Hypofractionated external beam radiotherapy as retreatment for symptomatic non–small-cell lung carcinoma : an effective treatment ?

Purpose To evaluate prospectively the efficacy, toxicity, and duration of the palliative effect of retreatment with external beam radiotherapy in symptomatic patients with recurrent non–small-cell lung cancer. Methods and materials Twenty-eight symptomatic patients with local recurrence of non–small-cell lung cancer underwent repeated treatment after previous radiotherapy (equivalent dose, 46–60 Gy). Reirradiation consisted of two fractions of 8 Gy on Days 1 and 8 with two opposed beams using 6–18-MV photon beams at the site of pulmonary recurrence. The physician scored symptom resolution. Results Relief of hemoptysis and superior vena cava syndrome could be obtained in all assessable cases (100%). Treatment was less effective for coughing (67%) and dyspnea (35%). The overall median duration of this palliative effect was 4 months. Palliation in almost all patients lasted more than one-half of their remaining life span. The Karnofsky performance score improved in 45% of assessable cases. One patient had Grade 2 esophagitis. Complications consisted of tumor-related fatal hemoptysis in 5 patients (17%) and 1 death from bronchoesophageal fistula (4%). Conclusion External beam hypofractionated reirradiation can be effective as a palliative treatment for local complaints in non–small-cell lung cancer. The complication rate of reirradiation was acceptably low.