Long-Term Outcomes of Salvage Stereotactic Ablation Radiotherapy for Isolated Lung Recurrence of Non-Small-Cell Lung Cancer: A Phase II Clinical Trial.

Long-Term Outcomes of Salvage Stereotactic Ablation Radiotherapy for Isolated Lung Recurrence of Non-Small-Cell Lung Cancer: A Phase II Clinical Trial.

J Thorac Oncol. 2017 Mar 01;:

Authors: Sun B, Brooks ED, Komaki R, Liao Z, Jeter M, McAleer M, Balter PA, Welsh JD, O'Reilly M, Gomez D, Hahn SM, Sepesi B, Rice DC, Heymach JV, Chang JY

Abstract
OBJECTIVES: Our goal was to evaluate stereotactic ablative radiotherapy (SABR) as a salvage option for isolated recurrence of non-small-cell lung cancer (NSCLC) in the lung parenchyma following definitive treatment of stage I-III disease.
METHODS: Patients who had histologically confirmed, positron emission tomography (PET) staged, isolated NSCLC recurring locally or metastasis in the lung parenchyma (≤3 cm, suitable for SABR) after previous definitive treatment, were prospectively enrolled in this trial and treated with volumetric, image-guided SABR to 50 Gy in four fractions. Patients were then followed with computed tomography (CT) or PET/CT. Primary endpoints included the pattern of failure following salvage SABR, overall survival (OS), and progression-free survival (PFS).
RESULTS: Fifty-nine recurrent patients were treated with salvage-SABR. The median age was 70 years (range: 45-86 years), and the median follow-up time after salvage-SABR was 58.3 months. Nineteen patients (32%) developed re-recurrence after salvage-SABR. Measuring from the date of salvage-SABR, the estimated 5-year rates of local, regional and distant failure were 5.2%, 10.3% and 22.4%, respectively; the estimated PFS was 46.2% at 3 years and 41.1% at 5 years; and OS rates were 63.5% at 3 years and 56.5% at 5 years. A high post-SABR neutrophil-to-lymphocyte ratio was found to predict poor survival. Three patients (5%) developed grade 3 treatment-related adverse events. No patient had grade 4 or 5 events.
CONCLUSION: Our study showed salvage-SABR provides excellent 5-year OS, local control, and PFS rates with minimal toxicity for patients with isolated NSCLC recurrence in the lung parenchyma. These results are striking and comparable to historically reported outcomes of patients with primary early-stage NSCLC treated with definitive SABR. SABR appears to be a very effective and safe salvage option for patients with isolated lung parenchyma recurrent disease following definitive treatment and should be considered along with surgery as a potential first-line option for patients with local lung parenchymal recurrent disease.

PMID: 28259750 [PubMed - as supplied by publisher]

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