Lung Cancer

PD 18 - Lung 5 - Poster Discussion - SBRT

1160 - Salvage Stereotactic Body Radiation Therapy for Local Recurrence after Primary Surgical Resection of Early Stage Non-Small Cell Lung Cancer

Wednesday, October 24
2:18 PM - 2:24 PM
Location: Room 217 C/D

Salvage Stereotactic Body Radiation Therapy for Local Recurrence after Primary Surgical Resection of Early Stage Non-Small Cell Lung Cancer
S. M. C. Sittenfeld, A. Juloori, C. A. Reddy, K. L. Stephans, and G. M. Videtic; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH

Purpose/Objective(s): Surgery is currently the standard of care for the treatment of early stage non-small cell lung cancer (NSCLC) in patients who are deemed to be operable candidates. It has been well established that stereotactic body radiation therapy (SBRT) can be used as a primary definitive therapy for patients who are medically inoperable. Given limited reports of outcomes following salvage SBRT (sSBRT) for local recurrence after surgery, we reviewed our large institutional database to further describe this population.

Materials/Methods: We surveyed our IRB-approved prospective lung SBRT data registry for pts who received sSBRT for local recurrence after previous resection of a primary early stage NSCLC. Following sSBRT, outcomes of interest included rates of local control (LC) and overall survival (OS), as well as treatment-related toxicity graded per CTCAE version 4.0.

Results: For the interval 2004-2017, 50 (3.4%) pts, of a total of 1,461 lung SBRT cases, met criteria for this analysis. Pre-sSBRT surgical approaches were: 23 (46%) wedge resection, 2 (4%) segmentectomy, 20 (40%) lobectomy, 2 (4%) bilobectomy, 1 (2%) pneumonectomy and 1 (2%) with unspecified surgery. At the time of resection, disease stage was: 34 (68%) stage I, 4 (8%) stage II, 5 (10%) stage III and for 3 (6%) pts, pre-operative stage was unknown. Median time to local recurrence after surgery was 27.45 months. At sSBRT, 38 (76%) pts had biopsy-proven recurrence while 12 (24%) had recurrence diagnosed only by radiographic findings. Forty seven (94%) pts could not have surgical salvage due to pulmonary (60%), cardiac (2%), technical unresectability (4%), poor KPS (2%), or multifactorial reasons (26%), with 3 (6%) refusing re-resection. Median age and KPS at salvage treatment was 74 years (range 50-89) and 80 (range 60-100) respectively. The most common sSBRT schedule was 50Gy in 5 fractions (68%), with all schedules having a BED of at least 100 Gy10. Median follow up after sSBRT was 22.2 months (3.8-108.8 months). Eight pts subsequently experienced local or lobar failure (16%), and 9 patients had nodal failure (18%). Median time to local failure after sSBRT was 12.5 months (2-66.1 months). At analysis, 11 (22%) pts remain alive and free from disease progression. At 24 months, LC and OS were 83.6% (95% CI 71.1-96) and 66.7% (95% CI 53.3-80.1), respectively. Median OS after sSBRT was 29.3 months. Twenty one (42%) pts failed distantly at a median time of 11.4 months and 12 (24%) pts received systemic therapy following distant failure. 74% of pts experienced no toxicity after sSBRT. Three patients (6%) developed grade III toxicity (cough, atelectasis or soft tissue necrosis) following treatment.

Conclusion: Similar to SBRT for primary early stage NSCLC, sSBRT for local relapse following initial surgical resection of NSCLC offers high rates of LC with limited toxicity. Distant failure remains the primary pattern of failure.

Author Disclosure: S.M. Sittenfeld: None. A. Juloori: None. K.L. Stephans: None. G.M. Videtic: Advisory Board; Astra Zeneca. Member; ASTRO, RTOG, IASLC.

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