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

Grambozov, Brane; Nussdorfer, Evelyn; Kaiser, Julia; Gerum, S.; Fastner, Gerd; Stana, Markus; Gaisberger, Christoph; Wass, Romana; Studnicka, Michael; Sedlmayer, Felix; Zehentmayr, Franz

doi:10.3390/curroncol28030170

Cited by 8 publications

(21 citation statements)

References 33 publications

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“…As mentioned before, a major problem of thoracic re-irradiation is toxicity and its inter-study comparability. Most of the included studies referred to the 4th version of the CTCAE classification except for Oghuri [23] and Grambozov [24], who used versions 3 and 5, respectively. With respect to the main OARs, i.e., lung and esophagus, these various editions of the CTCAE are similar.…”

Section: Toxicitymentioning

confidence: 99%

“…Severe (grade 3-4), acute, and late toxicities were observed in 0% [30]-39% [3] and 0% [25,29] to 12 % [3], respectively. Seven studies reported therapy-related mortality between 2% [24,27] and 14% [26].…”

Section: Toxicitymentioning

confidence: 99%

“…Prognostic and predictive variables for both clinical outcome (OS, PFS, LRC) and main toxicities, i.e., esophageal and pulmonary, are summarized in Table 5. If only the five studies that included multivariate analysis are considered [23,24,26,28,31], infield relapse combined with central tumor location [28] seemed to influence toxicity (p-value 0.03 HR 6.4). The following predictors and prognosticators for OS could be identified: PTV (p-value 0.000 HR 1.007) [24], histology (p-value 0.004 HR 0.4; p-value 0.04 HR 3.5) [11,23], cCRT (p-value 0.0045 HR 2.6 [11], re-irradiation dose (p-value 0.021 HR 0.2) [11], recurrent tumor size (p-value 0.001 HR 17.3) [23] and ECOG (p-value 0.028 HR 2.5) [11].…”

Section: Prognostic Factorsmentioning

confidence: 99%

“…If only the five studies that included multivariate analysis are considered [23,24,26,28,31], infield relapse combined with central tumor location [28] seemed to influence toxicity (p-value 0.03 HR 6.4). The following predictors and prognosticators for OS could be identified: PTV (p-value 0.000 HR 1.007) [24], histology (p-value 0.004 HR 0.4; p-value 0.04 HR 3.5) [11,23], cCRT (p-value 0.0045 HR 2.6 [11], re-irradiation dose (p-value 0.021 HR 0.2) [11], recurrent tumor size (p-value 0.001 HR 17.3) [23] and ECOG (p-value 0.028 HR 2.5) [11]. T4-stage (p-value 0.013 HR 3.5), cCRT (p-value 0.027 HR 0.5) [11] and extrathoracic disease (p-value 0.02 HR 2.9) [26] were found to predict PFS.…”

Section: Prognostic Factorsmentioning

confidence: 99%

“…Reports on doses to the OARs were inconsistent. One study [24] explicitly mentioned constraints, whereas another [27] listed the actual doses administered to the OARs. With regard to the four main OARs (esophagus, lung, heart, spinal cord), which limit doses in thoracic irradiation, the following information could be extracted from the eleven papers included in the analysis.…”

Section: Treatment 351 Re-irradiationmentioning

confidence: 99%

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High Dose Thoracic Re-Irradiation and Chemo-Immunotherapy for Centrally Recurrent NSCLC

