Stereotactic Body Radiation Therapy After Surgical Resection of Primary Lung Cancers

Purpose/Objective(s)Stereotactic body radiation therapy (SBRT) has been shown to be safe and effective in the treatment of early stage lung cancers. After prior lung surgery, surgical resection is the preferred treatment for recurrent or second primary lung cancers in the operable candidate. In non-operable patients, conventional RT, SBRT, and radiofrequency ablation are treatment options. We analyzed the outcomes of patients treated with SBRT after previous lung surgery to assess the safety and efficacy of SBRT after lung resection.Materials/MethodsIn this IRB-approved retrospective study, we reviewed 45 patients treated with SBRT to 59 non-small cell lung carcinoma (NSCLC) lesions after prior definitive wedge resection, lobectomy, or pneumonectomy. All patients were treated with SBRT after CT simulation with full body immobilization. SBRT doses ranged from 25 - 48 Gy (median 48 Gy) and were delivered in 3- 5 fractions, using IGRT with each fraction. Patient characteristics and outcomes were analyzed.ResultsMedian age was 70.9 (48 - 87) and 75.5 years (54 - 97) at surgery and SBRT, respectively. Twenty (44%) patients underwent wedge resection, 24 (53%) lobectomy, and 1 (2%) pneumonectomy. Thirteen (29%) patients had previous lung surgery. T stage was T1 in 26 (58%), T2 in 16 (36%), T3 in 1 (2%), and unknown in 2 (4%) patients. One (2%) patient was N2, while 3 (7%) were N1, 25 (56%) were N0, and 16 (36%) were unknown. Nine (20%) patients received adjuvant chemotherapy and 6 (13%) adjuvant radiation after surgery. Pathology was squamous cell in 11 (24%), adenocarcinoma in 30 (67%), poorly differentiated NSCLC in 2 (4%), large cell in 1 (2%) and unknown in 1 (2%) patients. At a median of 3.6 years (0.1 - 17) after surgery, SBRT was delivered to the same lobe as prior surgery in 14 (24%), ipsilateral lung in 24 (41%), contralateral lung in 16 (27%), and mediastinum in 5 (8%) lesions. There were other sites of disease outside of the SBRT target with 18 (31%) lesions. Failure occurred after SBRT in twenty-nine (49%) lesions. The most common site of failure was distant with a component in 25 (42%) of treated lesions while 8 (14%) had local failure and 11 (19%) had regional failure. Local failure alone occurred after treatment to 2 (3%) lesions. Of the patients that failed, 10 (35%) received salvage chemotherapy and 14 (48%) received further radiation therapy. At a median follow-up of 1.3 years (0.1 - 8.0), 24 (53%) patients were alive without evidence of active disease, 9 (20%) living with disease, and 12 (27%) dead with 8 dying from lung cancer. No patient experienced grade 3 or higher toxicity.ConclusionsSBRT appears to be a safe, feasible and effective treatment after prior lung surgery, however, with the high rate of distant failure more research into systemic treatments may benefit these patients. Purpose/Objective(s)Stereotactic body radiation therapy (SBRT) has been shown to be safe and effective in the treatment of early stage lung cancers. After prior lung surgery, surgical resection is the preferred treatment for recurrent or second primary lung cancers in the operable candidate. In non-operable patients, conventional RT, SBRT, and radiofrequency ablation are treatment options. We analyzed the outcomes of patients treated with SBRT after previous lung surgery to assess the safety and efficacy of SBRT after lung resection. Stereotactic body radiation therapy (SBRT) has been shown to be safe and effective in the treatment of early stage lung cancers. After prior lung surgery, surgical resection is the preferred treatment for recurrent or second primary lung cancers in the operable candidate. In non-operable patients, conventional RT, SBRT, and radiofrequency ablation are treatment options. We analyzed the outcomes of patients treated with SBRT after previous lung surgery to assess the safety and efficacy of SBRT after lung resection. Materials/MethodsIn this IRB-approved retrospective study, we reviewed 45 patients treated with SBRT to 59 non-small cell lung carcinoma (NSCLC) lesions after prior definitive wedge resection, lobectomy, or pneumonectomy. All patients were treated with SBRT after CT simulation with full body