- 作者：Marco Trovo ; MD&lowast ; ; marcotrovo33@hotmail.com" class="auth_mail ; Emilio Minatel ; MD&lowast ; ; Elena Durofil ; RTT&lowast ; ; Jerry Polesel ; ScD&dagger ; ; Michele Avanzo ; ScD&Dagger ; ; Tania Baresic ; MD§ ; ; Alessandra Bearz ; MD鈥?/sup> ; Alessandro Del Conte ; MD¶ ; ; Giovanni Franchin ; MD&lowast ; ; Carlo Gobitti ; MD&lowast ; ; Imad Abu Rumeileh ; MD&lowast ; ; Mauro G. Trovo ; MD&lowast ;
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：1 April, 2014
- 年：2014
- 卷：88
- 期：5
- 页码：1114-1119
- 全文大小：416 K
Purpose
To retrospectively assess toxicity and outcome of re-irradiation with stereotactic body radiation therapy (SBRT) in patients with recurrent or persistent non-small cell lung cancer (NSCLC), who were previously treated with radical radiation therapy (50-60聽Gy). The secondary endpoint was to investigate whether there are dosimetric parameter predictors of severe radiation toxicity.Methods and Materials
The analysis was conducted in 17 patients with 鈥渋n-field鈥?recurrent/persistent centrally located NSCLC, who underwent re-irradiation with SBRT. SBRT consisted of 30聽Gy in 5 to 6 fractions; these prescriptions would be equivalent for the tumor to 37.5 to 40聽Gy, bringing the total 2-Gy-per-fraction cumulative dose to 87 to 100聽Gy, considering the primary radiation therapy treatment. Actuarial analyses and survival were calculated by the Kaplan-Meier method, and P values were estimated by the log-rank test, starting from the date of completion of SBRT. Dosimetric parameters from the subgroups with and without grade 鈮? pulmonary toxicity were compared using a 2-tailed Student t test.
Results
The median follow-up was 18聽months (range, 4-57聽months). Only 2 patients had local failure, corresponding to a local control rate of 86% at 1聽year. The Kaplan-Meier estimates of overall survival (OS) rates at 1 and 2聽years were 59% and 29%, respectively; the median OS was 19聽months. Four patients (23%) experienced grade 3 radiation pneumonitis, and 1 patient developed fatal pneumonitis. One patient died of fatal hemoptysis 2聽months after the completion of SBRT. Unexpectedly, heart maximum dose, D5 (minimum dose to at least 5% of the heart volume), and D10 were correlated with risk of radiation pneumonitis (P<.05).
Conclusions
Re-irradiation with SBRT for recurrent/persistent centrally located NSCLC achieves excellent results in terms of local control. However, the high rate of severe toxicity reported in our study is of concern.