Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA.
Department of Radiation Oncology, Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO.
Semin Radiat Oncol. 2020 Jul;30(3):223-231. doi: 10.1016/j.semradonc.2020.02.001.
Treatment of locally recurrent non-small lung cancer (NSCLC) after definitive chemoradiation therapy is challenging as patients are often inoperable and systemic therapy alone frequently results in suboptimal outcomes. Re-irradiation of NSCLC may be the best strategy for treating locoregional failures with the goal of durable long-term control and potentially cure. Repeat irradiation is technically challenging for fear of life-threatening toxicities to previously irradiated organs at risk while also delivering definitive doses of radiation to recurrent disease. No standard guidelines exist with regards to re-irradiation technique and re-treatment dose constraints to organs at risks. We herein describe a case of locoregional recurrence after definitive chemoradiation therapy for NSCLC with expert opinions for subsequent management. As described and guided by our experts, we review the various techniques for repeat radiation therapy, treatment planning goals, and reported toxicities and outcomes in the re-irradiation setting.
根治性放化疗后局部复发性非小细胞肺癌（NSCLC）的治疗极具挑战性，因为患者通常无法手术，单独进行全身治疗往往效果不佳。对于局部区域复发，再放疗可能是治疗的最佳策略，其目的是持久的长期控制和潜在治愈。由于担心危及生命的毒性作用，对于既往照射的危险器官再次照射具有一定的技术挑战性，同时还需要将确定性剂量的放射用于复发性疾病。对于再放疗技术和再治疗时危及器官剂量限制，目前尚无标准指南。本文描述了一例 NSCLC 根治性放化疗后局部区域复发的病例，并提出了后续治疗的专家意见。根据我们的专家描述和指导，我们回顾了重复放疗的各种技术、治疗计划目标，以及再放疗中报告的毒性和结果。
