Salvage stereotactic body radiotherapy for post‑operative oligo‑recurrence of non‑small cell lung cancer: A single‑institution analysis of 59�patients

Abstract

A standard treatment for patients with early-stage non-small cell lung cancer (NSCLC) who undergo surgery, and subsequently develop local failure or intrathoracic oligorecurrence, has not yet been established. The present study aimed to assess the feasibility of stereotactic body radiotherapy (SBRT) for this subgroup of patients. Consequently, a retrospective analysis was conducted of patients with NSCLC recurrence who were treated with SBRT, and previously underwent curative surgical resection between October 2011 and October 2016. Post-SBRT survival [overall survival (OS); progression-free survival (PFS); and local control (LC)] and toxicity were analyzed. Prognostic factors for OS were identified using univariate and multivariate analysis. A total of 52 patients and 59 tumors were analyzed. The median follow-up time was 25 months (35 months for surviving patients), and median OS following salvage SBRT was 32 months. The 1-and 3-year OS rates were 84.4 and 67.8%, respectively. 1-and 3-year PFS rates were 80.8 and 58.7%, respectively. Only 4 patients (7.7%) developed local failure. Median LC was 71 months and 1-and 3-year LC rate were 97.9 and 94.9%, respectively. A total of 4 patients experienced grade 3 or higher adverse events (AEs) and two experienced grade 5 AEs (pneumonitis and hemoptysis). Central tumor location and the possibility of re-operation were independent prognostic factors for OS. The present study indicated that post-operative salvage SBRT is a promising therapeutic option for patients with NSCLC with locoregional or intrathoracic oligo-recurrence. We regard toxicity was also acceptable. However, further research is required on the appropriate selection of subjects, and stratification of the analysis by certain risk factors would increase the accuracy of the conclusions.

Clinical Outcomes and Prognostic Factors of Salvage Stereotactic Body Radiotherapy for Post-Surgical Thoracic Oligo-Recurrence/Metastasis of Non-Small-Cell Lung Cancer

“…1/28 patient experienced grade 3 toxicity. Aoki et al 18 investigated the feasibility of stereotactic body radiotherapy (SBRT) for post-operative oligo-recurrence of non-small cell lung cancer. The 1-and 3-year OS rates were 84.4 and 67.8%, respectively.1-and 3-year PFS rates were 80.8 and 58.7%, respectively.…”

Target volume definition for staple line recurrences of non-small cell lung cancer

“…The 5-year local failure rate after SABR for isolated local lung recurrence anywhere in the lung was 5.2% in a prospective phase II trial [ 15 ]. SABR for oligorecurrence after lung ca surgery resulted in a 3-year local control rate of 94.9% [ 14 ]. For patients with predominately stage I and II disease at the time of surgery, SABR for local and/or regional recurrences resulted in local control rates of about 85% after 2–3 years [ 5 , 15 ].…”

“…However, information on the outcome after salvage RT is limited. Excellent long-term local control rates of about 95% have been reported for isolated lung recurrences or oligorecurrences using SABR [ 14 – 15 ]. In other reports on patients with predominately stage I and II disease at the time of surgery, SABR for local and/or regional recurrences resulted in local control rates of about 85% after 2–3 years [ 5 , 16 ].…”

Stereotactic body radiotherapy (SBRT) for oligo-metastatic liver metastases from breast cancer, as an effective and safe alternative to surgery: a review

“…And an increasing number of prospective and retrospective trials on liver SBRT were published, with encouraging results in terms of local control (LC), toxicity and overall survival (OS), though only a few focusing on SBRT for LMs from breast cancer alone (13,14,23,32,(36)(37)(38)(39).…”

“…Liver SBRT is technically challenging due to respirationrelated organ motion, requiring highly precise dose planning and delivery, with multiple beams using either coplanar or non-coplanar geometries. Intensitymodulated RT (IMRT), and more recently volume arc radiation therapy (VMAT) and frameless robotic system for radiosurgery (Cyber-Knife ® ) have achieved a dose distribution that fits the unevenness of the target, reducing OAR exposure (14,28,44,48,49).…”