Thoracic Re-irradiation May Be an Option for Recurrent, Metastatic, or Secondary Primary Non-Small Cell Lung Cancer

Abstract

Purpose/Objective(s)To evaluate the efficacy and toxicity of thoracic re-irradiation for patients with recurrent, metastasis or new primary lung tumors.Materials/MethodsPatients with non-small cell lung cancer (NSCLC) who were treated with definitive thoracic radiation therapy previously and underwent thoracic re-irradiation between January 2007 and December 2011 were included in the present analysis. Biopsy based pathological evidence was not mandatory for the tumor diagnosis at the second course of treatment. Tumor-related symptoms were evaluated before and after re-irradiation. The radiation related toxicity was assessed according to the Radiation Therapy Oncology Group criteria.ResultsFifty-six patients (46 M: 10F) were eligible for the analysis, with the median age of 60 (range, 32-81). 53 patients were treated with intensity modulated radiation therapy, 2 patients with three dimensional radiation therapy and only one patient with 2-D radiation technique. The median dose of the first course of RT was 60 Gy (range, 20-86) and that for re-irradiation was 56 Gy (range, 16-70), which was delivered by a conventionally fractionated (1.8-2.0 Gy/fraction, 5 fractions/wk) or hypofractionated (3-6 Gy/fraction, 5 fractions/wk) schedule. The interval between two courses of RT varied from 2 to 177 months (median 12.5). The median follow-up time was 32 months (range, 2-57) from the beginning of re-irradiation. Twenty-eight patients presented with tumor related systems including dyspnea, cough, thoracic pain, or hemoptysis before re-irradiation. Symptom alleviation was observed in 64% of patients after re-irradiation. The median survival time was 16 months (range, 1-60) from re-irradiation. 3-year overall survival rate and 3-year progress free survival (PFS) rate from initial-diagnosis of NSCLC were 53% and 17%, and from re-irradiation were 32% and 23%. During and after the second course of radiation therapy, both grade 2 (G2) radiation esophagitis and G2 pneumonitis occurred in 7% of patients. No G3 or greater toxicity was recorded. At the last follow-up, 37 patients died including 26 deaths from disease progression, 6 from fatal hemoptysis (5 were considered tumor-related), 1 from pulmonary infection and 4 deaths with unknown causes. Longer PFS after the first course of RT may be predictive for better OS after the second course of RT. Staging, interval between two course of irradiation and symptom relief were not found to impact survival. No significant survival difference was observed among patients with recurrent, metastasis lung carcinoma or new primary lung tumors.ConclusionsThoracic re-irradiation may be an effective treatment with limited toxicity for patients with recurrent, metastatic or new primary lesions of lung cancer. The role of re-irradiation deserves future prospective study. Purpose/Objective(s)To evaluate the efficacy and toxicity of thoracic re-irradiation for patients with recurrent, metastasis or new primary lung tumors. To evaluate the efficacy and toxicity of thoracic re-irradiation for patients with recurrent, metastasis or new primary lung tumors. Materials/MethodsPatients with non-small cell lung cancer (NSCLC) who were treated with definitive thoracic radiation therapy previously and underwent thoracic re-irradiation between January 2007 and December 2011 were included in the present analysis. Biopsy based pathological evidence was not mandatory for the tumor diagnosis at the second course of treatment. Tumor-related symptoms were evaluated before and after re-irradiation. The radiation related toxicity was assessed according to the Radiation Therapy Oncology Group criteria. Patients with non-small cell lung cancer (NSCLC) who were treated with definitive thoracic radiation therapy previously and underwent thoracic re-irradiation between January 2007 and December 2011 were included in the present analysis. Biopsy based pathological evidence was not mandatory for the tumor diagnosis at the second course of treatment. Tumor-related symptoms were evaluated before and after re-irradiation. The radiation related toxicity was assessed according to the Radiation Therapy Oncology Group criteria. ResultsFifty-six patients (46 M: 10F) were eligible for the analysis, with the median age of 60 (range, 32-81). 