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Reirradiation for Locoregionally Recurrent Lung Cancer: Outcomes in Small Cell and Non–Small Cell Lung Carcinoma

Kruser, Tim J. MD*; McCabe, Bradley P. MS; Mehta, Minesh P. MD; Khuntia, Deepak MD§; Campbell, Toby C. MD; Geye, Heather M. MS*; Cannon, George M. MD*

American Journal of Clinical Oncology: February 2014 - Volume 37 - Issue 1 - p 70–76
doi: 10.1097/COC.0b013e31826b9950
Original Articles: Thoracic

Objectives: To our knowledge this is the largest report analyzing outcomes for reirradiation (reRT) for locoregionally recurrent lung cancer, and the first to assess thoracic reRT outcomes in patients with small cell lung cancer (SCLC).

Methods: Forty-eight patients (11 SCLC, 37 non–small cell lung cancer [NSCLC]) receiving reRT to the thorax were identified; 44 (92%) received reRT by intensity-modulated radiotherapy. Palliative responses, survival outcomes, and prognostic factors were analyzed.

Results: NSCLC patients received a median of 30 Gy in a median of 10 fractions, whereas SCLC patients received a median of 37.5 Gy in a median of 15 fractions. Median survival for the entire cohort from reRT was 4.2 months. Median survival for NSCLC patients was 5.1 months, versus 3.1 months for the SCLC patients (P=0.15). In NSCLC patients, multivariate analysis demonstrated that Karnofsky performance status≥80 and higher radiation dose were associated with improved survival following reRT, and 75% of patients with symptoms experienced palliative benefit. In SCLC, 4 patients treated with the intent of life prolongation for radiographic recurrence had a median survival of 11.7 months. However, acute toxicities and new disease symptoms limited the duration of palliative benefit in the 7 symptomatic SCLC patients to 0.5 months.

Conclusions: ReRT to the thorax for locoregionally recurrent NSCLC can provide palliative benefit, and a small subset of patients may experience long-term survival. Select SCLC patients may experience meaningful survival prolongation after reRT, but reRT for patients with symptomatic recurrence and/or extrathoracic disease did not offer meaningful survival or durable symptom benefit.

Departments of *Human Oncology

Medical Physics, University of Wisconsin Carbone Cancer Center

Department of Medicine, Division of Hematology and Oncology, University of Wisconsin Carbone Cancer Center, Madison, WI

Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL

§Western Radiation Oncology, Mountain View, CA

D.K. has or has had the following roles in the past 2 years: Consultant: Procertus, Radion Global Advisor, and Varian Medical Systems; Research grant from Tomotherapy; Stock Options: Radion Global Advisor; Speaker honorarium from Tomotherapy; Board membership: Medical Physics Publishing. M.P.M. has or has had the following roles in 2011-12: Consultant: Abbott, BioStrategies, MAPI Values, Bristol-Meyers-Squibb (Knowledgepoint), Elekta, Frankel Group, Gerson, Merck, NCI, Novartis (Articulate Science), Quark, SS Bala, Tomotherapy, US Oncology, Vertex; Stock Options: Accuray, Colby, Pharmacyclics, Procertus, Stemina; Data Safety Monitoring Boards: Apogenix; Protocol Data Review: Adnexus; Board of Directors: Pharmacyclics; Medical Advisory Boards: Colby, Stemina, Procertus; Speaker: ASCO, Cleveland Clinic, GRACE Foundation, IL Radiological Society, MDACCC, Merck, priME Oncology, Resurrection Hospital, UT San Antonio, Vindico, WebMD; Patents: WARF; Royalties: DEMOS Publishers, Elsevier; CME Products: MCM, Medscape. The remaining authors declare no conflicts of interest.

Reprints: Tim J. Kruser, MD, Department of Human Oncology, University of Wisconsin Carbone Cancer Center, K4/B100 CSC, 600 Highland Avenue, Madison, WI 53792. E-mail: kruser@humonc.wisc.edu.

© 2014 by Lippincott Williams & Wilkins, Inc