Reirradiation for Locoregionally Recurrent Lung Cancer
| Autor: | Toby C. Campbell, Deepak Khuntia, Tim J. Kruser, Minesh P. Mehta, Bradley P. McCabe, Heather M. Geye, George M. Cannon |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Thorax Oncology Cancer Research medicine.medical_specialty Lung Neoplasms Kaplan-Meier Estimate Article Carcinoma Non-Small-Cell Lung Internal medicine Carcinoma medicine Humans Carcinoma Small Cell Karnofsky Performance Status Lung cancer neoplasms Aged Proportional Hazards Models Superior vena cava syndrome business.industry Dose fractionation Cancer Middle Aged medicine.disease respiratory tract diseases Treatment Outcome Mediastinal lymph node Multivariate Analysis Retreatment Female Topotecan Dose Fractionation Radiation Neoplasm Recurrence Local medicine.symptom business medicine.drug |
| Zdroj: | American Journal of Clinical Oncology. 37:70-76 |
| ISSN: | 0277-3732 |
| DOI: | 10.1097/coc.0b013e31826b9950 |
| Popis: | Lung cancer is the leading cause of cancer death in the United States, with approximately 220,000 new cases and 157,000 deaths annually.1 External beam radiation plays an important role in curative management strategies for both small cell lung cancer (SCLC) and non–small cell lung cancer (NSCLC). Intrathoracic recurrence of lung cancer after upfront fractionated radiotherapy (RT) remains a challenging clinical scenario. In NSCLC patients treated with concurrent chemo-radiation to the thorax, 5-year rates of locoregional recurrence approach 30%.2 Current National Comprehensive Cancer Network guidelines for locoregionally recurrent NSCLC include the consideration of external beam RT in cases of endobronchial obstruction, mediastinal lymph node recurrence, or symptomatic recurrence (ie, superior vena cava syndrome or hemoptysis).3 Estimates of utilization of reirradiation (reRT) for locoregionally recurrent NSCLC range from 1.5% to 3.7% of patients receiving upfront RT.4,5 Approximately 30% of SCLC patients have limited-stage disease at diagnosis and are treated with curative intent chemo-radiotherapy. Local failure remains problematic in these patients, and occurred in 36% of patients in the landmark study by Turrisi et al.6 Patients who have recurrent or progressive SCLC experience enormous symptom burden7 and a short life expectancy. Currently, topotecan is the only Food and Drug Administration-approved drug for second-line treatment of SCLC, but response rates in the second-line setting range from 15% to 38%.8 Outcomes after reRT to the thorax specific to locoregionally recurrent SCLC have not been described to date. The existing body of literature of chest reRT for locoregionally recurrent lung cancer was recently reviewed.9 The utilization of intensity-modulated RT (IMRT) was either rare or nonexistent in the reviewed publications. Nonetheless, the authors noted that “IMRT appears particularly suited to the setting of retreatment.” We report on a cohort of 48 patients with locoregional lung cancer after upfront fractionated RT undergoing reRT to the thorax, predominantly using IMRT. To our knowledge, this is largest series reported to date, and the first report of reRT outcomes in which IMRT is the dominant method of radiation delivery. In addition, we report outcomes as analyzed by histology, and provide the first results specific to SCLC patients. |
| Databáze: | OpenAIRE |
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