Re-irradiation in lung disease by SBRT: a retrospective, single institutional study
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RESEARCH
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Re-irradiation in lung disease by SBRT: a retrospective, single institutional study Donatella Caivano1*, Maurizio Valeriani2, Sara De Matteis2, Paolo Bonome2, Ivana Russo3, Vitaliana De Sanctis2, Giuseppe Minniti4 and Mattia Falchetto Osti2
Abstract Background: The loco regional relapse is frequent in the lung disease. The aim of this study was to evaluate the outcomes of re-irradiation by SBRT in terms of Local Control (LC) and toxicities. Methods: From April 2011 to December 2016, twenty-two patients received a re-irradiation by SBRT. Twenty- seven lesions were treated. The medium BED(10) of re-irradiation was 100.6 Gy (range: 48–151.2 Gy) and the medium EQD2 (10) was 93.8 Gy (range: 40–126 Gy). In the previous treatment the medium BED(10) was 97.2 Gy (range: 40–120 Gy), the medium EQD2(10) was 81 Gy (range: 32.5–100 Gy). The median time between the first and the second treatment was 18 months. Results: Local Control was reached in 18 out of 27 (66%) re-irradiated lesions, with rates of 67 and 54% at 1- year and 2- years respectively. The treatment was well tolerated; the maximum recorded toxicity was Grade 3. Conclusions: Re- irradiation by SBRT may represent an option for the treatment of lung disease with good results in terms of LC and toxicity. Keywords: Re-irradiation, SBRT, Lung, Primary or metastatic disease
Background Lung cancer is one of the most important causes of death for cancer in the world. Patients with early-stage lung cancer have a probability of 4–10% developing a second lung tumor in the first 5 years after treatment [1, 2]. Patients with stage III Non-Small Cell Lung Cancer (NSCLC) treated with concurrent chemo-radiotherapy (CRT) have a risk of 30% for isolated locoregional failure [3]. The lungs are a common site for metastases. A considerable percentage of patients have disease limited to the thorax, which represents an ideal subset for local therapy [4]. A considerable number of patients with primary or metastatic lung lesions need to repeat thorax treatment for recurrent or metachronous disease. For this reason, thoracic reirradiation starts to be common in clinical practice. Thorax recurrences can be separated in local (lung parenchyma, bronchial stump, or chest wall) and regional (mediastinal lymph nodes). The aim of treatment can be palliative or * Correspondence: [email protected] 1 Departement of Radiation Oncology, CNAO (National Centre of Oncological Hadrontherapy), Str. Campeggi, 53, 27100 Pavia, Italy Full list of author information is available at the end of the article
curative [5]. The improvements of technologies with Stereotactic Body Radiation Therapy (SBRT) have introduced the concept of ablative radiotherapy with curative intent. The SBRT is able to give a high dose of radiation sparing the surrounding normal tissue in 1–5 fractions [6]. The purpose of this study was to evaluate clinical outcomes in terms of Local Control (LC) and toxicity in patients with lung disease (primary or metastatic) which have received re-irradiation by SBRT
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