Grambozov

Stana

Kaiser

et al. 2022

Cancers

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Introduction: Thoracic re-irradiation for recurrent lung cancer dates back four decades, when the first small series on 29 patients receiving palliative doses was published. With 5-year overall survival rates of 57% in PDL-1 positive patients after primary chemo-radio-immunotherapy, the number of patients who experience loco-regional relapse will increase in the near future. In this context, centrally recurring lung tumors pose a major treatment challenge. Hence, the aim of the current review is to compile the available evidence on curatively intended thoracic re-irradiation for this special clinical situation. Methods: A systematic literature search according to the PRISMA guidelines was performed. A study was included when the following criteria were met: (1) 66% of the patients had NSCLC, (2) a total dose of 50 Gy in the second course and/or a biologically effective dose of at least 100 Gy in both treatment courses was administered, (3) re-irradiation was administered with modern radiation techniques, (4) 50% or more of the patients had a centrally located relapse, (5) the minimum cohort size was 30 patients. Results: Of the initial 227 studies, 11 were analyzed, 1 of which was prospective. Median overall survival (OS) was 18.1 months (range 9.3–25.1), median progression free survival (PFS) was nine months (range 4.5–16), and median loco-regional control (LRC) was 12.1 months (range 6.5–20). Treatment-related mortality rates ranged from 2% to 14%. The total dose at re-irradiation correlated with both LRC (p-value = 0.012) and OS (p-value = 0.007) with a close relation between these two clinical endpoints (p-value = 0.006). The occurrence of acute toxicity grade 1 to 4 depended on the PTV size at re-irradiation (p-value = 0.033). Conclusion: The evidence regarding curative re-irradiation for centrally recurrent NSCLC is primarily based on scarce retrospective data, which are characterized by a high degree of heterogeneity. The OS in this clinically challenging situation is expected to be around 1.5 years after re-treatment. Patients with a good performance score, younger age, small tumors, and a longer interval to recurrence potentially benefit most from re-irradiation. In this context, prospective trials are warranted to achieve substantial advances in the field.

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Section: Toxicitymentioning

confidence: 99%

Section: Toxicitymentioning

confidence: 99%

Section: Prognostic Factorsmentioning

confidence: 99%

Section: Prognostic Factorsmentioning

confidence: 99%

Section: Treatment 351 Re-irradiationmentioning

confidence: 99%

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High Dose Thoracic Re-Irradiation and Chemo-Immunotherapy for Centrally Recurrent NSCLC

Grambozov

Stana

Kaiser

et al. 2022

Cancers

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Pattern of failure and clinical value of local therapy for oligo‐recurrence in locally advanced non‐small cell lung cancer after definitive chemoradiation: Impact of driver mutation status

Zhang

Mao

et al. 2022

Cancer Medicine

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Introduction Considerable differences of treatment response and pattern of failure may exist between definitive chemoradiation (CRT) treated locally advanced non‐small cell lung cancer (LA‐NSCLC) patients. The clinical value of additional tyrosine kinase inhibitors (TKIs) before disease recurrence and salvage local therapy after initial recurrent disease remain controversial. Methods and Materials Consecutive LA‐NSCLC patients receiving definitive CRT and having definite results about driver mutations (EGFR, ALK and ROS1) were retrospectively reviewed. Initial recurrent disease was classified as in‐field recurrence, out‐of‐field recurrence and distant metastasis. Recurrent disease occurred only in the brain or limited to ≤3 extra‐cranial organs and ≤5 extra‐cranial lesions, was defined as oligo‐recurrence. Progression free survival and overall survival (OS) were calculated from diagnosis to disease progression or death, and to death, respectively. OS2 was measured from initial disease recurrence to death among patients who had recurrent disease. Results Of the 153 enrolled patients, 39 had driver mutations and 13 received additional TKI therapy besides definitive CRT. Patients harboring driver mutations but without additional TKI therapy had a similar PFS and significantly longer OS ( p = 0.032) than those without driver mutations. Additional TKI therapy prolonged PFS ( p = 0.021) but not OS among patients with driver mutations. No significant difference of pattern of failure was observed between patient subgroups stratified by the status of driver mutations and the usage of additional TKI therapy. Furthermore, 57 of the 95 patients with initial recurrent disease developed oligo‐recurrence and salvage local therapy significantly improved OS2 ( p = 0.01) among patients with oligo‐recurrence disease. Conclusion LA‐NSCLC patients receiving definitive CRT generally had similar PFS and pattern of treatment failure, regardless of driver mutation status. Additional TKI therapy besides definitive CRT could prolong PFS but not OS. The majority of recurrent disease after definitive CRT belongs to oligo‐recurrence and salvage local therapy may provide survival benefit.

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Thoracic reirradiation of recurrent non-small cell lung carcinoma: A comprehensive review

Grasso,

Bourbonne,

Lucia

2024

Cancer/Radiothérapie

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

Cited by 8 publications

References 33 publications

High Dose Thoracic Re-Irradiation and Chemo-Immunotherapy for Centrally Recurrent NSCLC

High Dose Thoracic Re-Irradiation and Chemo-Immunotherapy for Centrally Recurrent NSCLC

Pattern of failure and clinical value of local therapy for oligo‐recurrence in locally advanced non‐small cell lung cancer after definitive chemoradiation: Impact of driver mutation status

Thoracic reirradiation of recurrent non-small cell lung carcinoma: A comprehensive review

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