A long-term survival case following salvage stereotactic radiotherapy for local recurrence after definitive chemoradioth
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CASE REPORT
A long‑term survival case following salvage stereotactic radiotherapy for local recurrence after definitive chemoradiotherapy for stage III non‑small cell lung cancer Yuta Sato1 · Keiichi Jingu1 · Rei Umezawa1 · Takaya Yamamoto1 · Yojiro Ishikawa1 · Kazuya Takeda1 · Yu Suzuki1 · Haruo Matsushita1 Received: 12 May 2020 / Accepted: 27 June 2020 © The Japan Society of Clinical Oncology 2020
Abstract A 56-year-old male with stage IIIA (UICC 7th) non-small cell lung cancer (adenocarcinoma) received radiotherapy with 66 Gy/33 fractions concomitant with CBDCA and PTX. A partial response was achieved after chemoradiotherapy and the tumor continued to shrink over a period of 1 year; however, regrowth of the tumor attached to the aortic arch was observed without any other residual tumor or metastases. We diagnosed recurrence with slightly increased 18F-FDG uptake (maximum standardized uptake value: 12.2). Stereotactic radiotherapy was performed for the relapsed lesion with 60 Gy/10 fractions. The patient has survived for more than 5 years after stereotactic radiotherapy without recurrence or metastases, although he has been suffering from chest pain that has required treatment with a low dose of oxycodone. Keywords Non-small cell lung cancer · Salvage stereotactic radiotherapy · Definitive chemoradiotherapy
Introduction
Case report
Chemoradiotherapy is one of the definitive treatment methods for patients with stage III non-small cell lung cancer (NSCLC). However, local recurrence in the primary site is often seen after definitive chemoradiotherapy [1]. Even without metastases, it is still difficult to cure in-field recurrence after chemoradiotherapy. The effectiveness of stereotactic radiotherapy for a small target has been reported; however, re-irradiation for recurrence after definitive radiotherapy is risky. Re-irradiation, even re-irradiation using stereotactic radiotherapy, should be performed carefully, especially for central regions of the lung, in order to prevent severe radiation-induced complication (e.g., fistula and bleeding) [2].
The patient was a 56-year-old Japanese male who was a heavy smoker with a 54-pack-year history. A tumor in the left upper lobe and left hilar swelling were revealed by a chest X-ray in a health examination. Results of a blood test showed a high serum carcinoembryonic antigen (CEA) level of 12.9 ng/ml. He had no significant historical disease. Adenocarcinoma was proved by biopsy through bronchoscopy. A diagnosis of clinical T3N2M0 (Union for International Cancer Control (UICC) 7th) NSCLC was made by CT and F18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET). He was judged to be inoperable and concomitant chemoradiotherapy consisting of elective nodal irradiation and carboplatin (2 area under the blood concentration–time curve (AUC)) and paclitaxel (45 mg/m2) was performed. Elective nodal regions were irradiated by 3-dimensional conformal radiotherapy (3D-CRT) with 40 Gy/20 fractions (fr.) (Fig. 1a), and a sequential boost to the gross tumo
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