If at First You Don't Succeed—Stereotactic Body Radiation Therapy for Recurrent Non-Small Cell Lung Cancer

Abstract

Primary tumor recurrence remains a challenge to treat after high-dose thoracic radiation for early-stage or locoregionally advanced non-small cell lung cancer (NSCLC). 1 Bradley JD Hu C Komaki RR et al. Long-term results of NRG Oncology RTOG 0617: Standard- versus high-dose chemoradiotherapy with or without cetuximab for unresectable stage III non-small-cell lung cancer. J Clin Oncol. 2020; 38: 706-714 Crossref PubMed Scopus (186) Google Scholar , 2 Bradley JD Paulus R Komaki R et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): A randomised, two-by-two factorial phase 3 study. Lancet Oncol. 2015; 16: 187-199 Abstract Full Text Full Text PDF PubMed Google Scholar , 3 Timmerman RD Paulus R Pass HI et al. Stereotactic body radiation therapy for operable early-stage lung cancer: Findings from the NRG Oncology RTOG 0618 Trial. JAMA Oncol. 2018; 4: 1263-1266 Crossref PubMed Scopus (163) Google Scholar , 4 Videtic GMM Donington J Giuliani M et al. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive summary of an ASTRO evidence-based guideline. Pract Radiat Oncol. 2017; 7: 295-301 Abstract Full Text Full Text PDF PubMed Scopus (253) Google Scholar , 5 Timmerman R Paulus R Galvin J et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 2010; 303: 1070-1076 Crossref PubMed Scopus (1883) Google Scholar Although stereotactic radiation offers excellent local control for early-stage NSCLC, there is a 10% risk of intralobar recurrence adjacent to or within a prior radiated volume. 3 Timmerman RD Paulus R Pass HI et al. Stereotactic body radiation therapy for operable early-stage lung cancer: Findings from the NRG Oncology RTOG 0618 Trial. JAMA Oncol. 2018; 4: 1263-1266 Crossref PubMed Scopus (163) Google Scholar , 4 Videtic GMM Donington J Giuliani M et al. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive summary of an ASTRO evidence-based guideline. Pract Radiat Oncol. 2017; 7: 295-301 Abstract Full Text Full Text PDF PubMed Scopus (253) Google Scholar , 5 Timmerman R Paulus R Galvin J et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 2010; 303: 1070-1076 Crossref PubMed Scopus (1883) Google Scholar In patients with locally advanced lung cancer treated in the modern era with chemoradiation and consolidative immunotherapy, there is a 25% risk of intrathoracic recurrence. 6 Spigel DR Faivre-Finn C Gray JE et al. Five-year survival outcomes from the PACIFIC trial: Durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer. J Clin Oncol. 2022; JCO2101308 Crossref Scopus (50) Google Scholar ,7 Raben D Rimner A Senan S et al. Patterns of disease progression with durvalumab in stage III non-small cell lung cancer (PACIFIC). Int J Radiat Oncol Biol Phys. 2019; 105 (683-683) Abstract Full Text Full Text PDF Google Scholar Often, these recurrences are not resectable, and nonoperative approaches are sought. An increasing body of literature has reported on the feasibility, safety, and outcomes of reirradiation with SBRT with the risk of this treatment depending greatly on location, degree of overlap with prior radiation fields, and the prior dose to adjacent organs at risk (OARs). 8 Milano MT Mihai A Kong FS Review of thoracic reirradiation with stereotactic body radiation therapy: A focus on toxicity risks. Pract Radiat Oncol. 2018; 8: 251-265 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar ,9 De Bari B Filippi AR Mazzola R et al. Available evidence on re-irradiation with stereotactic ablative radiotherapy following high-dose previous thoracic radiotherapy for lung malignancies. Cancer Treat Rev. 2015; 41: 511-518 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar