title: Local failure after primary radiotherapy in lung cancer: Is there a role for SBRT?
abstract: OBJECTIVE
  Our purpose is to construe the role of stereotactic body radiation therapy (SBRT) in the management of lung cancer from our early experience with SBRT for salvage treatment in patients with recurrent lung cancer after initial radiation therapy.
  
  
  BACKGROUND
  Locoregional recurrences are a frequent challenge in patients treated with radio-chemotherapy for locally advanced NSCLC. Conventional external beam radiation therapy (EBRT) is rarely given as salvage treatment because of the risk of toxicity. There is a paucity of published studies evaluating the role of SBRT in this clinical setting.
  
  
  METHODS
  Between 2008 and present, 10 patients with biopsy proven non-small cell lung cancer (NSCLC) underwent 14 radiosurgical procedures for salvage therapy after failing initial radiation treatment. Patients' age ranged from 54 to 88 years with a median of 74 years in 6 males and 4 females. Intervals from initial radiation treatment to salvage SBRT were 3-33 months with a median of 13 months. SBRT treatments were delivered using Intensity Modulated Volumetric Arc Therapy (VMAT). All patients received concomitant chemotherapy.
  
  
  RESULTS
  Overall survival after salvage radiosurgery ranged from 6 to 41 months (mean 20 months, median 18 months). Four of the ten patients are alive with disease locally controlled. Of the remaining 6 patients, 4 had distant progression of disease with brain metastases and one had both brain and lung metastases. The other patient had a regional failure. Toxicities were found in three of the ten (30%) patients with grade I pneumonitis.
  
  
  CONCLUSIONS
  In our early experience, salvage SBRT is an effective modality of treating patients who failed after conventional irradiation, achieving excellent results in terms of local control with acceptable toxicity. Further prospective studies are needed to determine optimal fractionation schemes.
authors.affiliation: Innovative Cancer Institute of South Florida, 6141 Sunset Drive, Suite 102, South Miami, FL 33143, United States.
authors.forename: Beatriz E
authors.initials: BE
authors.lastname: Amendola
authors.affiliation: Innovative Cancer Institute of South Florida, 6141 Sunset Drive, Suite 102, South Miami, FL 33143, United States.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Amendola
authors.affiliation: Innovative Cancer Institute of South Florida, 6141 Sunset Drive, Suite 102, South Miami, FL 33143, United States.
authors.forename: Naipy
authors.initials: N
authors.lastname: Perez
authors.affiliation: Innovative Cancer Institute of South Florida, 6141 Sunset Drive, Suite 102, South Miami, FL 33143, United States.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Wu
authors.affiliation: Innovative Cancer Institute of South Florida, 6141 Sunset Drive, Suite 102, South Miami, FL 33143, United States.
authors.forename: Jesús Blanco
authors.initials: JB
authors.lastname: Suarez
keywords: Lung cancer; Radiation therapy; Radiosurgery; SBRT; Salvage