Background: We evaluated the efficacy, toxicity, and dose responses of re-irradiation with stereotactic body radiotherapy (SBRT) in patients with recurrent non- small cell lung cancer (NSCLC) after previous irradiation. Patients and Methods: 28 patients were included. Previous median radiation doses were 54 and 66 Gy. The median interval time between previous radiotherapy and SBRT was 14 months. The median follow-up time after SBRT was 9 months (range 3-93 months). To evaluate the effectiveness of SBRT, local control, overall survival, and treatment-related toxicity were reported. Results: SBRT doses and fractionation ranged from 60 to 30 Gy and from 3 to 8, respectively, according to previous doses, location of the recurrence, and interval time. 65% of tumor recurrences overlapped with previous treatment, while 35% of tumors recurred outside of the previous treatment. 4 patients had local progression after SBRT at their first follow-up. The Kaplan-Meier estimates of the 1- and 2-year actuarial overall survival were 71 and 42%, respectively. The mean survival following SBRT was 32.8 months, and the median survival was 21 months. No grade 3 or higher toxicities were observed. Conclusion: Robotic SBRT is a tolerable treatment option with manageable toxicity which can be used with radical or palliative intent in carefully selected patients with locally recurrent tumors after previous irradiation.

Perez CA, Stanley K, Grundy G, et al.: Impact of irradiation technique and tumor extent in tumor control and survival of patients with unresectable non-oat cell carcinoma of the lung: report by the Radiation Therapy Oncology Group. Cancer 1982;50:1091-1099.
Blackstock AW, Govindan R: Definitive chemoradiation for the locally advanced non-small-cell lung cancer. J Clin Oncol 2007;25:4146-4152.
Noble J, Ellis PM, Mackay JA, et al.: Second-line or subsequent systemic therapy for recurrent or progressive non-small cell lung cancer: a systematic review and practice guideline. J Thorac Oncol 2006;1:1042-1058.
Wu K L, Jiang G L, Qian H, et al.: Three-dimensional conformal radiotherapy for locoregionally recurrent lung carcinoma after external beam irradiation: a prospective phase I-II clinical trial. Int J Radiat Oncol Biol Phys 2003;57:1345-1350.
Tada T, Fukuda H, Matsui K, et al.: Non-small-cell lung cancer: re-irradiation for loco-regional relapse previously treated with radiation therapy. Int J Clin Oncol 2004;10:247-250.
Kramer GWPM, Gans S, Ullmann E, et al.: Hypofractionated external beam radiotherapy as retreatment for symptomatic non-small-cell lung carcinoma: an effective treatment? Int J Radiat Oncol Biol Phys 2004;58:1388-1393.
Jeremic B, Videtic GM: Chest re-irradiaiton with external beam radiotherapy for locally recurrent non-small-cell lung cancer: a review. Int J Radiat Oncol Biol Phys 2011;80:969-977.
Amini A, Yeh N, Gaspar LE, et al.: Stereotactic body radiation therapy (SBRT) for lung cancer patients previously treated with conventional radiotherapy: a review. Radiation Oncology 2014;9:210.
Owen D, Olivier KR, Song L, et al.: Safety and tolerability of SBRT after high-dose external beam radiation to the lung. Front Oncol 2015;4:376.
Trakul N, Harris JP, Le QT, et al.: Stereotactic ablative radiotherapy for re-irradiation of locally recurrent lung tumors. J Thorac Oncol 2012;7:1462-1465.
Trovo M, Minatel E, Durofi lE, et al.: Stereotactic body radiation therapy for re-irradiation of persistent or recurrent non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2014;88:1114-1119.
Reyngold M, J Wu A, McLane A, et al.: Toxicity and outcomes of thoracic re-irradiation using stereotactic body radiation therapy (SBRT). Radiat Oncol 2013;8:99.
Patel NR, Lanciano R, Sura K, et al.: Stereotactic body radiotherapy for re-irradiation of lung cancer recurrence with lower biological effective doses. J Radiat Oncol 2015;4:65-70.
Cox DR: 1972. Regression models and life tables (with discussion). J Royal Stat Soc B 1972;34:187-220.
