p < 0.000; HR 1.007; 95%-CI: 1.003–1.012). In terms of toxicity, 17.9% acute and 2.6% late side effects were observed, with a toxicity grade >3 occurring in only one patient. Thoracic high dose reirradiation plays a significant role in prolonging survival, especially in patients with small tumor volume at recurrence. MDPI 2021-05-13 /pmc/articles/PMC8161822/ /pubmed/34068043 http://dx.doi.org/10.3390/curroncol28030170 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Grambozov, Brane
Nussdorfer, Evelyn
Kaiser, Julia
Gerum, Sabine
Fastner, Gerd
Stana, Markus
Gaisberger, Christoph
Wass, Romana
Studnicka, Michael
Sedlmayer, Felix
Zehentmayr, Franz
Re-Irradiation for Locally Recurrent Lung Cancer: A Single Center Retrospective Analysis
title Re-Irradiation for Locally Recurrent Lung Cancer: A Single Center Retrospective Analysis
title_full Re-Irradiation for Locally Recurrent Lung Cancer: A Single Center Retrospective Analysis
title_fullStr Re-Irradiation for Locally Recurrent Lung Cancer: A Single Center Retrospective Analysis
title_full_unstemmed Re-Irradiation for Locally Recurrent Lung Cancer: A Single Center Retrospective Analysis
title_short Re-Irradiation for Locally Recurrent Lung Cancer: A Single Center Retrospective Analysis
title_sort re-irradiation for locally recurrent lung cancer: a single center retrospective analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161822/
https://www.ncbi.nlm.nih.gov/pubmed/34068043
http://dx.doi.org/10.3390/curroncol28030170
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