Local recurrence following initial resection of NSCLC: salvage is possible with radiation therapy

After surgical resection of non-small cell lung cancer, local/regional recurrence is observed in 20% to 50% of patients, often without evidence of distant metastases. This retrospective study evaluates the utility of salvage radiation therapy in this setting.

Between 1991 and 2003, 29 consecutive patients were treated with definitive radiotherapy (N=14) or chemoradiotherapy (N=15) for recurrent non-small cell lung cancer after surgical resection at Duke University Medical Center. The median time from date of surgery to date of recurrence was 18 months (range, 2-151). At the time of recurrence, most patients had mediastinal adenopathy (N=19), but seven patients had disease confined to the surgical stump and three had hilar adenopathy with (N=2) or without (N=1) a stump recurrence. The median radiation therapy dose was 66 Gy (range, 46-74). Local control and overall survival were estimated using the Kaplan-Meier method. A univariate regression analysis was performed to evaluate the effect of several patient- and treatment-related factors on local control and overall survival.

Median survival after radiation therapy was 17 months. Of the 29 patients, five are alive without evidence of disease 22, 28, 34, 54, and 158 months since completing radiation therapy. Actuarial local control and overall survival at 2 years were 62% and 38%, respectively. There was a trend toward improved survival with younger age and a longer disease-free interval between surgery and local recurrence, but these findings were not statistically significant.

Radiation therapy, with or without chemotherapy, produced a 2-year survival of 38% in our series of patients with local/regional recurrence of non-small cell lung cancer after resection. Aggressive therapy in this population of patients is warranted.