Definitive radiotherapy for local recurrence of NSCLC after surgery

• Published in: Clinical lung cancer Vol. 18; no. 3; pp. e161 - e168
• Main Authors: Wu, Abraham J., M.D, Garay, Elizabeth, M.D, Foster, Amanda, M.S, Hsu, Meier, M.S, Zhang, Zhigang, Ph.D, Chaft, Jamie E., M.D, Huang, James, M.D, Rosenzweig, Kenneth E., M.D, Rimner, Andreas, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2017
• Subjects: Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - radiotherapy; Chemotherapy; Female; Hematology, Oncology and Palliative Medicine; Humans; IMRT; Lung Neoplasms - mortality; Lung Neoplasms - radiotherapy; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Non–small-cell lung cancer; Prognosis; Pulmonary/Respiratory; Radiation dose; Radiosurgery; SBRT; Sex Factors; Survival Analysis; Treatment Outcome; non-small cell lung cancer; radiotherapy; local recurrence; Non–small-cell lung cancer; Chemotherapy; Radiation dose; IMRT; SBRT
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2017.01.014

Abstract Introduction /Background: Locoregional recurrence after resection of non-small cell lung cancer (NSCLC) is common. We examined outcomes after definitive radiotherapy (RT) to identify prognostic factors for survival and further recurrence. Patients and Methods We reviewed 152 patients receiving RT for LR-NSCLC, analyzing subsequent overall survival (OS), locoregional failure (LRF), distant metastasis (DM) and any progression (LRF + DM). Results Two and 5-year OS were 49% and 28% respectively. Two and 5-year LRF, DM, and any-progression rates were 40%/45%, 33%/37%, and 53%/57%. Performance status and IMRT were independently associated with OS, as was RT dose ≥60Gy. Stage, chemotherapy at recurrence, and surgery-to-recurrence interval were not independently associated with outcome. Chemotherapy at initial presentation, adenocarcinoma histology, and male gender were independently associated with higher DM. Conclusion This is the largest reported series of LR-NSCLC treated with definitive RT. Survival appears comparable to or greater than that of primary NSCLC. Subsequent locoregional failure is more common than distant failure. Established prognostic factors for primary NSCLC, such as chemotherapy and stage, were not clearly prognostic in this analysis. IMRT and higher RT doses were associated with improved survival, though IMRT patients were also treated more recently. This data supports definitive-intent RT with optimal dose and technique in such patients.