Yonsei Med J.  2012 Nov;53(6):1120-1127. 10.3349/ymj.2012.53.6.1120.

High Dose Involved Field Radiation Therapy as Salvage for Loco-Regional Recurrence of Non-Small Cell Lung Cancer

• Bae SH
• Ahn YC
• Nam H
• Park HC
• Pyo HR
• Shim YM
• Kim J
• Kim K
• Ahn JS
• Ahn MJ
• Park K

• KMID: 1414253
• DOI: http://doi.org/10.3349/ymj.2012.53.6.1120

Abstract

PURPOSE
To determine the effectiveness of salvage radiation therapy (RT) in patients with loco-regional recurrences (LRR) following initial complete resection of non-small cell lung cancer (NSCLC) and assess prognostic factors affecting survivals.
MATERIALS AND METHODS
Between 1994 and 2007, 64 patients with LRR after surgery of NSCLC were treated with high dose RT alone (78.1%) or concurrent chemo-radiation therapy (CCRT, 21.9%) at Samsung Medical Center. Twenty-nine patients (45.3%) had local recurrence, 26 patients (40.6%) had regional recurrence and 9 patients (14.1%) had recurrence of both components. The median RT dose was 54 Gy (range, 44-66 Gy). The radiation target volume included the recurrent lesions only.
RESULTS
The median follow-up time from the start of RT in survivors was 32.0 months. The rates of in-field failure free survival, intra-thoracic failure free survival and extra-thoracic failure free survival at 2 years were 52.3%, 33.9% and 59.4%, respectively. The median survival after RT was 18.5 months, and 2-year overall survival (OS) rate was 47.9%. On both univariate and multivariate analysis, the interval from surgery till recurrence and CCRT were significant prognostic factors for OS.
CONCLUSION
The current study demonstrates that involved field salvage RT is effective for LRR of NSCLC following surgery.

Keyword

Concurrent chemo-radiation therapy; locoregional recurrence; non-small cell lung cancer; radiation therapy; salvage treatment

MeSH Terms

Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung/mortality/*radiotherapy/surgery
Female
Humans
Lung Neoplasms/mortality/*radiotherapy/surgery
Male
Middle Aged
Neoplasm Recurrence, Local/*radiotherapy/surgery
Survival Rate
Treatment Outcome

Figure

• 

  Fig. 1 In-field failure free survival (circle, IFFFS), intra-thoracic failure free survival (square, ITFFS), extra-thoracic failure free survival (triangle, ETFFS) and overall survival (diamond, OS) rates with salvage treatment in loco-regional recurrence of resected non-small cell lung cancer.

• 

  Fig. 2 Overall survival rate according to biologically equivalent dose (BED, A) and concurrent chemo-radiation therapy (CCRT, B). BED more than 70.2 Gy10 (p=0.018) and CCRT (p=0.029) were statistically significant prognostic factors in univariate analysis.

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