Long term efficacy and toxicity after stereotactic ablative reirradiation in locally relapsed stage III non-small cell lung cancer

Shakeel Sumodhee,Jérôme Doyen,Josiane Otto,Pierre-Yves Bondiau,Axel Leysalle,Bernard Padovani,Charlotte Cohen,Michel Poudenx,Hannah Ghalloussi,Arash O Naghavi,Jocelyn Gal,Daniel Maneval

doi:10.1186/s12885-019-5542-3

Abstract

BackgroundIn stage III non-small cell lung cancer (NSCLC) treated with concomitant chemoradiotherapy, there is a high rate of relapse. Some of these relapses are only local and can be treated by stereotactic ablative radiation therapy (SABR). Previous studies reporting outcome after SABR reirradiation of the thorax consisted of a heterogeneous population of various lung cancer stages or even different types of cancer. The purpose of study is to evaluate toxicity and outcome of this strategy in locally relapsed stage III NSCLC only.MethodsFrom February 2007 to November 2015, 46 Stage III NSCLC patients treated with SABR, for lung recurrence following conventionally fractionated radiation therapy (CFRT), were retrospectively analyzed.ResultsMedian follow-up was 47.3 months (1–76.9). The 2 and 4-year progression-free survival (PFS), and overall survival (OS) were of 25.5%/8.6 and 48.9%/30.8%, respectively. Highest presenting toxicity in patients (grade 1 through 5) was: 13 (28.3%), 7 (15.2%), 1 (2.2%), 0 and 2 (4.4%), with deaths due to hemoptysis (n = 1) and alveolitis (n = 1). Although the Biological Effective Dose (at Planning Tumor Volume isocenter) was lower for central tumors treated for an in-field relapse (n = 21, 116 Gy versus 168 Gy, p = 0.005), they had no significant difference in OS than the remaining cohort, but with a higher rate of grade 2–5 toxicities (OR = 0.22, [0.06–0.8], p = 0.02).ConclusionReirradiation with SABR for local relapse in patients previously treated for stage III NSCLC, is feasible and associated with good outcome. This is also true for central tumors treated for an in-field relapse, but should be radiated with caution to mitigate toxicity.

Highlights

In stage III non-small cell lung cancer (NSCLC) treated with concomitant chemoradiotherapy, there is a high rate of relapse
Conventionally fractionated radiation therapy (CFRT) with concurrent chemotherapy is the standard of care in patients who have been diagnosed with stage III non-small cell lung cancer (NSCLC) [1], and approximately 40% of these patients will experience intrathoracic recurrences [2]
In order to be considered as local recurrence/reirradiation situation, the mass had to be located in the ipsilateral lung and/or in the mediastinum [17] (because previous irradiation was performed with 3 dimensional conformal radiation therapy (3D-CRT) for stage III disease, relapses occurred at least the low/ intermediate dose level)

Summary

Introduction

In stage III non-small cell lung cancer (NSCLC) treated with concomitant chemoradiotherapy, there is a high rate of relapse. Fractionated radiation therapy (CFRT) with concurrent chemotherapy is the standard of care in patients who have been diagnosed with stage III non-small cell lung cancer (NSCLC) [1], and approximately 40% of these patients will experience intrathoracic recurrences [2]. Several studies already reported an acceptable toxicity profile with SABR thoracic reirradiation with 0 to 30% late grade 3–5 pneumonitis, with rare observations of late esophagitis, skin ulceration or fatal hemoptysis [6,7,8,9,10,11,12,13,14,15] In these studies, it is difficult to evaluate outcome because of their short follow-up and patient heterogeneity (previous stage I, II, III or oligometastatic IV disease) [12]. The purpose of the present study is to retrospectively assess toxicity and outcomes of thoracic reirradiation with SABR in patients with locally recurrent NSCLC who were previously treated with CFRT and concurrent chemotherapy limited to stage III NSCLC patients

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