53 patients were treated with intensity modulated radiation therapy, 2 patients with three dimensional radiation therapy and only one patient with 2-D radiation technique. The median dose of the first course of RT was 60 Gy (range, 20-86) and that for re-irradiation was 56 Gy (range, 16-70), which was delivered by a conventionally fractionated (1.8-2.0 Gy/fraction, 5 fractions/wk) or hypofractionated (3-6 Gy/fraction, 5 fractions/wk) schedule. The interval between two courses of RT varied from 2 to 177 months (median 12.5). The median follow-up time was 32 months (range, 2-57) from the beginning of re-irradiation. Twenty-eight patients presented with tumor related systems including dyspnea, cough, thoracic pain, or hemoptysis before re-irradiation. Symptom alleviation was observed in 64% of patients after re-irradiation. The median survival time was 16 months (range, 1-60) from re-irradiation. 3-year overall survival rate and 3-year progress free survival (PFS) rate from initial-diagnosis of NSCLC were 53% and 17%, and from re-irradiation were 32% and 23%. During and after the second course of radiation therapy, both grade 2 (G2) radiation esophagitis and G2 pneumonitis occurred in 7% of patients. No G3 or greater toxicity was recorded. At the last follow-up, 37 patients died including 26 deaths from disease progression, 6 from fatal hemoptysis (5 were considered tumor-related), 1 from pulmonary infection and 4 deaths with unknown causes. Longer PFS after the first course of RT may be predictive for better OS after the second course of RT. Staging, interval between two course of irradiation and symptom relief were not found to impact survival. No significant survival difference was observed among patients with recurrent, metastasis lung carcinoma or new primary lung tumors. Fifty-six patients (46 M: 10F) were eligible for the analysis, with the median age of 60 (range, 32-81). 53 patients were treated with intensity modulated radiation therapy, 2 patients with three dimensional radiation therapy and only one patient with 2-D radiation technique. The median dose of the first course of RT was 60 Gy (range, 20-86) and that for re-irradiation was 56 Gy (range, 16-70), which was delivered by a conventionally fractionated (1.8-2.0 Gy/fraction, 5 fractions/wk) or hypofractionated (3-6 Gy/fraction, 5 fractions/wk) schedule. The interval between two courses of RT varied from 2 to 177 months (median 12.5). The median follow-up time was 32 months (range, 2-57) from the beginning of re-irradiation. Twenty-eight patients presented with tumor related systems including dyspnea, cough, thoracic pain, or hemoptysis before re-irradiation. Symptom alleviation was observed in 64% of patients after re-irradiation. The median survival time was 16 months (range, 1-60) from re-irradiation. 3-year overall survival rate and 3-year progress free survival (PFS) rate from initial-diagnosis of NSCLC were 53% and 17%, and from re-irradiation were 32% and 23%. During and after the second course of radiation therapy, both grade 2 (G2) radiation esophagitis and G2 pneumonitis occurred in 7% of patients. No G3 or greater toxicity was recorded. At the last follow-up, 37 patients died including 26 deaths from disease progression, 6 from fatal hemoptysis (5 were considered tumor-related), 1 from pulmonary infection and 4 deaths with unknown causes. Longer PFS after the first course of RT may be predictive for better OS after the second course of RT. Staging, interval between two course of irradiation and symptom relief were not found to impact survival. No significant survival difference was observed among patients with recurrent, metastasis lung carcinoma or new primary lung tumors. ConclusionsThoracic re-irradiation may be an effective treatment with limited toxicity for patients with recurrent, metastatic or new primary lesions of lung cancer. The role of re-irradiation deserves future prospective study. Thoracic re-irradiation may be an effective treatment with limited toxicity for patients with recurrent, metastatic or new primary lesions of lung cancer. The role of re-irradiation deserves future prospective study.