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  • Title: Salvage stereotactic body radiation therapy (SBRT) for local failure after primary lung SBRT.
    Author: Hearn JW, Videtic GM, Djemil T, Stephans KL.
    Journal: Int J Radiat Oncol Biol Phys; 2014 Oct 01; 90(2):402-6. PubMed ID: 25017480.
    Abstract:
    PURPOSE: Local failure after definitive stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) is uncommon. We report the safety and efficacy of SBRT for salvage of local failure after previous SBRT with a biologically effective dose (BED) of ≥ 100 Gy10. METHODS AND MATERIALS: Using an institutional review board-approved lung SBRT registry, we identified all patients initially treated for early-stage NSCLC between August 2004 and January 2012 who received salvage SBRT for isolated local failure. Failure was defined radiographically and confirmed histologically unless contraindicated. All patients were treated on a Novalis/BrainLAB system using ExacTrac for image guidance, and received a BED of ≥ 100 Gy10 for each SBRT course. Tumor motion control involved a Bodyfix vacuum system for immobilization along with abdominal compression. RESULTS: Of 436 patients treated from August 2004 through January 2012, we identified 22 patients with isolated local failure, 10 of whom received SBRT for salvage. The median length of follow-up was 13.8 months from salvage SBRT (range 5.3-43.5 months). Median tumor size was 3.4 cm (range 1.7-4.8 cm). Two of the 10 lesions were "central" by proximity to the mediastinum, but were outside the zone of the proximal bronchial tree. Since completing salvage, 3 patients are alive and without evidence of disease. A fourth patient died of medical comorbidities without recurrence 13.0 months after salvage SBRT. Two patients developed distant disease only. Four patients had local failure. Toxicity included grade 1-2 fatigue (3 patients) and grade 1-2 chest wall pain (5 patients). There was no grade 3-5 toxicity. CONCLUSIONS: Repeat SBRT with a BED of ≥ 100 Gy10 after local failure in patients with early-stage medically inoperable NSCLC was well tolerated in this series and may represent a viable salvage strategy in select patients with peripheral tumors ≤ 5 cm.
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