1. Salvage radiotherapy with simultaneous integrated boost in non small-cell lung cancer patients with mediastinal relapse after surgery: a pilot study
- Author
-
Giuseppe Minniti, Linda Agolli, Luca Marinelli, Maurizio Valeriani, J. Di Muzio, Mattia Falchetto Osti, Chiara Reverberi, V. De Sanctis, and Luca Nicosia
- Subjects
0301 basic medicine ,Male ,Lung Neoplasms ,medicine.medical_treatment ,Pilot Projects ,0302 clinical medicine ,Carcinoma, Non-Small-Cell Lung ,Intensity modulated radiotherapy with simultaneous integrated boost ,Lymph node ,Middle Aged ,Prognosis ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Survival Rate ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,Mediastinal recurrent NSCLC ,Female ,Simultaneous integrated boost ,lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,lcsh:R895-920 ,Adenocarcinoma ,Mediastinal Neoplasms ,lcsh:RC254-282 ,03 medical and health sciences ,Post-surgical relapse ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Lung cancer ,Pneumonitis ,Aged ,Retrospective Studies ,Salvage Therapy ,business.industry ,Research ,medicine.disease ,Surgery ,Radiation therapy ,Salvage radiotherapy ,030104 developmental biology ,Concomitant ,Radiotherapy, Intensity-Modulated ,Neoplasm Recurrence, Local ,business ,Esophagitis ,Follow-Up Studies - Abstract
Background The aim of our study was to evaluate feasibility, toxicity profile and local control of salvage intensity modulated radiotherapy (IMRT) delivered with simultaneous integrated boost (SIB) associated or not to concomitant weekly cisplatin in patients affected by NSCLC with mediastinal nodal recurrence after surgery. Patterns of recurrence, outcomes and prognostic factors were assessed. Methods Fourteen consecutive patients received 25 fractions of 50Gy/2Gy to the elective nodal stations and boost up to 62.5Gy/2.5Gy to the macroscopic lymph node metastases. Concomitant weekly cisplatin (40 mg/m2) was administered to 8 (57.1%) patients. Results Five (35.7%) patients experienced grade 2 pneumonitis and 5 (35.7%) patients had grade 2 esophagitis. One case of grade 3 pneumonitis occurred and was successfully treated with antibiotics and steroids with no sequelae. No patient recurred locally in the boost volume (local control 100%). Loco-regional control was 79% with 3 patients that developed nodal recurrence principally marginal to the elective volume. Seven patients developed distant metastases. Median PFS was 7 months. The nodal involvement of station 7 was associated to a significantly lower median metastasis-free survival (4 months vs. not reached, p = 0.036). Conclusions Salvage radiotherapy with IMRT-SIB is a feasible and a well-tolerated treatment option for mediastinal recurrent NSCLC after surgery. The role of more intensified radiation regimens and association to systemic therapy remain to be evaluated in larger cohorts.
- Published
- 2018