title: Salvage stereotactic ablative irradiation for isolated postsurgical local recurrence of lung cancer.
abstract: BACKGROUND
  For isolated postsurgical local recurrences (IPSLR) of lung cancer, salvage resection is often unfeasible due to a high risk of morbidity and death. Stereotactic ablative body radiotherapy (SABR) provides excellent therapeutic effects, with mild toxicities, for patients with medically inoperable lung cancer. However, the outcomes of SABR for IPSLR have not been reported.
  
  
  METHODS
  Patients with IPSLR who were treated with SABR between 2005 and 2012 were retrospectively identified. The prescribed doses were 40 to 60 Gy per 5 to 10 fractions. Treatment outcomes and toxicities were evaluated.
  
  
  RESULTS
  We identified 23 patients with IPSLR, including 21 with bronchial stump or staple line recurrences and 2 with chest wall recurrences. During follow-up, IPSLR occurred at a median of 36.7 months (range, 5.0 to 190 months) after resection. All patients were N0 M0, and the T stages at recurrence were T1a, T1b, T2a, and T4 in 6, 5, 3, and 9 patients, respectively. The initial pathologic diagnoses were adenocarcinoma in 17 patients and squamous cell carcinoma in 6. At a median follow-up duration of 17.0 months (range, 6.0 to 89.6 months) after SABR, there were 2 local recurrences. Local control and overall survival rates at 1 and 2 years were 94.7% and 86.8% and 84.0% and 76.4%, respectively. Grade 3 to 5 radiation pneumonitis occurred in 1 patient each. Grade 3 temporary but repeated obstructive pneumonia occurred in 2 patients.
  
  
  CONCLUSIONS
  SABR for IPSLR achieved high local control with limited toxicities. SABR may lead to a potential cure and should be considered as a salvage treatment option for IPSLR.
authors.affiliation: Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan.
authors.forename: Atsuya
authors.initials: A
authors.lastname: Takeda
authors.forename: Naoko
authors.initials: N
authors.lastname: Sanuki
authors.forename: Takahisa
authors.initials: T
authors.lastname: Eriguchi
authors.forename: Tatsuji
authors.initials: T
authors.lastname: Enomoto
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yokosuka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kaneko
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Handa
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Aoki
authors.forename: Yohei
authors.initials: Y
authors.lastname: Oku
authors.forename: Etsuo
authors.initials: E
authors.lastname: Kunieda
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D016634:Radiosurgery; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*
keywords: 10