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Metachronous NSCLC in previously irradiated patients: is re-irradiation with SBRT a good option as definitive treatment?

Published online by Cambridge University Press:  23 December 2019

Corrado Spatola ,
Roberto Massimo Milazzotto Open the ORCID record for Roberto Massimo Milazzotto [Opens in a new window] ,
Alessandra Tocco ,
Luigi Raffaele ,
Viviana La Monaca ,
Vincenzo Salamone ,
Pietro Milone ,
Pietro Valerio Foti ,
Stefano Pergolizzi  and
Antonio Basile
...Show all authors
Corrado Spatola
Affiliation:
Department of Radiodiagnostica e Radioterapia Oncologica, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Catania, Italy
Roberto Massimo Milazzotto*
Affiliation:
Department of Radiodiagnostica e Radioterapia Oncologica, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Catania, Italy
Alessandra Tocco
Affiliation:
Department of Radiodiagnostica e Radioterapia Oncologica, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Catania, Italy
Luigi Raffaele
Affiliation:
Department of Radiodiagnostica e Radioterapia Oncologica, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Catania, Italy
Viviana La Monaca
Affiliation:
Department of Radiodiagnostica e Radioterapia Oncologica, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Catania, Italy
Vincenzo Salamone
Affiliation:
Department of Radiodiagnostica e Radioterapia Oncologica, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Catania, Italy
Pietro Milone
Affiliation:
Department of Radiodiagnostica e Radioterapia Oncologica, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Catania, Italy
Pietro Valerio Foti
Affiliation:
Department of Radiodiagnostica e Radioterapia Oncologica, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Catania, Italy
Stefano Pergolizzi
Affiliation:
Department of Radiotherapy, Azienda Ospedaliera Universitaria Policlinico of Messina, Messina, Italy
Antonio Basile
Affiliation:
Department of Radiodiagnostica e Radioterapia Oncologica, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Catania, Italy
Giuseppe Privitera
Affiliation:
Department of Radiodiagnostica e Radioterapia Oncologica, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Catania, Italy
*
Author for correspondence: Roberto Massimo Milazzotto, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Via Santa Sofia n. 78, Catania 95123, Italy. E-mail: [email protected]
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Abstract

Aim:

Treatment of metachronous second primary non-small cell lung cancer (NSCLC) in patients already treated with definitive radiotherapy is a matter of debate, since most patients are excluded from surgical treatment, which remains a therapeutic standard for patients with isolated lung masses. Salvage chemotherapy or immunotherapy alone offers a low probability of disease control. The option of re-irradiation often remains the only viable, but the risks of severe acute or late toxicities affecting the surrounding normal tissues make this a real clinical challenge.

Materials and methods:

From January 2015 to April 2018, five patients (male/female: 4/1; age 54–81 years, median 68) with previously irradiated NSCLC presented with a second primary lung tumour.

Results:

A partial response was seen in four patients, one complete responses in the fifth. The toxicity was low: two patients experienced a grade 2 asymptomatic radiation pneumonitis after 6 and 12 months from the end of stereotactic body radiation therapy, resolved with cortisone therapy. No acute or late oesophageal or cardiac toxicity was found.

Findings:

In this work, we present our initial experience about the use of stereotactic radiotherapy technique in already irradiated patients. We reported a local disease control in all cases with an acceptable toxicity.

Keywords

lung cancernon-small cellNSCLCre-irradiationSBRTSRTstereotactic radiotherapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 19 , Issue 3 , September 2020 , pp. 215 - 218
Copyright
© Cambridge University Press 2019

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References

Tyldesley, S, Boyd, C, Schulze, K, Walker, H, Mackillop, W J. Estimating the need for radiotherapy for lung cancer: an evidence-based, epidemiologic approach. Int J Radiat Oncol Biol Phys 2001; 49: 973–985.CrossRefGoogle ScholarPubMed
Curran, WJ, Jr, Paulus, R, Langer, CJ, et al.Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst 2011; 103: 1452–1460.10.1093/jnci/djr325CrossRefGoogle ScholarPubMed
Martini, N, Bains, MS, Burt, ME, et al.Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg 1995; 109: 120–129.10.1016/S0022-5223(95)70427-2CrossRefGoogle ScholarPubMed
Patel, NR, Lanciano, R, Sura, K, et al.: Stereotactic body radiotherapy for re-irradiation of lung cancer recurrence with lower biological effective doses. J Radiat Oncol 2015; 4: 65–70.10.1007/s13566-014-0175-2CrossRefGoogle ScholarPubMed
Spatola, C, Tocco, A, Milazzotto, R, et al.Role, timing and technique of radiotherapy in pediatric pleuropulmonary synovial sarcoma. Future Oncol 2016; 12 (23s): 73–77. doi: 10.2217/fon-2016-0331CrossRefGoogle ScholarPubMed
Spatola, C, Militello, C, Tocco, A, et al.Single-institution experience of intensity-modulated radiotherapy for malignant pleural mesothelioma at University of Catania. Future Oncol 2018; 14 (6s), 17–21.CrossRefGoogle ScholarPubMed
Timmerman, RD.An overview of hypofractionation and introduction to this issue of Seminars in Oncology. Semin Radiat Oncol 2008; 18 (4): 215–222.10.1016/j.semradonc.2008.04.001CrossRefGoogle Scholar
Noble, J, Ellis, PM, Mackay, JA, Evans, WK.Lung Cancer Disease Site Group of Cancer Care Ontario’s Program in evidence-based care. Second-line or subsequent systemic therapy for recurrent or progressive non-small cell lung cancer: a systematic review and practice guideline. J Thorac Oncol 2006; 1: 1042–1058.10.1097/01243894-200611000-00021CrossRefGoogle ScholarPubMed
Drodge, SC, Ghosh, S, Fairchild, A: Thoracic irradiation for lung cancer: a literature review and practical guide. Ann Palliat Med 2014; 3: 75–91.Google ScholarPubMed
Willner, J, Baier, K, Caragiani, E, et al.Dose, volume, and tumor control prediction in primary radiotherapy of non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2002; 52: 382–389.CrossRefGoogle ScholarPubMed
Jeremic, B, Videtic, GM: Chest reirradiation with external beam radiotherapy for locally recurrent non-small-cell lung cancer: a review. Int J Radiat Oncol Biol Phys 2011; 80 (4): 969–977.10.1016/j.ijrobp.2011.01.069CrossRefGoogle ScholarPubMed
Kilburn, JM, Kuremsky, JG, Blackstock, AW, et al.Thoracic re-irradiation using stereotactic body radiotherapy (SBRT) techniques as first or second course of treatment. Radiother Oncol 2014; 110: 505–510.10.1016/j.radonc.2013.11.017CrossRefGoogle ScholarPubMed
Onishi, H, Araki, T, Shirato, H, et al.Stereotactic hypofractionated high-dose irradiation for stage I non small cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multi institutional study. Cancer 2004; 101: 1623–1631.10.1002/cncr.20539CrossRefGoogle Scholar
Kelly, P, Balter, PA, Rebueno, N, et al.Stereotactic body radiation therapy for patients with lung cancer previously treated with thoracic radiation. Int J Radiat Oncol Biol Phys 2010; 78: 1387–1393.CrossRefGoogle ScholarPubMed
Trovo, M, Minatel, E, Durofil, E, et al.Stereotactic body radiation therapy for re-irradiation of persistent or recurrent non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2014; 88: 1114–1119.10.1016/j.ijrobp.2014.01.012CrossRefGoogle ScholarPubMed