title: Toxicity after reirradiation of pulmonary tumours with stereotactic body radiotherapy.
abstract: OBJECTIVE
  To assess toxicity and feasibility of reirradiation with stereotactic body radiotherapy (SBRT) after prior lung SBRT for primary lung cancer or lung metastases.
  
  
  METHODS
  Twenty-nine patients reirradiated with SBRT on 32 lung lesions (11 central, 21 peripheral) were retrospectively reviewed. Median follow-up time was 12 months (range 1-97). The primary endpoint was toxicity, secondary endpoints were local control and overall survival time. Toxicity was scored according to the NCI-CTCAE version 3.
  
  
  RESULTS
  Grade 3-4 toxicity was scored 14 times in eight patients. Three patients died because of massive bleeding (grade 5). Larger clinical target volumes (CTV) and central tumour localization were associated with more severe toxicity. There was no correlation between mean lung dose (MLD) and lung toxicity. Local control at 5 months after reirradiation was 52%, as assessed by CT-scan (n=12) or X-thorax (n=3). A larger CTV was associated with poorer local control. Kaplan-Meier estimated 1- and 2-year survival rates were 59% and 43%, respectively.
  
  
  CONCLUSIONS
  Reirradiation with SBRT is feasible although increased risk of toxicity was reported in centrally located tumours. Further research is warranted for more accurate selection of patients suitable for reirradiation with SBRT.
authors: Department of Radiation Oncology, MAASTRO Clinic, Maastricht, The Netherlands.
authors: Heike
authors: H
authors: Peulen
authors: Kristin
authors: K
authors: Karlsson
authors: Karin
authors: K
authors: Lindberg
authors: Owe
authors: O
authors: Tullgren
authors: Pia
authors: P
authors: Baumann
authors: Ingmar
authors: I
authors: Lax
authors: Rolf
authors: R
authors: Lewensohn
authors: Peter
authors: P
authors: Wersäll
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011013:Pneumonectomy; D016634:Radiosurgery / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D019233:Retreatment; D012189:Retrospective Studies; D015996:Survival Rate