immobilization. SBRT doses ranged from 25 - 48 Gy (median 48 Gy) and were delivered in 3- 5 fractions, using IGRT with each fraction. Patient characteristics and outcomes were analyzed. In this IRB-approved retrospective study, we reviewed 45 patients treated with SBRT to 59 non-small cell lung carcinoma (NSCLC) lesions after prior definitive wedge resection, lobectomy, or pneumonectomy. All patients were treated with SBRT after CT simulation with full body immobilization. SBRT doses ranged from 25 - 48 Gy (median 48 Gy) and were delivered in 3- 5 fractions, using IGRT with each fraction. Patient characteristics and outcomes were analyzed. ResultsMedian age was 70.9 (48 - 87) and 75.5 years (54 - 97) at surgery and SBRT, respectively. Twenty (44%) patients underwent wedge resection, 24 (53%) lobectomy, and 1 (2%) pneumonectomy. Thirteen (29%) patients had previous lung surgery. T stage was T1 in 26 (58%), T2 in 16 (36%), T3 in 1 (2%), and unknown in 2 (4%) patients. One (2%) patient was N2, while 3 (7%) were N1, 25 (56%) were N0, and 16 (36%) were unknown. Nine (20%) patients received adjuvant chemotherapy and 6 (13%) adjuvant radiation after surgery. Pathology was squamous cell in 11 (24%), adenocarcinoma in 30 (67%), poorly differentiated NSCLC in 2 (4%), large cell in 1 (2%) and unknown in 1 (2%) patients. At a median of 3.6 years (0.1 - 17) after surgery, SBRT was delivered to the same lobe as prior surgery in 14 (24%), ipsilateral lung in 24 (41%), contralateral lung in 16 (27%), and mediastinum in 5 (8%) lesions. There were other sites of disease outside of the SBRT target with 18 (31%) lesions. Failure occurred after SBRT in twenty-nine (49%) lesions. The most common site of failure was distant with a component in 25 (42%) of treated lesions while 8 (14%) had local failure and 11 (19%) had regional failure. Local failure alone occurred after treatment to 2 (3%) lesions. Of the patients that failed, 10 (35%) received salvage chemotherapy and 14 (48%) received further radiation therapy. At a median follow-up of 1.3 years (0.1 - 8.0), 24 (53%) patients were alive without evidence of active disease, 9 (20%) living with disease, and 12 (27%) dead with 8 dying from lung cancer. No patient experienced grade 3 or higher toxicity. Median age was 70.9 (48 - 87) and 75.5 years (54 - 97) at surgery and SBRT, respectively. Twenty (44%) patients underwent wedge resection, 24 (53%) lobectomy, and 1 (2%) pneumonectomy. Thirteen (29%) patients had previous lung surgery. T stage was T1 in 26 (58%), T2 in 16 (36%), T3 in 1 (2%), and unknown in 2 (4%) patients. One (2%) patient was N2, while 3 (7%) were N1, 25 (56%) were N0, and 16 (36%) were unknown. Nine (20%) patients received adjuvant chemotherapy and 6 (13%) adjuvant radiation after surgery. Pathology was squamous cell in 11 (24%), adenocarcinoma in 30 (67%), poorly differentiated NSCLC in 2 (4%), large cell in 1 (2%) and unknown in 1 (2%) patients. At a median of 3.6 years (0.1 - 17) after surgery, SBRT was delivered to the same lobe as prior surgery in 14 (24%), ipsilateral lung in 24 (41%), contralateral lung in 16 (27%), and mediastinum in 5 (8%) lesions. There were other sites of disease outside of the SBRT target with 18 (31%) lesions. Failure occurred after SBRT in twenty-nine (49%) lesions. The most common site of failure was distant with a component in 25 (42%) of treated lesions while 8 (14%) had local failure and 11 (19%) had regional failure. Local failure alone occurred after treatment to 2 (3%) lesions. Of the patients that failed, 10 (35%) received salvage chemotherapy and 14 (48%) received further radiation therapy. At a median follow-up of 1.3 years (0.1 - 8.0), 24 (53%) patients were alive without evidence of active disease, 9 (20%) living with disease, and 12 (27%) dead with 8 dying from lung cancer. No patient experienced grade 3 or higher toxicity. ConclusionsSBRT appears to be a safe, feasible and effective treatment after prior lung surgery, however, with the high rate of distant failure more research into systemic treatments may benefit these patients. SBRT appears to be a safe, feasible and effective treatment after prior lung surgery, however, with the high rate of distant failure more research into systemic treatments may benefit these patients.