PDF
ePub
Citation
Print
Abstract
Purpose:
To retrospectively evaluate the outcomes and complications of curative radiotherapy for locoregionally recurrent non-small cell lung cancer (NSCLC). Materials and Methods: From 2004 to 2008, 21 patients received curative radiotherapy for locoregionally recurrent NSCLC without systemic metastasis after surgery. At the time of recurrence, the median age was 70 years (range 49∼81 years), and 19 patients were male. Most patients (n=17) were ECOG 0 or 1 performance status. The median disease-free interval was 15 months. Distribution of recurrence sites were mediastinal lymph nodes (n=10), ipsilateral hilar lymph nodes (n=4), ipsilateral lung parenchyma (n=4), bronchial stump (n=2) and ipsilateral supraclavicular lymph nodes (n=1). Radiotherapy was administered (median 66 Gy, range 59.4∼70 Gy) by a three-dimensional conformal technique. Thirteen patients received chemotherapy concurrently during radiotherapy. Pulmonary function test (PFT) was also used to detect lung function change before and after radiation.
Results:
The median survival and 1- and 2-year survival rates were 17 months, 68% and 34%, respectively. Concurrent chemotherapy did not affect post- recurrence overall survival (p=0.183). Seven patients (33% of all patients) had re-progression within the radiation field at a median time of 4 months after completion of radiation. Diffusing lung capacity for carbon monoxide of lung after radiotherapy decreased significantly compared with pre-radiotherapy status (p=0.033). Radiation pneumonitis of any grade was seen in 11 patients. Three patients died of pulmonary complications: one of bacterial pneumonia, one of exacerbation of underlying interstitial pulmonary fibrosis and one of radiation pneumonitis.
Conclusion:
This retrospective study showed that curative radiotherapy for locoregionally recurrent NSCLC resulted in a median survival of 17 months and a 2-year survival rate of 34%, which is comparable to other studies. Patients suitable for curative radiotherapy for recurrent NSCLC could be treated aggressively, such as using high dose radiation with or without chemotherapy. However, pre-radiotherapy lung function should be carefully evaluated to avoid serious post-treatment lung damage considering poor lung function of postresection patients.
REFERENCES
1. 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.
2. The Ludwig Lung Cancer Study Group. Patterns of failure in patients with resected stage I and II non-small-cell carcinoma of the lung. Ann Surg. 1987; 205:67–71.
3. Immerman SC, Vanecko RM, Fry WA, Head LR, Shields TW. Site of recurrence in patients with stages I and II carcinoma of the lung resected for cure. Ann Thorac Surg. 1981; 32:23–27.
4. Feld R, Rubinstein LV, Weisenberger TH. Sites of recurrence in resected stage I non-small-cell lung cancer: a guide for future studies. J Clin Oncol. 1984; 2:1352–1358.
5. Voltolini L, Paladini P, Luzzi L, Ghiribelli C, Di Bisceglie M, Gotti G. Iterative surgical resections for local recurrent and second primary bronchogenic carcinoma. Eur J Cardiothorac Surg. 2000; 18:529–534.
6. Watanabe Y, Shimizu J, Oda M, Tatsuzawa Y, Hayashi Y, Iwa T. Second surgical intervention for recurrent and second primary bronchogenic carcinomas. Scand J Thorac Cardiovasc Surg. 1992; 26:73–78.
7. Leung J, Ball D, Worotniuk T, Laidlaw C. Survival following radiotherapy for post-surgical locoregional recurrence of non-small cell lung cancer. Lung Cancer. 1995; 13:121–127.
8. Kagami Y, Nishio M, Narimatsu N, et al. Radiotherapy for locoregional recurrent tumors after resection of non-small cell lung cancer. Lung Cancer. 1998; 20:31–35.
9. Foo K, Gebski V, Yeghiaian-Alvandi R, Foroudi F, Cakir B. Outcome following radiotherapy for locoregionally recurrent non-small cell lung cancer. Australas Radiol. 2005; 49:108–112.
10. Jeremic B, Shibamoto Y, Milicic B, et al. External beam radiation therapy alone for locoregional recurrence of non-small-cell lung cancer after complete resection. Lung Cancer. 1999; 23:135–142.
11. Curran WJ Jr, Herbert SH, Stafford PM, et al. Should patients with postresection locoregional recurrence of lung cancer receive aggressive therapy? Int J Radiat Oncol Biol Phys. 1992; 24:25–30.
12. Cai XW, Xu LY, Wang L, et al. Comparative survival in patients with postresection recurrent versus newly diagnosed non-small-cell lung cancer treated with radiotherapy. Int J Radiat Oncol Biol Phys. 2010; 76:1100–1105.
