Salvage Therapy for Recurrent SABR-Treated Early-Stage NSCLC Increases Survival

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Researchers sought to determine the long-term outcomes for patients with isolated local or regional recurrence after stereotactic ablative radiotherapy for early-stage NSCLC.
Researchers sought to determine the long-term outcomes for patients with isolated local or regional recurrence after stereotactic ablative radiotherapy for early-stage NSCLC.

Patients who received salvage treatment for recurrence of early-stage non-small cell lung cancer (NSCLC) after initial treatment with stereotactic ablative radiotherapy (SABR) with isolated local recurrence (iLR) had a life expectancy similar to that of patients who did not experience a recurrence, whereas those with isolated regional recurrence (iRR) had a survival similar to those with stage III NSCLC, according to a study published in JAMA Network Open.

Eric D. Brooks, MD, from the Department of Radiation Oncology at the University of Texas MD Anderson Cancer Center in Houston, and colleagues conducted a retrospective review of 912 patients prospectively enrolled in an institutional database from January 1, 2004, through December 31, 2014, to determine the long-term outcomes for patients with iLR or iRR after SABR for early-stage NSCLC.

A total of 82.9% of patients had T1 tumors at diagnosis; 502 tumors (55.0%) were adenocarcinomas, 309 (33.9%) were squamous cell carcinomas. After being treated with SABR, 658 patients had no recurrence, whereas 102 developed isolated recurrence. Median time to recurrence after SABR was 14.5 months for iLR and 9.0 months for iRR. Of the 49 patients with iLR, 39 underwent salvage with reirradiation surgery, thermal ablation, or chemotherapy compared with 48 of the 53 patients with iRR. Median follow-up time from recurrence was 38.5 months.

Overall survival at 5 years from initial SABR therapy was 57.9% for patients with iLR and 54.9% for patients who did not experience a recurrence, but was lower for those with iRR (31.1%). However, patients receiving salvage treatment had longer overall survival than those who did not (median overall survival, 37 vs 7 months after recurrence). Among those who received salvage treatment for either iLR or iRR, 27.6% ultimately developed distant metastases.

The authors suggested that the results of this study may help clinicians and patients make treatment decisions.

Reference

Brooks ED, Sun B, Feng L, et al. Association of long-term outcomes and survival with multidisciplinary salvage treatment for local and regional recurrence after stereotactic ablative radiotherapy for early-stage lung cancer [published online August 24, 2018]. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.1390

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