Feeling isolated.

Top Line: What is the best way to manage an isolated nodal recurrence after SABR for early stage NSCLC?

The Study: This retrospective study of 342 patients treated with SABR for T1-3N0 NSCLC evaluates management and outcomes for patients with isolated nodal recurrence (INR). While 90.6% were staged with PET, only 12.9% had pathologic lymph node staging. The most common fractionation schemes were 25 Gy in 1 fraction (40.9%) and 50 Gy in 4 fractions (29.2%), and the average BED10 was 102Gy. The rate of INR at 3 years was 10.6%, and the median time to INR was 8.4 months. Roughly half of all recurrences (46.9%) involved lymph nodes while just over a third (35.4%) were INRs. Management of INR included concurrent chemoradiation (43.3%), RT alone (26.7%), no treatment (16.7%), and chemotherapy alone (13.3%). Overall, outcomes were poor after INR with a median OS of 2.1 years and a 3 year OS rate of 39.3%. Patients who received salvage CRT had the best survival outcomes (3 year OS 81.5%), but those patients were also younger, had better performance status, a longer time since initial treatment, and the highest proportion of N1 disease. Patients tolerated salvage RT or CRT relatively well with a 14.3% rate of grade 3 toxicity and no grade 4 or 5 events.

TBL: Isolated nodal recurrence after primary SABR may be effectively salvaged with definitive chemoradiation in select patients. | Devine, Pract Radiat Oncol 2022