13. Kong FM, Ten Haken RK, Schipper MJ, et al. High-dose radiation improved local tumor control and overall survival in patients with inoperable/unresectable non-small-cell lung cancer: long-term results of a radiation dose escalation study. Int J Radiat Oncol Biol Phys. 2005; 63:324–333.
14. Rosenman JG, Halle JS, Socinski MA, et al. High-dose conformal radiotherapy for treatment of stage IIIA/IIIB non- small-cell lung cancer: technical issues and results of a phase I/II trial. Int J Radiat Oncol Biol Phys. 2002; 54:348–356.
15. Le Chevalier T, Arriagada R, Quoix E, et al. Radiotherapy alone versus combined chemotherapy and radiotherapy in nonresectable non-small-cell lung cancer: first analysis of a randomized trial in 353 patients. J Natl Cancer Inst. 1991; 83:417–423.
16. Dillman RO, Herndon J, Seagren SL, Eaton WL Jr, Green MR. Improved survival in stage III non-small-cell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial. J Natl Cancer Inst. 1996; 88:1210–1215.
17. Kim TY, Yang SH, Lee SH, et al. A phase III randomized trial of combined chemoradiotherapy versus radiotherapy alone in locally advanced non-small-cell lung cancer. Am J Clin Oncol. 2002; 25:238–243.
18. Furuse K, Fukuoka M, Kawahara M, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. J Clin Oncol. 1999; 17:2692–2699.
19. Fournel P, Robinet G, Thomas P, et al. Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer: Groupe Lyon-Saint-Etienne d'Oncologie Thora-cique-Groupe Franç ais de Pneumo-Cancé rologie NPC 95-01 Study. J Clin Oncol. 2005; 23:5910–5917.
20. Winton T, Livingston R, Johnson D, et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med. 2005; 352:2589–2597.
21. Arriagada R, Bergman B, Dunant A, et al. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004; 350:351–360.
22. Miller KL, Zhou SM, Barrier RC Jr, et al. Long-term changes in pulmonary function tests after definitive radiotherapy for lung cancer. Int J Radiat Oncol Biol Phys. 2003; 56:611–615.
23. Gopal R, Starkschall G, Tucker SL, et al. Effects of radiotherapy and chemotherapy on lung function in patients with non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2003; 56:114–120.
24. De Jaeger K, Seppenwoolde Y, Boersma LJ, et al. Pulmonary function following high-dose radiotherapy of non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2003; 55:1331–1340.
25. Allen AM, Henning GT, Ten Haken RK, Hayman JA, Martel MK. Do dose-volume metrics predict pulmonary function changes in lung irradiation? Int J Radiat Oncol Biol Phys. 2003; 55:921–929.
Fig. 2.
Overall survival rate according to the use of chemotherapy. CCRT: concurrent chemoradiotherapy.
Table 1.
Characteristics of the Patients
| Variables | Patients |
|---|---|
| Age∗, yr | 70 (49∼81) |
| Gender | |
| Male | 19 (91) |
| Female | 2 (9) |
| Histology | |
| Squamous cell carcinoma | 11 (54) |
| Adenocarcinoma | 5 (23) |
| Other | 5 (23) |
| Performance status | |
| ECOG 0∼1 | 17 (82) |
| ECOG 2 | 4 (18) |
| Disease free interval, mo | 15† |
| ≥15 | 10 (45) |
| ＜15 | 11 (55) |
| Recurrence site | |
| Mediastinal lymph node | 10 (45) |
| Hilar lymph node | 4 (18) |
| Lung parenchyma | 4 (18) |
| Bronchial stump | 2 (9) |
| Supraclavicular lymph node | 1 (5) |
| Initial stage | |
| I | 8 (38) |
| II | 4 (19) |
| IIIA | 5 (24) |
| IIIB | 4 (19) |
| Recurrence stage | |
| I | 4 (18) |
| II | 6 (28) |
| IIIA | 9 (45) |
| IIIB | 2 (9) |
Table 2.
Analysis of Prognostic Factors
| Factor | p-value∗ | p-value† |
|---|---|---|
| Age, yr (<70 vs. ≥70) | 0.406 | 0.727 |
| Stages on recurrence (III vs. I∼ II) | 0.291 | 0.060 |
| DFI, mo (＜15 vs. ≥15) | 0.556 | 0.195 |
| Concurrent chemoradiotherapy or not | 0.183 | 0.956 |
| Radiation dose (＜66 Gy or ≥66 Gy) | 0.698 | 0.058 |
Table 3.
Changes in Lung Function
| FEV1 | DLCO | |||
|---|---|---|---|---|
| Mean value | p-value | Mean value | p-value | |
| Pre-Op∗ | 2.41 | 17.64 | ||
| Pre-RT | 1.893 | }0.312 | 14.529 | }0.033 |
| Post-RT | 1.821 | 12.524 | ||
XML Download