title: Repeat stereotactic body radiation therapy for patients with pulmonary malignancies who had previously received SBRT to the same or an adjacent tumor site.
abstract: OBJECTIVE
  Retrospective analysis of patients with recurrences at or closely adjacent to the site of prior lung stereotactic body radiation therapy (SBRT) who received repeat SBRT.
  
  
  METHODS
  Nine patients with non-small cell lung cancer (n = 8) or oligometastatic colonic adenocarcinoma (n = 1) were treated with image-guided lung SBRT to a median of 60 Gy (range, 30-60) in a median of 3 fractions (3-5). Patients developed in-field relapse (n = 3) or recurrence adjacent (≤ 3.5 cm away) to the previous tumor location (n = 6) and received 2 nd lung SBRT to a median of 60 Gy.
  
  
  RESULTS
  Median follow-up after 2 nd SBRT was 22 months (4-40). All completed prescribed course of repeat SBRT and acute toxicity was limited. There was no grade >3 late toxicity. 3 (33.3%) patients developed Grade 3 late reactions: 2 pulmonary and 1 chest wall pain. Late pulmonary toxicity included 2 (22.2%) patients with Grade 3 and 3 (33.3%) with Grade 2. One patient (11.1%) had late Grade 3 and 1 (11.1%) Grade 2 chest wall pain. 1 (11.1%) developed Grade 2 late brachial plexopathy. No myelopathy was observed. Two patients developed progression of tumors treated by 2 nd SBRT. Local recurrence free survival and overall survival was 75% and 68.6%, respectively at 2 years. Relative volume of ipsilateral lung receiving 5 Gy (V5) and V10 were lower for 2 nd SBRT.
  
  
  CONCLUSIONS
  Repeat image-guided SBRT for patients with small peripheral recurrences was feasible and severe toxicity was not observed. Additional studies are needed to evaluate the safety and efficacy of lung reirradiation using 2 nd SBRT.
authors: Temple University School of Medicine, Department of Radiation Oncology. Philadelphia, PA, USA.
authors: Vladimir
authors: V
authors: Valakh
authors: Curtis
authors: C
authors: Miyamoto
authors: Bizhan
authors: B
authors: Micaily
authors: Philip
authors: P
authors: Chan
authors: Toni
authors: T
authors: Neicu
authors: Shidong
authors: S
authors: Li
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D003110:Colonic Neoplasms / Q000532:radiotherapy; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000532:radiotherapy*; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods; D061089:Radiotherapy, Image-Guided; D012189:Retrospective Studies; D016896:Treatment Outcome