title: Stereotactic body radiation therapy for re-irradiation of persistent or recurrent non-small cell lung cancer.
abstract: OBJECTIVE
  To retrospectively assess toxicity and outcome of re-irradiation with stereotactic body radiation therapy (SBRT) in patients with recurrent or persistent non-small cell lung cancer (NSCLC), who were previously treated with radical radiation therapy (50-60 Gy). The secondary endpoint was to investigate whether there are dosimetric parameter predictors of severe radiation toxicity.
  
  
  METHODS
  The analysis was conducted in 17 patients with "in-field" recurrent/persistent centrally located NSCLC, who underwent re-irradiation with SBRT. SBRT consisted of 30 Gy in 5 to 6 fractions; these prescriptions would be equivalent for the tumor to 37.5 to 40 Gy, bringing the total 2-Gy-per-fraction cumulative dose to 87 to 100 Gy, considering the primary radiation therapy treatment. Actuarial analyses and survival were calculated by the Kaplan-Meier method, and P values were estimated by the log-rank test, starting from the date of completion of SBRT. Dosimetric parameters from the subgroups with and without grade ≥3 pulmonary toxicity were compared using a 2-tailed Student t test.
  
  
  RESULTS
  The median follow-up was 18 months (range, 4-57 months). Only 2 patients had local failure, corresponding to a local control rate of 86% at 1 year. The Kaplan-Meier estimates of overall survival (OS) rates at 1 and 2 years were 59% and 29%, respectively; the median OS was 19 months. Four patients (23%) experienced grade 3 radiation pneumonitis, and 1 patient developed fatal pneumonitis. One patient died of fatal hemoptysis 2 months after the completion of SBRT. Unexpectedly, heart maximum dose, D5 (minimum dose to at least 5% of the heart volume), and D10 were correlated with risk of radiation pneumonitis (P<.05).
  
  
  CONCLUSIONS
  Re-irradiation with SBRT for recurrent/persistent centrally located NSCLC achieves excellent results in terms of local control. However, the high rate of severe toxicity reported in our study is of concern.
authors.affiliation: Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone, Italy. Electronic address: marcotrovo33@hotmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Trovo
authors.affiliation: Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Minatel
authors.affiliation: Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Durofil
authors.affiliation: Department of Epidemiology and Biostatistics, Centro di Riferimento Oncologico of Aviano, Pordenone, Italy.
authors.forename: Jerry
authors.initials: J
authors.lastname: Polesel
authors.affiliation: Department of Medical Physics, Centro di Riferimento Oncologico of Aviano, Pordenone, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Avanzo
authors.affiliation: Department of Nuclear Medicine, Centro di Riferimento Oncologico of Aviano, Pordenone, Italy.
authors.forename: Tania
authors.initials: T
authors.lastname: Baresic
authors.affiliation: Department of Medical Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bearz
authors.affiliation: Department of Medical Oncology, Pordenone General Hospital, Aviano, Pordenone, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Conte
authors.affiliation: Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Franchin
authors.affiliation: Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Gobitti
authors.affiliation: Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone, Italy.
authors.forename: Imad Abu
authors.initials: IA
authors.lastname: Rumeileh
authors.affiliation: Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone, Italy.
authors.forename: Mauro G
authors.initials: MG
authors.lastname: Trovo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D049268:Positron-Emission Tomography; D011832:Radiation Injuries / Q000209:etiology; D017564:Radiation Pneumonitis / Q000209:etiology; D011874:Radiometry / Q000379:methods; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome