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Re-irradiation in locally recurrent lung cancer patients

Rebestrahlung bei Lokalrezidiven von Lungenkarzinomen

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Abstract

Purpose

Lung cancer remains one of the tumour diagnoses with high lethality, although innovative treatment approaches have yielded improvements in local control and survival rates. There is still no consensus on how to treat local relapse in patients after first-line treatments. Radiotherapy may be considered in this situation; however, data supporting its effectiveness are rare. The purpose of this retrospective analysis was to evaluate outcomes of patients re-irradiated for thoracic tumours in terms of overall survival (OS), local progression-free survival (LPFS), toxicity and dose–volume parameters.

Patients and methods

Sixty-two patients with locally recurrent previously irradiated lung cancer were analysed retrospectively (NSCLC n = 52, SCLC n = 10). Target volumes both in lung and mediastinum were re-irradiated with conventional three-dimensional or intensity-modulated radiotherapy techniques. Median overall dose of re-irradiation was 38.5 Gy (range 20–60 Gy) with a median single dose per fraction of 2 Gy (1.8–3.0 Gy). Clinical documents and treatment plans were evaluated.

Results

Median follow-up was 8.2 months (range 0–27 months). OS following re-irradiation was 9.3 months (range: 0–27 months) and LPFS was 6.5 months (range: 0–24 months). OS and LPFS were not affected by histology, total dose or patient age and gender. OS was improved in patients whose re-irradiation volumes included less than two mediastinal lymph node stations (p = 0.016). Twelve patients suffered from pneumonitis ≥grade II (19%) and two from pneumonitis grade III. One patient presumably died from pneumonitis grade V. A slight decline in forced expiratory volume (FEV1) was detected in post-re-irradiation lung function testing.

Conclusions

Re-irradiation is an option for patients with tumour recurrence to control local progression and lower the symptom burden. Oncological outcome appears to be affected by size, location of mediastinal target volumes and lung function. Prospective clinical trials are warranted to substantiate the role of re-irradiation in recurrent lung cancer.

Zusammenfassung

Hintergrund

Lungenkarzinome bleiben eine der letalsten Tumorerkrankungen und innovative Behandlungsansätze haben nur zu geringfügigen Verbesserungen der lokalen Kontroll- und Überlebensraten geführt. Es gibt keinen Konsens darüber, wie Lokalrezidive zu behandeln sind. In dieser Situation kann eine Rebestrahlung in Erwägung gezogen werden. Daten zur Effektivität der Strahlentherapie bei Rezidiven sind jedoch selten. Diese retrospektive Analyse untersucht Ergebnisse nach Rebestrahlung von Lungenkarzinomen hinsichtlich Gesamtüberleben (OS), lokalrezidivfreiem Überleben (LPFS), Toxizität und Dosis-Volumen-Parametern.

Patienten und Methoden

Insgesamt wurden 62 Patienten mit Lokalrezidiven von Lungenkarzinomen (NSCLC n = 52, SCLC n = 10) retrospektiv untersucht. Die mediane Nachbeobachtungszeit betrug 8,2 Monate (Spanne 0–27 Monate). Zielvolumina sowohl in der Lunge als auch im Mediastinum wurden mit dreidimensionaler oder intensitätsmodulierter Technik erneut bestrahlt. Die mediane Gesamtdosis der Rebestrahlung betrug 38,5 Gy (Spanne 20–60 Gy) mit einer mittleren Einzeldosis von 2 Gy (Spanne 1,8–3,0 Gy). Klinische Dokumente und Behandlungspläne wurden ausgewertet.

Ergebnisse

Das mediane Follow-up war 8,2 Monate (Spanne 0–27 Monate). Das mediane OS nach Rebestrahlung betrug 9,3 Monate (Spanne 0–27 Monate) und das mediane LPFS war 6,5 Monate (Spanne 0–24 Monate). OS und LPFS wurden nicht durch Histologie, Gesamtdosis oder Alter und Geschlecht des Patienten beeinflusst. Das OS war bei Patienten besser, deren Rebestrahlungsvolumen weniger als 2 mediastinale Lymphknotenstationen umfasste (p = 0,016). Zwölf Patienten erlitten eine Pneumonitis ≥Grad II (19 %) und zwei eine Pneumonitis Grad III. Ein Patient starb an einer Pneumonitis Grad V. Ein leichter Abfall der Einsekundenkapazität (FEV1) wurde bei Lungenfunktionstests nach der Rebestrahlung festgestellt.

