Milano Michael T, Kong Feng-Ming Spring, Movsas Benjamin
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.
Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Transl Lung Cancer Res. 2019 Feb;8(1):78-87. doi: 10.21037/tlcr.2018.08.15.
Treatment options for thoracic recurrences of non-small cell lung cancer (NSCLC) are limited. Stereotactic body radiation therapy (SBRT) is an emerging, potentially effective technology to manage recurrent NSCLC, although with limited prospective studies. This work reviews the outcomes of patients undergoing salvage SBRT for pulmonary recurrences after prior resection or prior radiotherapy for NSCLC. Following salvage SBRT, after prior external beam radiation (SBRT or conventionally fractionated), the 2-year overall survival (OS) ranged from 37% to 79% in 11 of the studies (397 patients) reviewed here, while the 2-year local control (LC) ranged from 37% to 90% in 6 studies that reported that outcome. Toxicity risks are acceptable albeit with appreciable risks of severe to potentially fatal toxicity, necessitating the need to weigh risks benefits in the re-irradiation setting. There were fewer studies on the use of SBRT after prior resection. Following salvage SBRT, after prior resection, the 2-year OS ranged from 56% to 68% in 4 studies (131 patients) reviewed here, while the 2-year LC ranged from 83% to 100% in 3 of these studies. SBRT in the salvage setting after prior resection appeared to be well-tolerated, with toxicity risks comparable to historical patients treated with SBRT alone (i.e., SBRT without prior resection, which is not reviewed here). The data are limited due to the retrospective nature of published studies (all but 4 with <40 patients), with various clinical scenarios (i.e., original NSCLC stage, prior treatment, location of target amenable to salvage SBRT) and a range of SBRT dosing and techniques. More studies are needed to better understand the tumor control, survival and toxicity of SBRT for salvage therapy of NSCLC patients, as well as the potentially prognostic factors that could affect these outcomes.
非小细胞肺癌（NSCLC）胸部复发的治疗选择有限。立体定向体部放射治疗（SBRT）是一种新兴的、可能有效的治疗复发性NSCLC的技术，尽管前瞻性研究有限。本文回顾了接受挽救性SBRT治疗NSCLC肺复发患者的结果，这些患者之前接受过手术切除或放射治疗。在接受挽救性SBRT之前接受过外照射（SBRT或常规分割放疗）后，本文回顾的11项研究（397例患者）中2年总生存率（OS）为37%至79%，而6项报告该结果的研究中2年局部控制率（LC）为37%至90%。毒性风险是可以接受的，尽管存在严重至潜在致命毒性的明显风险，因此在再照射情况下需要权衡风险和益处。关于先前切除后使用SBRT的研究较少。在接受挽救性SBRT之前接受过手术切除后，本文回顾的4项研究（131例患者）中2年OS为56%至68%，而其中3项研究中2年LC为83%至100%。先前切除后挽救性SBRT似乎耐受性良好，毒性风险与仅接受SBRT治疗的历史患者相当（即未进行过先前切除的SBRT，本文未对此进行回顾）。由于已发表研究的回顾性性质（除4项研究外，其余研究患者均<40例）、各种临床情况（即原发性NSCLC分期、先前治疗、适合挽救性SBRT的靶区位置）以及一系列SBRT剂量和技术，数据有限。需要更多研究来更好地了解SBRT对NSCLC患者挽救治疗的肿瘤控制、生存和毒性，以及可能影响这些结果的潜在预后因素。
