Journal List > J Lung Cancer > v.10(1) > 1050627

Kim, Kim, and Lee: Radiotherapy for Locoregional Recurrent Non-Small Cell Lung Cancer

Abstract

Purpose:

To retrospectively evaluate the outcomes and complications of curative radiotherapy for locoregionally recurrent non-small cell lung cancer (NSCLC). Materials and Methods: From 2004 to 2008, 21 patients received curative radiotherapy for locoregionally recurrent NSCLC without systemic metastasis after surgery. At the time of recurrence, the median age was 70 years (range 49∼81 years), and 19 patients were male. Most patients (n=17) were ECOG 0 or 1 performance status. The median disease-free interval was 15 months. Distribution of recurrence sites were mediastinal lymph nodes (n=10), ipsilateral hilar lymph nodes (n=4), ipsilateral lung parenchyma (n=4), bronchial stump (n=2) and ipsilateral supraclavicular lymph nodes (n=1). Radiotherapy was administered (median 66 Gy, range 59.4∼70 Gy) by a three-dimensional conformal technique. Thirteen patients received chemotherapy concurrently during radiotherapy. Pulmonary function test (PFT) was also used to detect lung function change before and after radiation.

Results:

The median survival and 1- and 2-year survival rates were 17 months, 68% and 34%, respectively. Concurrent chemotherapy did not affect post- recurrence overall survival (p=0.183). Seven patients (33% of all patients) had re-progression within the radiation field at a median time of 4 months after completion of radiation. Diffusing lung capacity for carbon monoxide of lung after radiotherapy decreased significantly compared with pre-radiotherapy status (p=0.033). Radiation pneumonitis of any grade was seen in 11 patients. Three patients died of pulmonary complications: one of bacterial pneumonia, one of exacerbation of underlying interstitial pulmonary fibrosis and one of radiation pneumonitis.

Conclusion:

This retrospective study showed that curative radiotherapy for locoregionally recurrent NSCLC resulted in a median survival of 17 months and a 2-year survival rate of 34%, which is comparable to other studies. Patients suitable for curative radiotherapy for recurrent NSCLC could be treated aggressively, such as using high dose radiation with or without chemotherapy. However, pre-radiotherapy lung function should be carefully evaluated to avoid serious post-treatment lung damage considering poor lung function of postresection patients.

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Fig. 1.
Overall survival rate.
jlc-10-37f1.tif
Fig. 2.
Overall survival rate according to the use of chemotherapy. CCRT: concurrent chemoradiotherapy.
jlc-10-37f2.tif
Table 1.
Characteristics of the Patients
Variables Patients
Age, yr 70 (49∼81)
Gender  
Male 19 (91)
Female 2 (9)
Histology  
Squamous cell carcinoma 11 (54)
Adenocarcinoma 5 (23)
Other 5 (23)
Performance status  
ECOG 0∼1 17 (82)
ECOG 2 4 (18)
Disease free interval, mo 15
≥15 10 (45)
<15 11 (55)
Recurrence site  
Mediastinal lymph node 10 (45)
Hilar lymph node 4 (18)
Lung parenchyma 4 (18)
Bronchial stump 2 (9)
Supraclavicular lymph node 1 (5)
Initial stage  
I 8 (38)
II 4 (19)
IIIA 5 (24)
IIIB 4 (19)
Recurrence stage  
I 4 (18)
II 6 (28)
IIIA 9 (45)
IIIB 2 (9)

Values are presented as number (%) unless otherwise indicat-ed.

Median age (range)

Mean months. ECOG: Eastern Cooperative Oncology Group.

Table 2.
Analysis of Prognostic Factors
Factor p-value p-value
Age, yr (<70 vs. ≥70) 0.406 0.727
Stages on recurrence (III vs. I∼ II) 0.291 0.060
DFI, mo (<15 vs. ≥15) 0.556 0.195
Concurrent chemoradiotherapy or not 0.183 0.956
Radiation dose (<66 Gy or ≥66 Gy) 0.698 0.058

Univariate analysis by log-rank test

Multivariate analysis by Cox regression model.

Table 3.
Changes in Lung Function
FEV1 DLCO
Mean value p-value Mean value p-value
Pre-Op 2.41   17.64  
Pre-RT 1.893 }0.312 14.529 }0.033
Post-RT 1.821 12.524

Baseline pulmonary function test before initial operation.

FEV1: forced expiratory volume in one second, DLCO: diffusing lung capacity for carbon monoxide.

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