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Ross D, Chan D, Kuo E, Harkenrider M. Thoracic Reirradiation with Stereotactic Body Radiation Therapy (SBRT) for Recurrent Advanced Non-Small Cell Lung Cancer (NSCLC). Pract Radiat Oncol 2024; 14:234-240. [PMID: 38387781 DOI: 10.1016/j.prro.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Non-small cell lung cancer (NSCLC) local control remains suboptimal with rates around 75%. Stereotactic body radiation therapy (SBRT) is an option for isolated local recurrences of small-volume recurrences. This study investigates the safety and efficacy of 60 Gy in 8 fractions in large-volume local recurrences. METHODS AND MATERIALS We conducted a retrospective chart review of patients treated with salvage SBRT for NSCLC lung parenchymal recurrence between July 2013 and February 2020. Reirradiation prescribed dose was 60 Gy in 8 fractions using the SBRT technique. The primary endpoint was local control at most recent follow-up or death. Secondary endpoints included overall survival, disease-free interval, cancer-specific survival, and treatment related toxicities. RESULTS Seven patients met inclusion criteria. Median follow up time was 38 months (18.1-72.4). Median age was 67 years (63-80). Median time to reirradiation was 18.2 months (7.3-28.6). Retreatment median ITV was 57.9 cc (15.8-344.6), and PTV median was 113.6 cc (38.3-506.9). Local control was maintained in 4 of 7 patients (57.1%). Two of the 7 patients (28.6%) remained alive. Median disease-free interval was 22.5 months (11-65). Three of 7 patients (42.9%) had grade 2 toxicities. One patient (14.3%) had a grade 3 rib/chest wall toxicity with concurrent disease recurrence invading the chest wall. CONCLUSION This study reports that SBRT of 60 Gy in 8 fractions was delivered safely and effectively to large volume recurrent NSCLC previously treated with radiation therapy. The disease-free interval of nearly 2 years is meaningful for patients' quality of life and duration of time off systemic therapy.
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Affiliation(s)
- Dylan Ross
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, Illinois
| | - Dennis Chan
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, Illinois
| | - Ellen Kuo
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, Illinois
| | - Matthew Harkenrider
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, Illinois; Department of Radiation Oncology, Edward Hines Jr. VA Hospital, Hines, Illinois.
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Dickhoff C, Heineman DJ, Bahce I, Senan S. Unresectable Stage III NSCLC Can Be Reevaluated for Resectability After Initial Treatment. J Thorac Oncol 2023; 18:1124-1128. [PMID: 37599045 DOI: 10.1016/j.jtho.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
| | - David Jonathan Heineman
- Department of Cardiothoracic Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Idris Bahce
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands; Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Suresh Senan
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands; Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Joosten PJ, Winkelman TA, Heineman DJ, Hashemi SM, Bahce I, Senan S, Paul MA, Hartemink KJ, Dahele M, Dickhoff C. Salvage Surgery for Patients With Local Recurrence or Persistent Disease After Treatment With Chemoradiotherapy for SCLC. JTO Clin Res Rep 2021; 2:100172. [PMID: 34590022 PMCID: PMC8474289 DOI: 10.1016/j.jtocrr.2021.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/28/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The role of salvage surgery for patients with locoregional (LR) recurrence or persistent SCLC after radical chemoradiotherapy (CRT) for limited-stage disease is not well established. We evaluated our experience. Methods We conducted a retrospective study of consecutive patients who underwent salvage pulmonary resection for LR-recurrent or persistent SCLC between 2008 and 2020 at the Amsterdam University Medical Center. Results A total of 10 patients were identified. Median age at initial diagnosis of limited-stage SCLC was 58.5 years (48-71 y). All patients had radical-intent concurrent CRT. Of the 10 patients, 9 were diagnosed with LR-recurrent or persistent disease with a median of 18 months (3-78 y) after CRT. All patients underwent an anatomical radical resection and mediastinal lymph node dissection. No 90-day mortality was recorded. In addition, one patient developed a LR recurrence 7 months after resection. Distant progression was found in three patients at 6, 32, and 61 months after surgery, all of whom subsequently died of progressive SCLC. Median follow-up was 22.5 months (2-86 mos). Disease-free survival was 34 months; overall survival was not reached. Conclusions For highly selected patients with LR-recurrent or persistent SCLC after CRT, salvage surgery is feasible and can result in clinically meaningful survival. Such patients should be presented to the multidisciplinary tumor board.
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Affiliation(s)
- Pieter J.M. Joosten
- Department of Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Toon A. Winkelman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - David J. Heineman
- Department of Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Sayed M.S. Hashemi
- Department of Pulmonary Medicine, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Idris Bahce
- Department of Pulmonary Medicine, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Marinus A. Paul
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Koen J. Hartemink
- Department of Surgery, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Chris Dickhoff
- Department of Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Corresponding author. Address for correspondence: Chris Dickhoff, MD, PhD, Department Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
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