Takaoka Taiki, Tomita Natsuo, Hashizume Chisa, Tsugawa Takahiko, Torii Akira, Okazaki Dai, Niwa Masanari, Kita Nozomi, Oguri Masanosuke, Takano Seiya, Sasaguchi Masahiro, Ukai Machiko, Ogawa Yasutaka, Niimi Akio, Hiwatashi Akio
Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Radiation Oncology, Nishichita General Hospital, Tokai, Japan.
Transl Lung Cancer Res. 2025 May 30;14(5):1650-1659. doi: 10.21037/tlcr-2025-89. Epub 2025 May 27.
Salvage treatment for local recurrence of non-small cell lung cancer (NSCLC) after stereotactic body radiotherapy (SBRT) remains unestablished. We investigated the safety and efficacy of a second SBRT course for in-field local recurrence of NSCLC after definitive SBRT.
This study included 35 patients with NSCLC who received a second SBRT course between July 2004 and August 2021. The median interval between the first and second SBRT was 24 months (range, 6-81 months). The median prescription dose was 60 Gy in eight fractions (range, 48-66 Gy) for the second SBRT. Overall survival (OS), local control (LC), progression-free survival (PFS), and toxicity after a second SBRT were assessed.
The median follow-up period was 29 months (range, 3-124 months). The three-year OS, LC, and PFS rates were 50%, 47%, and 34% for all 35 patients and 72% 21%, 85% 34%, and 62% 9% in the adenocarcinoma and squamous cell carcinoma groups, respectively (P=0.04, 0.01, and 0.003, respectively). Four patients demonstrated no further recurrence for more than five years after the second SBRT. Radiation pneumonitis after the second SBRT was grade 2 in three (8.5%) patients, rib fractures occurred in nine (25.7%) patients, and no patient developed grade 3 or higher toxicity.
Re-irradiation with SBRT was safe and can be a salvage treatment option for in-field local recurrence of NSCLC, especially adenocarcinoma, after definitive SBRT.
立体定向体部放疗（SBRT）后非小细胞肺癌（NSCLC）局部复发的挽救治疗尚未确立。我们研究了在确定性SBRT后对NSCLC野内局部复发进行第二次SBRT疗程的安全性和有效性。
本研究纳入了2004年7月至2021年8月期间接受第二次SBRT疗程的35例NSCLC患者。第一次和第二次SBRT之间的中位间隔时间为24个月（范围6 - 81个月）。第二次SBRT的中位处方剂量为60 Gy，分8次照射（范围48 - 66 Gy）。评估了第二次SBRT后的总生存期（OS）、局部控制率（LC）、无进展生存期（PFS）和毒性反应。
中位随访期为29个月（范围3 - 124个月）。35例患者的三年OS、LC和PFS率分别为50%、47%和34%，腺癌组和鳞癌组分别为72%±21%、85%±34%和62%±9%（P值分别为0.04、0.01和0.003）。4例患者在第二次SBRT后超过5年未出现进一步复发。第二次SBRT后放射性肺炎在3例（8.5%）患者中为2级，9例（25.7%）患者发生肋骨骨折，无患者出现3级或更高等级的毒性反应。
SBRT再程放疗是安全的，对于确定性SBRT后NSCLC野内局部复发，尤其是腺癌，可作为一种挽救治疗选择。
