title: Stereotactic body radiotherapy for re-irradiation of lung cancer recurrence with lower biological effective doses.
abstract: OBJECTIVE
  Few studies have evaluated re-irradiation of lung cancer recurrences with stereotactic body radiotherapy (SBRT). This study evaluates outcomes with SBRT re-irradiation for recurrent lung cancer.
  
  
  METHODS
  Two hundred and seventy-eight patients treated with SBRT for lung cancer were retrospectively reviewed. Of those, 26 patients with 29 tumors were re-irradiated with SBRT. Ninety percent of tumors received prior external beam irradiation and 10 % received prior SBRT. Previous median radiation dose was 61.2 Gy with a median 8-month interval from previous radiation. The median re-irradiation SBRT dose was 30 Gy (48 Gy10biological effective dose (BED)). Endpoints evaluated included local control, overall survival, and progression-free survival.
  
  
  RESULTS
  Twenty-five of 29 tumors were evaluable for local control, with 27 tumors (93 %) considered in-field recurrences. In-field crude local control rate was 80 % (20/25) with 1 and 2-year actuarial rates of 78.6 and 65.5 %, respectively. One and 2-year actuarial survival rates were 52.3 and 37.0 %, respectively. One and 2-year actuarial progression-free survival rates were 56.7 and 37.0 %, respectively. Fifty-five percent of patients reported acute/chronic grades 1 and 2 toxicities. No grade 3 or higher toxicities were reported.
  
  
  CONCLUSIONS
  Patients with recurrent lung cancer have limited options. SBRT re-irradiation is tolerable even after a median 61.2 Gy to the re-irradiation site. The lower BED used provided acceptable progression-free survival with low toxicity. Given the poor prognosis with current treatment options, new paradigms for re-treatment should include SBRT-re-irradiation as an adjunct to systemic therapy for in-field lung cancer recurrence.
authors.affiliation: Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA.
authors.forename: Nisha R
authors.initials: NR
authors.lastname: Patel
authors.affiliation: Department of Radiation Oncology, Delaware County Memorial Hospital, Philadelphia CyberKnife Center, Havertown, PA USA ; Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Lanciano
authors.affiliation: Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA.
authors.forename: Karna
authors.initials: K
authors.lastname: Sura
authors.affiliation: Department of Radiation Oncology, Delaware County Memorial Hospital, Philadelphia CyberKnife Center, Havertown, PA USA ; Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Radiation Oncology, Delaware County Memorial Hospital, Philadelphia CyberKnife Center, Havertown, PA USA ; Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA.
authors.forename: John
authors.initials: J
authors.lastname: Lamond
authors.affiliation: Department of Radiation Oncology, Delaware County Memorial Hospital, Philadelphia CyberKnife Center, Havertown, PA USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Feng
authors.affiliation: Department of Radiation Oncology, Delaware County Memorial Hospital, Philadelphia CyberKnife Center, Havertown, PA USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Good
authors.affiliation: Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA.
authors.forename: Ed J
authors.initials: EJ
authors.lastname: Gracely
authors.affiliation: Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA.
authors.forename: Lydia
authors.initials: L
authors.lastname: Komarnicky
authors.affiliation: Department of Radiation Oncology, Delaware County Memorial Hospital, Philadelphia CyberKnife Center, Havertown, PA USA ; Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA USA.
authors.forename: Luther
authors.initials: L
authors.lastname: Brady
keywords: Lung cancer; Radiation; Re-irradiation; Recurrence; SBRT