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High Dose Thoracic Re-Irradiation and Chemo-Immunotherapy for Centrally Recurrent NSCLC.
Grambozov, Brane; Stana, Markus; Kaiser, Bernhard; Karner, Josef; Gerum, Sabine; Ruznic, Elvis; Zellinger, Barbara; Moosbrugger, Raphaela; Studnicka, Michael; Fastner, Gerd; Sedlmayer, Felix; Zehentmayr, Franz.
Afiliação
  • Grambozov B; Department of Radiation Oncology, Paracelsus Medical University, SALK, A-5020 Salzburg, Austria.
  • Stana M; Department of Radiation Oncology, Paracelsus Medical University, SALK, A-5020 Salzburg, Austria.
  • Kaiser B; Department of Pneumology, Paracelsus Medical University, SALK, A-5020 Salzburg, Austria.
  • Karner J; Department of Radiation Oncology, Paracelsus Medical University, SALK, A-5020 Salzburg, Austria.
  • Gerum S; Department of Radiation Oncology, Paracelsus Medical University, SALK, A-5020 Salzburg, Austria.
  • Ruznic E; Department of Radiation Oncology, Paracelsus Medical University, SALK, A-5020 Salzburg, Austria.
  • Zellinger B; Institute of Pathology, Paracelsus Medical University, SALK, A-5020 Salzburg, Austria.
  • Moosbrugger R; Department of Pneumology, Paracelsus Medical University, SALK, A-5020 Salzburg, Austria.
  • Studnicka M; Department of Pneumology, Paracelsus Medical University, SALK, A-5020 Salzburg, Austria.
  • Fastner G; Department of Radiation Oncology, Paracelsus Medical University, SALK, A-5020 Salzburg, Austria.
  • Sedlmayer F; Department of Radiation Oncology, Paracelsus Medical University, SALK, A-5020 Salzburg, Austria.
  • Zehentmayr F; Department of Radiation Oncology, Paracelsus Medical University, SALK, A-5020 Salzburg, Austria.
Cancers (Basel) ; 14(3)2022 Jan 23.
Article em En | MEDLINE | ID: mdl-35158841
ABSTRACT

INTRODUCTION:

Thoracic re-irradiation for recurrent lung cancer dates back four decades, when the first small series on 29 patients receiving palliative doses was published. With 5-year overall survival rates of 57% in PDL-1 positive patients after primary chemo-radio-immunotherapy, the number of patients who experience loco-regional relapse will increase in the near future. In this context, centrally recurring lung tumors pose a major treatment challenge. Hence, the aim of the current review is to compile the available evidence on curatively intended thoracic re-irradiation for this special clinical situation.

METHODS:

A systematic literature search according to the PRISMA guidelines was performed. A study was included when the following criteria were met (1) 66% of the patients had NSCLC, (2) a total dose of 50 Gy in the second course and/or a biologically effective dose of at least 100 Gy in both treatment courses was administered, (3) re-irradiation was administered with modern radiation techniques, (4) 50% or more of the patients had a centrally located relapse, (5) the minimum cohort size was 30 patients.

RESULTS:

Of the initial 227 studies, 11 were analyzed, 1 of which was prospective. Median overall survival (OS) was 18.1 months (range 9.3-25.1), median progression free survival (PFS) was nine months (range 4.5-16), and median loco-regional control (LRC) was 12.1 months (range 6.5-20). Treatment-related mortality rates ranged from 2% to 14%. The total dose at re-irradiation correlated with both LRC (p-value = 0.012) and OS (p-value = 0.007) with a close relation between these two clinical endpoints (p-value = 0.006). The occurrence of acute toxicity grade 1 to 4 depended on the PTV size at re-irradiation (p-value = 0.033).

CONCLUSION:

The evidence regarding curative re-irradiation for centrally recurrent NSCLC is primarily based on scarce retrospective data, which are characterized by a high degree of heterogeneity. The OS in this clinically challenging situation is expected to be around 1.5 years after re-treatment. Patients with a good performance score, younger age, small tumors, and a longer interval to recurrence potentially benefit most from re-irradiation. In this context, prospective trials are warranted to achieve substantial advances in the field.
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Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2022 Tipo de documento: Article