Tarone R: Tests for trend in life table analysis. Biometrika 1975;62:679-682.
Tarone R, Ware J: On distribution free tests for equality of survival distributions. Biometrika 1977;64:156-160.
Gehan EA: Statistical methods for survival time studies; in Staquet MJ (ed): Cancer Therapy: Prognostic Factors and Criteria. New York, NY, Raven Press, 1975.
Lee E, Desu M: A computer program for comparing k samples with right censored data. Computer Programs in Biomedicine 1972;2:315-321.
Drodge SC, Ghosh S, Fairchild A: Thoracic irradiation for lung cancer: a literature review and practical guide. Ann Palliat Med 2014;3:75-91.
Gressen EL, Werner Wasik M, Chon J, et al.: Thoracic re-irradiation for symptomatic relief after prior radiotherapeutic management for lung cancer. Am J Clin Oncol 2000;23:160-163.
Casamassima F, Masi L, Bonucci I, et al.: Relevance of biologically equivalent dose values in outcome evaluation of stereotactic radiotherapy for lung nodules. Int J Radiat Oncol Biol Phys 2008;71:145-151.
Willner J, Baier K, Caragiani E, et al.: Dose, volume, and tumor control prediction in primary radiotherapy of non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2002;52:382-389.
Guckenberger M, Wulf J, Mueller G, et al.: Dose-response relationship for image-guided stereotactic body radiotherapy of pulmonary tumors: relevance of 4D dose calculation. Int J Radiat Oncol Biol Phys 2009;74:47-54.
Schanne DH, Nestle U, Allgaeuer M, et al.: Stereotactic body radiotherapy for centrally located stage I NSCLC: a multicenter analysis. Strahlenther Onkol 2015;191:125-132.
Wu K-L, Jiang G-L, Qian H, et al.: Three-dimensional conformal radiotherapy for locoregionally recurrent lung carcinoma after external beam irradiation: a prospective phase I-II clinical trial. Int J Radiat Oncol Biol Phys 2003;57:1345-1350.
Kilburn JM, Kuremsky JG, Blackstock AW, et al.: Thoracic re-irradiation using stereotactic body radiotherapy (SBRT) techniques as first or second course of treatment. Radiother Oncol 2014;110:505-510.
Kelly P, Balter PA, Rebueno N, et al.: Stereotactic body radiation therapy for patients with lung cancer previously treated with thoracic radiation. Int J Radiat Oncol Biol Phys 2010;78:1387-1393.
Amendola BE, Amendola MA, Perez N, et al.: Local failure after primary radiotherapy in lung cancer: is there a role for SBRT? Rep Pract Oncol Radiother 2015;20:440-445.
Zwicker F, Roeder F, Hauswald H, et al.: Re-irradiation with intensity-modulated radiotherapy in recurrent head and neck cancer. Head Neck 2011;33:1695-1702.
Meijneke TR, Petit SF, Wentzler D, et al.: Reirradiation and stereotactic radiotherapy for tumors in the lung: dose summation and toxicity. Radiother Oncol 2013;107:432-427.
Mantel F, Flentje M, Guckenberger M: Stereotactic body radiation therapy in the re-irradiation situation - a review. Radiat Oncol 2013;8:7.
Okamoto Y, Murakami M, Yoden E, et al.: Re-irradiation for locally recurrent lung cancer previously treated with radiotherapy. Int J Radiat Oncol Biol Phys 2002:52:390-396.
Poltinnikov IM, Fallon K, Xiao Y, et al.: Combination of longitudinal and circumferential three-dimensional esophageal dose distribution predicts acute esophagitis in hypofractionated reirradiation of patients with non-small-cell lung cancer treated in stereotactic body frame. Int J Radiat Oncol Biol Phys 2005;62:652-658.
Coon D, Gokhale AS, Burton SA, et al.: Fractionated stereotactic body radiation therapy in the treatment of primary, recurrent, and metastatic lung tumors: the role of positron emission tomography/computed tomography-based treatment planning. Clin Lung Cancer 2008;9:217-221.
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