Schlussfolgerung

Die Rebestrahlung ist eine Möglichkeit für Patienten mit Tumorrezidiven, um die lokale Progression zu kontrollieren und die Symptombelastung zu verringern. Das onkologische Ergebnis scheint durch Größe, Lokalisation mediastinaler Zielvolumina und Lungenfunktion beeinflusst zu sein. Prospektive klinische Studien sind gerechtfertigt, um die Rolle der Rebestrahlung bei rezidivierten Lungentumoren zu belegen.

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Acknowledgements

We thank Samuel Macrom for proofreading the manuscript.

Author information

Authors and Affiliations

  1. University Hospital of Heidelberg, Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Ingmar Schlampp, Juliane Rieber, Sebastian Adeberg, Thomas Welzel, Jürgen Debus & Stefan Rieken

  2. HIRO – Heidelberger Institut für RadioOnkologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Ingmar Schlampp, Juliane Rieber, Sebastian Adeberg, Thomas Welzel, Jürgen Debus & Stefan Rieken

  3. National Center for Tumor diseases (NCT), Heidelberg, Germany

    Ingmar Schlampp, Juliane Rieber, Sebastian Adeberg, Thomas Welzel, Jürgen Debus & Stefan Rieken

  4. Department of Thoracic Oncology, Thoraxlinik, Translational Lung Research Centre Heidelberg (TLRC-H), Heidelberg University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Farastuk Bozorgmehr, Martin Steins & Jutta Kappes

  5. Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany

    Farastuk Bozorgmehr, Claus Peter Heußel, Martin Steins & Jutta Kappes

  6. Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany

    Claus Peter Heußel

  7. Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany

    Claus Peter Heußel

  8. Department of Pneumology, Thoraxklinik, Heidelberg University, Heidelberg, Germany

    Jutta Kappes

  9. Dept. of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany

    Hans Hoffmann

Authors
  1. Ingmar Schlampp
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Contributions

I. Schlampp and S. Rieken developed and planned the retrospective analysis. I. Schlampp and S. Rieken are responsible for statistical considerations/basis of the analysis and made the data collection. J. Rieber, and S. Adeberg were responsible for the radiation treatment and patient care. F. Bozorgmehr, C.P. Heußel, M. Steins, J. Kappes and H. Hoffmann were responsible for patient selection, interdisciplinary decision making and follow-up examinations. T. Welzel performed the treatment planning CT examinations. J. Debus supervised the treatment and approved the study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ingmar Schlampp.

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Conflict of interest

C.P. Heußel is a stock owner of Stada and GSK and has received consultation and lecture fees and/or honoraria from Schering-Plough, Pfizer, Basilea, Boehringer Ingelheim, Novartis, Roche, Astellas, Gilead, MSD, Lilly, Intermune, Fresenius, Olympus, Essex, AstraZeneca, Bracco, MEDA Pharma, Chiesi, Siemens, Covidien, Pierre Fabre, Grifols and Bayer and research funding from Siemens, Pfizer, MeVis and Boehringer Ingelheim. I. Schlampp, J. Rieber, S. Adeberg, F. Bozorgmehr, M. Steins, J. Kappes, H. Hoffmann, T. Welzel, J. Debus and S. Rieken declare that they have no competing interests.

Ethical standards

All patients provided written informed consent after thorough information about treatment concepts and possible side effects. The responsible ethics committee approved the analysis.

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Schlampp, I., Rieber, J., Adeberg, S. et al. Re-irradiation in locally recurrent lung cancer patients. Strahlenther Onkol 195, 725–733 (2019). https://doi.org/10.1007/s00066-019-01457-2

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  • DOI: https://doi.org/10.1007/s00066-019-01457-2

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