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Patients affected with non-small cell lung cancer (NSCLC) may present local recurrences inside the irradiated area after receiving external beam radiotherapy. Re-irradiation with High dose radiotherapy appears as a promising approach, achieving long-term control with acceptable toxicity.This is a descriptive study reviewing the clinical outcomes of patients treated in our hospital with High dose re-irradiation either with SBRT or hypofractionated EBRT after local recurrence of NSCLC.

The records of patients treated with thoracic SBRT or hypofractionated EBRT from 2012 through 2019 were retrospectively reviewed. We identified twelve patients treated with prior thoracic radiation therapy for NSCLC with subsequent “in field” re-irradiation, defined as overlapping of PTV of both treatments; or “border field”, defined as overlapping of the recurrence PTV with the previous 30 Gy isodose. Overall survival, local control, recurrences and toxicity were assessed. 

Median age at the time of re-irradiation was 63 years (47-83).  The re-irradiation dose ranged from 50 to 60 Gy (BED 75-180Gy) given in 3-10 fractions. Median follow-up was 23 months. Local control was 91.7% at 1 year and 75% at 2 years, with a median of 15 months of progression-free survival and a median of 24 months for overall survival. One patient died of hemoptysis 3 months after re-irradiation, no other patients presented toxicity above grade 2.

Results indicate that lung re-irradiation with High dose radiotherapy may offer satisfactory long term disease control, but could present important toxicity.

Special care must be taken when treating patients with thoracic reirradiation.