Re-irradiation (RRT) of recurrent non-small cell lung cancer (NSCLC) ± chemotherapy (CT): A retrospective review of 14 patients (pts)
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文摘
Fourteen Pts with recurrent NSCLC underwent RRT ± CT. As primary treatment four patients had Accelerated Hyper-Fractionated Radiotherapy (AHFRT) with concomitant CT as per our in house protocol. The remaining 10 Pts had received definitive standard RT, two of which had pre RT Platinum and Vinblastine q 3 wks × 2. Mean total dose (MTD) for all the 14 Pts during primary RT was 6250 cGy (range 6040-7000 cGy). Symptoms of recurrent disease included cough, hemoptysis, shortness of breath, and pain. All Pts were treated with RRT- patients had RT with CT and Pts had standard RT alone. Pts also had intra-luminal high dose rate (HDR) brachy-therapy (1000-1500 cGy). The total dose to spinal cord was kept below 5000 cGy in all Pts. Median follow-up was 3 months (mean 8 months, range 0-24 months). Pts developed esophageal complications (1 structure & 2 tracheo - esophageal fistulae & bleeding). MTD for these 3 Pts was 9593 cGy (range 8560-10620 cGy). of these Pts had AHFRT + CT initially and the third had HDR. Pts developed pericardial effusions (PCE). Two of these four Pts developed PCE before RRT and both had AHFRT + CT the first time around. Pts had PCE tapped and one other Pt had pericardial biopsy which showed reactive mesothelial hyperplasia and fibrosis without evidence of malignancy. These Pts had MTD of 9660 cGy (range 8560-10480 cGy). For the remaining Pts, the MTD was 9570 cGy (8400-13,000 cGy). One patient developed radiation pneumonitis after the RRT. 71 % ( Pts) had improvement in their symptoms following the RRT. Median duration of control of symptoms was 3 months (mean 5.85 months, range 0-20 months).