Lung Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_37_3692 - Long-term survival after salvage SBRT for recurrent or secondary non-small cell lung cancer after surgery or radiation therapy

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Long-term survival after salvage SBRT for recurrent or secondary non-small cell lung cancer after surgery or radiation therapy
C. He1,2, L. Y. Mei3, A. Cerra-Franco4, K. Shiue4, R. Liu1,2, M. Langer1, K. Rieger5, D. Ceppa6, T. Birdas5, K. Kesler7, R. C. Zellars4, T. Lautenschlaeger4, and F. M. Kong4; 1Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, indianapolis, IN, 2Department of Thoracic Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, zhengzhou, China, 3West China Hospital of Sichuan University, Chengdu, China, 4Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, 5Department of Surgery, Thoracic Surgery, Indiana University School of Medicine, indianapolis, IN, 6Department of Surgery, Thoracic Surgery, Indiana University School of Medicine, indianapolis, IN, China, 7Department of Surgery, Indiana University, Indianapolis, IN

Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) provides outstanding local tumor control in newly diagnosed early stage inoperable non-small cell lung cancer (NSCLC). However, patients with locally recurrent or newly diagnosed primary NSCLC after previous definitive radiotherapy (RT) or surgery pose a challenge in management. SBRT has been attempted as option of salvage treatment. This study aimed to report long-term outcome of SBRT in patients with recurrent or second primary NSCLC after previous local treatment.

Materials/Methods: This single-institution retrospective study included patients with NSCLC who received thoracic SBRT for newly diagnosed or recurrent NSCLC. The primary and second endpoints were overall survival and radiation pneumonitis, respectively. Clinical factors analyzed included age, gender, race, tobacco history, respiratory/cardiovascular comorbidity, histology, modality of previous treatment, T stage, gross tumor volume (GTV), planning target volume (PTV), and prescription dose. Overall survival (OS) was evaluated using the Kaplan-Meier method and significance was tested using the log-rank test. Radiation pneumonitis was graded consistently per RTOG1106.

Results: A total of 326 patients met the inclusion criteria, including 43, 40 and 243 patients with prior RT, surgery, and no prior treatment, respectively. The median follow-up was 59 (95% CI 48-68) months. There was no significant difference in patients and tumor factors between these groups. The median survival were 23 (95% CI 15-31), 50 (95% CI 35-65), and 32 (95% CI 25-40) months, and the 5-year survival rates were 26.2%, 42.4%, and 24.7%, respectively (P=0.077). In those treated with previous RT, there were no significant differences in overall survival between conventionally fractionated radiation therapy and SBRT (median survival 25.0 vs 13.4month, P=0.280). In those treated with prior surgery, there was no significant difference in overall survival between pneumonectomy and lobectomy (56.0 vs 50.0 months, P=0.576). The were significant differences in rates of grade 1+ (44.2%, 30.0%, 21.5%, P=0.007), and 2+ RP (18.6%, 12.5%, 7.0%, P=0.039), but no statistically significant differences in grade 3+ pneumonitis among these three groups.

Conclusion: Salvage SBRT after previous radiation or surgery provides a chance of cure, with 5-year survival not significantly different from that of SBRT for newly diagnosed NSCLC, with significantly increased but acceptable risk of radiation pneumonitis. Future study may need to set stringent limits for lung SBRT after previous surgery or radiation.

Author Disclosure: C. He: None. L.Y. Mei: None. A. Cerra-Franco: None. R. Liu: None. M. Langer: None. R. Zellars: Board Member; Indiana University Health Physicians. T. Lautenschlaeger: None. F.(. Kong: Research Grant; Varian, NCI/NIH. Founding President and Board of Director; Sino-American Network for Therapeutic Radiation On. President 2015; American Association of Women Radiologists (AAWR). President 2012-2013; Association for Chinese Professors. Founding Board Member; Sino-American Network for Therapeutic Radiology.

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