Salvage stereotactic body radiotherapy for locally recurrent non-small cell lung cancer after sublobar resection and I125 vicryl mesh brachytherapy
Purpose: Locally-recurrent non-small cell lung cancer (LR-NSCLC) remains challenging treat, particularly in patients having received prior radiotherapy. Heterogeneous populations and varied treatment intent in existing literature result in significant limitations in evaluating efficacy of lung re-ir...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2015-05-01
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| Series: | Frontiers in Oncology |
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| Online Access: | http://journal.frontiersin.org/Journal/10.3389/fonc.2015.00109/full |
| _version_ | 1819230938025951232 |
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| author | Beant Singh Gill David Anthony Clump Steven A Burton Neil A Christie Matthew J Schuchert Dwight E Heron |
| author_facet | Beant Singh Gill David Anthony Clump Steven A Burton Neil A Christie Matthew J Schuchert Dwight E Heron |
| author_sort | Beant Singh Gill |
| collection | DOAJ |
| description | Purpose: Locally-recurrent non-small cell lung cancer (LR-NSCLC) remains challenging treat, particularly in patients having received prior radiotherapy. Heterogeneous populations and varied treatment intent in existing literature result in significant limitations in evaluating efficacy of lung re-irradiation. In order to better establish the impact of re-irradiation in patients with LR-NSCLC following high-dose radiotherapy, we report outcomes for patients treated with prior sublobar resection and brachytherapy that subsequently underwent stereotactic body radiotherapy (SBRT).Methods: A retrospective review of patients initially treated with sublobar resection and I125 vicryl mesh brachytherapy, who later developed LR-NSCLC along the suture line, was performed. Patients received salvage SBRT with curative intent. Dose and fractionation was based on tumor location and size, with a median prescription dose of 48 Gy in 4 fractions (range 20-60 Gy in 1-4 fractions).Results: Thirteen consecutive patients were identified with median follow-up of 2.1 years (range 0.7-5.6 years). Two in-field local failures occurred at 7.5 and 11.1 months, resulting in 2-year local control of 83.9% (95% CI 63.5-100.0%). Two-year disease-free survival and overall survival estimates were 38.5% (95% CI 0.0-65.0%) and 65.8% (95% CI, 38.2-93.4%). Four patients (31%) remained disease-free at last follow-up. All but one patient who experienced disease recurrence developed isolated or synchronous distant metastases. Only one patient (7.7%) developed grade ≥3 toxicity, consisting of grade 3 esophageal stricture following a centrally located recurrence previously treated with radiofrequency ablation.Conclusion: Despite high local radiation doses delivered to lung parenchyma previously with I125 brachytherapy, re-irradiation with SBRT for LR-NSCLC results in excellent local control with limited morbidity, allowing for potential disease cure in a subset of patients. |
| first_indexed | 2024-12-23T11:37:01Z |
| format | Article |
| id | doaj.art-34071ad8e022461faf47951fce63833f |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-23T11:37:01Z |
| publishDate | 2015-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-34071ad8e022461faf47951fce63833f2022-12-21T17:48:37ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2015-05-01510.3389/fonc.2015.00109133823Salvage stereotactic body radiotherapy for locally recurrent non-small cell lung cancer after sublobar resection and I125 vicryl mesh brachytherapyBeant Singh Gill0David Anthony Clump1Steven A Burton2Neil A Christie3Matthew J Schuchert4Dwight E Heron5University of Pittsburgh Cancer InstituteUniversity of Pittsburgh Cancer InstituteUniversity of Pittsburgh Cancer InstituteUniversity of Pittsburgh Medical CenterUniversity of Pittsburgh Medical CenterUniversity of Pittsburgh Cancer InstitutePurpose: Locally-recurrent non-small cell lung cancer (LR-NSCLC) remains challenging treat, particularly in patients having received prior radiotherapy. Heterogeneous populations and varied treatment intent in existing literature result in significant limitations in evaluating efficacy of lung re-irradiation. In order to better establish the impact of re-irradiation in patients with LR-NSCLC following high-dose radiotherapy, we report outcomes for patients treated with prior sublobar resection and brachytherapy that subsequently underwent stereotactic body radiotherapy (SBRT).Methods: A retrospective review of patients initially treated with sublobar resection and I125 vicryl mesh brachytherapy, who later developed LR-NSCLC along the suture line, was performed. Patients received salvage SBRT with curative intent. Dose and fractionation was based on tumor location and size, with a median prescription dose of 48 Gy in 4 fractions (range 20-60 Gy in 1-4 fractions).Results: Thirteen consecutive patients were identified with median follow-up of 2.1 years (range 0.7-5.6 years). Two in-field local failures occurred at 7.5 and 11.1 months, resulting in 2-year local control of 83.9% (95% CI 63.5-100.0%). Two-year disease-free survival and overall survival estimates were 38.5% (95% CI 0.0-65.0%) and 65.8% (95% CI, 38.2-93.4%). Four patients (31%) remained disease-free at last follow-up. All but one patient who experienced disease recurrence developed isolated or synchronous distant metastases. Only one patient (7.7%) developed grade ≥3 toxicity, consisting of grade 3 esophageal stricture following a centrally located recurrence previously treated with radiofrequency ablation.Conclusion: Despite high local radiation doses delivered to lung parenchyma previously with I125 brachytherapy, re-irradiation with SBRT for LR-NSCLC results in excellent local control with limited morbidity, allowing for potential disease cure in a subset of patients.http://journal.frontiersin.org/Journal/10.3389/fonc.2015.00109/fullBrachytherapyRadiosurgerylung cancerSBRTNon-small cell lung cancerrecurrent |
| spellingShingle | Beant Singh Gill David Anthony Clump Steven A Burton Neil A Christie Matthew J Schuchert Dwight E Heron Salvage stereotactic body radiotherapy for locally recurrent non-small cell lung cancer after sublobar resection and I125 vicryl mesh brachytherapy Frontiers in Oncology Brachytherapy Radiosurgery lung cancer SBRT Non-small cell lung cancer recurrent |
| title | Salvage stereotactic body radiotherapy for locally recurrent non-small cell lung cancer after sublobar resection and I125 vicryl mesh brachytherapy |
| title_full | Salvage stereotactic body radiotherapy for locally recurrent non-small cell lung cancer after sublobar resection and I125 vicryl mesh brachytherapy |
| title_fullStr | Salvage stereotactic body radiotherapy for locally recurrent non-small cell lung cancer after sublobar resection and I125 vicryl mesh brachytherapy |
| title_full_unstemmed | Salvage stereotactic body radiotherapy for locally recurrent non-small cell lung cancer after sublobar resection and I125 vicryl mesh brachytherapy |
| title_short | Salvage stereotactic body radiotherapy for locally recurrent non-small cell lung cancer after sublobar resection and I125 vicryl mesh brachytherapy |
| title_sort | salvage stereotactic body radiotherapy for locally recurrent non small cell lung cancer after sublobar resection and i125 vicryl mesh brachytherapy |
| topic | Brachytherapy Radiosurgery lung cancer SBRT Non-small cell lung cancer recurrent |
| url | http://journal.frontiersin.org/Journal/10.3389/fonc.2015.00109/full |
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