No lobe, no problem.

Top Line: Can the ever popular stereotactic body radiation (SBRT) techniques be used as salvage therapy for post-op recurrences of non-small cell lung cancer (NSCLC)?

The Study: First question that comes to mind here is: heck, why not? This retrospective look at a prospectively generated database of lung SBRT cases evaluates toxicity and disease outcomes specifically among the 48 patients receiving SBRT as salvage post-op therapy between 2004-2017. Previous surgeries almost exclusively spanned wedge resections to lobectomies, with 4% having had bi-lobectomies, and 94% of patients were deemed anatomically or medically unresectable at time of recurrence. SBRT was delivered per usual as if this was a first presentation, with the most common dose being 10 Gy x 5 = 50 Gy. At a median follow-up of roughly 2 years, the rate of grade 3 toxicity was only 6%. Local control was excellent and in-line with upfront SBRT: 94% at 1 year and 87% at 3 years. However, despite negative PET scans preceding salvage SBRT, distant mets became apparent in 21% at 1 year and 42% at 3 years. And, interestingly, this didn’t appear reduced in the quarter of patients who received systemic therapy at time of isolated local recurrence. Median overall survival was just over 29 months.

TBL: Recognizing the need to better identify those most at risk for developing distant mets, SBRT for isolated local post-op recurrence of NSCLC is a low-risk way to provide excellent local control. | Sittenfeld, Clin Lung Cancer 2020