Abstract
Purpose
The optimal treatment for hilar or mediastinal lymph node (LN) recurrence developing after stereotactic body radiotherapy (SBRT) for stage I non-small cell lung cancer remains unclear. This study evaluated 5-year results of radiotherapy in such patients in comparison with those for postoperative LN metastases.
Materials and methods
Between 2004 and 2013, 27 patients with hilar and/or mediastinal LN metastases without local recurrence and distant metastasis after SBRT (n = 14) or surgery (n = 13) were treated with definitive conventional radiotherapy. The median total dose for treating metastatic LN was 60 Gy for the post-SBRT group and 66 Gy for the post-surgery group.
Results
The median follow-up for the 5 surviving patients was 62 months. The overall survival, cause-specific survival, progression-free survival, and local control rates at 5 years after mediastinal irradiation were 14%, 45%, 21%, and 58%, respectively, for the 14 patients in the post-SBRT group. These rates were 36%, 45%, 39%, and 92%, respectively for the post-surgery group (p = 0.066, 0.64, 0.38, and 0.41, respectively). Four patients in the post-SBRT group survived 3 or more years (range 36–92 months) after mediastinal irradiation.
Conclusions
A proportion of patients in both groups achieved long-term survival by conventional radiotherapy.
Similar content being viewed by others
References
Chang JY, Senan S, Paul MA, Mehran RJ, Louie AV, Balter P, et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol. 2015;16:630–7.
Iwata H, Demizu Y, Fujii O, Terashima K, Mima M, Niwa Y, et al. Long-term outcome of proton therapy and carbon-ion therapy for large (T2a–T2bN0M0) non-small-cell lung cancer. J Thorac Oncol. 2013;8:726–35.
Nagata Y, Hiraoka M, Shibata T, Onishi H, Kokubo M, Karasawa K, et al. Prospective trial of stereotactic body radiation therapy for both operable and inoperable T1N0M0 non-small cell lung cancer: Japan Clinical Oncology Group Study JCOG0403. Int J Radiat Oncol Biol Phys. 2015;93:989–96.
Shibamoto Y, Hashizume C, Baba F, Ayakawa S, Miyakawa A, Murai T, et al. Stereotactic body radiotherapy using a radiobiology-based regimen for stage I non-small-cell lung cancer: five-year mature results. J Thorac Oncol. 2015;10:960–4.
Wink KCJ, van Baardwijk A, Troost EGC, De Ruysscher D. Nodal recurrence after stereotactic body radiotherapy for early stage non-small cell lung cancer: incidence and proposed risk factors. Cancer Treat Rev. 2017;56:8–15.
Manabe Y, Shibamoto Y, Baba F, Murata R, Yanagi T, Hashizume C, et al. Radiotherapy for hilar or mediastinal lymph node metastases after definitive treatment with stereotactic body radiotherapy or surgery for stage I non-small cell lung cancer. Pract Radiat Oncol. 2012;2:e137–43.
Hayashi K, Yamamoto N, Karube M, Nakajima M, Tsuji H, Ogawa K, et al. Feasibility of carbon-ion radiotherapy for re-irradiation of locoregionally recurrent, metastatic, or secondary lung tumors. Cancer Sci. 2018;109:1562–9.
McAvoy SA, Ciura KT, Rineer JM, Allen PK, Liao Z, Chang JY, et al. Feasibility of proton beam therapy for reirradiation of locoregionally recurrent non-small cell lung cancer. Radiother Oncol. 2013;109:38–44.
Ward MC, Oh SC, Pham YD, Woody NM, Marwaha G, Videtic GM, et al. Isolated nodal failure after stereotactic body radiotherapy for lung cancer: the role for Salvage mediastinal radiotherapy. J Thorac Oncol. 2016;11:1558–64.
Baba F, Shibamoto Y, Tomita N, Ikeya-Hashizume C, Oda K, Ayakawa S, et al. Stereotactic body radiotherapy for stage I lung cancer and small lung metastasis: evaluation of an immobilization system for suppression of respiratory tumor movement and preliminary results. Radiat Oncol. 2009;4:15.
Rulach R, Hanna GG, Franks K, McAleese J, Harrow S. Re-irradiation for locally recurrent lung cancer: evidence, risks and benefits. Clin Oncol (R Coll Radiol). 2018;30:101–09.
Nguyen QN, Ly NB, Komaki R, Levy LB, Gomez DR, Chang JY, et al. Long-term outcomes after proton therapy, with concurrent chemotherapy, for stage II–III inoperable non-small cell lung cancer. Radiother Oncol. 2015;115:367–72.
Ono T, Nakamura T, Yamaguchi H, Azami Y, Takayama K, Suzuki M, et al. Clinical results of proton beam therapy for elderly patients with non-small cell lung cancer. Radiat Oncol. 2018;13:19.
Okami J, Nishiyama K, Fujiwara A, Konishi K, Kanou T, Tokunaga T, et al. Radiotherapy for postoperative thoracic lymph node recurrence of non-small-cell lung cancer provides better outcomes if the disease is asymptomatic and a single-station involvement. J Thorac Oncol. 2013;8:1417–24.
Kim E, Song C, Kim MY, Kim JS. Long-term outcomes after salvage radiotherapy for postoperative locoregionally recurrent non-small-cell lung cancer. Radiat Oncol J. 2017;35:55–64.
Seol KH, Lee JE, Cho JY, Lee DH, Seok Y, Kang MK. Salvage radiotherapy for regional lymph node oligo-recurrence after radical surgery of non-small cell lung cancer. Thorac Cancer. 2017;8:620–29.
Maemondo M, Inoue A, Kobayashi K, Sugawara S, Oizumi S, Isobe H, et al. Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR. N Engl J Med. 2010;362:2380–8.
Solomon BJ, Mok T, Kim DW, Wu YL, Nakagawa K, Mekhail T, et al. First-line crizotinib versus chemotherapy in ALK-positive lung cancer. N Engl J Med. 2014;371:2167–77.
Brahmer J, Reckamp KL, Baas P, Crino L, Eberhardt WE, Poddubskaya E, et al. Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med. 2015;373:123–35.
Goto K, Endo M, Kusumoto M, Yamamoto N, Ohe Y, Shimizu A, et al. Bevacizumab for non-small-cell lung cancer: A nested case control study of risk factors for hemoptysis. Cancer Sci. 2016;107:1837–42.
Pollom EL, Deng L, Pai RK, Brown JM, Giaccia A, Loo BW Jr, et al. Gastrointestinal toxicities with combined antiangiogenic and stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys. 2015;92:568–76.
Acknowledgements
A part of this work was presented at the ASTRO’s 59th Annual Meeting, San Diego, September 24–27, 2017. We thank all staffs of the radiation oncology section.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None declared.
Ethical standards
All procedures performed in studies involving human participants were carried out in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.
About this article
Cite this article
Manabe, Y., Shibamoto, Y., Baba, F. et al. Definitive radiotherapy for hilar and/or mediastinal lymph node metastases after stereotactic body radiotherapy or surgery for stage I non-small cell lung cancer: 5-year results. Jpn J Radiol 36, 719–725 (2018). https://doi.org/10.1007/s11604-018-0776-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11604-018-0776-6