Accelerated radiotherapy and concurrent chemotherapy for patients with contralateral central or mediastinal lung cancer relapse after pneumonectomy.
BACKGROUND
Treatment options are very limited for patients with lung cancer who experience contralateral central or mediastinal relapse following pneumonectomy. We present results of an accelerated salvage chemoradiotherapy regimen.


METHODS
Patients with localized contralateral central intrapulmonary or mediastinal relapse after pneumonectomy were offered combined chemoradiotherapy including concurrent weekly cisplatin (25 mg/m(2)) and accelerated radiotherapy [accelerated fractionated (AF), 60 Gy, 8×2 Gy per week] to reduce time for repopulation. Based on 4D-CT-planning, patients were irradiated using multifield intensity-modulated radiotherapy (IMRT) or helical tomotherapy.


RESULTS
Between 10/2011 and 12/2012, seven patients were treated. Initial stages were IIB/IIIA/IIIB: 3/1/3; histopathological subtypes scc/adeno/large cell: 4/1/2. Tumour relapses were located in mediastinal nodal stations in five patients with endobronchial tumour in three patients. The remaining patients had contralateral central tumour relapses. All patients received 60 Gy (AF), six patients received concurrent chemotherapy. Median dose to the remaining contralateral lung, esophagus, and spinal cord was 6.8 (3.3-11.4), 8.0 (5.1-15.5), and 7.6 (2.8-31.2) Gy, respectively. With a median follow-up of 29 [17-32] months, no esophageal or pulmonary toxicity exceeding grade 2 [Common terminology criteria for adverse events (CTC-AE) v. 3] was observed. Median survival was 17.2 months, local in-field control at 12 months 80%. Only two local recurrences were observed, both in combination with out-field metastases.


CONCLUSIONS
This intensified accelerated chemoradiotherapy schedule was safely applicable and offers a curative chance in these pretreated frail lung cancer patients.
1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany.
Christoph
C
Pöttgen
1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany.
Jehad
J
Abu Jawad
1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany.
Eleni
E
Gkika
1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany.
Lutz
L
Freitag
1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany.
Wolfgang
W
Lübcke
1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany.
Stefan
S
Welter
1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany.
Thomas
T
Gauler
1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany.
Martin
M
Schuler
1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany.
Wilfried Ernst Erich
WE
Eberhardt
1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany.
Georgios
G
Stamatis
1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany.
Martin
M
Stuschke
Post-pneumonectomy; accelerated radiotherapy; salvage