Survival outcomes of salvage intensity modulated radiation therapy in patients with postoperative recurrent non-small cell lung cancer

Purpose To evaluate survival outcomes and prognostic factors in patients with postoperative locoregional recurrence of non-small cell lung cancer (NSCLC) treated with salvage intensity-modulated radiation therapy (IMRT), with or without chemotherapy. Methods This study evaluated 129 individuals undergoing radical radiotherapy for locoregional NSCLC recurrence between January 2015 and December 2018. Intensify the intensity modulation radiation therapy delivery of 66Gy (average value in the range from 45 to 70Gy). Seventy-nine subjects (61.2%) received chemoradiotherapy (48 concurrent, 31 sequential), and 32 subjects (24.8%) received radiotherapy alone. Following up on it every six months. Result The median age of the entire cohort was 62 years (range: 30-84). The median follow-up duration was 28.4 months (range: 2.3-72.4 months). In the OS group, there were 25 patients still alive at three years; In comparison, it reached only 16 in the PFS group. The two-year survival rates of OS, PFS, LRFS and DMFS are 70.5%, 45.6%, 73.6% and 59.7%, respectively; the five-year survival rates are 17.7%, 16.6%, 62.7% and 31.2%, respectively. Smaller GTV (<34 cm 3 ); longer disease-free interval (≥11 months), chemoradiotherapy, and favorable response to radiotherapy (CR/PR) were associated with improved OS and PFS. Radiation-induced pneumonitis and esophagitis were common acute toxicities. Thirty-two patients (24.8%) and three individuals (2.3%) suffered from Grade III or IV Radiation Pneumonitis, respectively. Thirty patients (23.3 per cent) and one person (0.8%) developed grade 3 or 4 esophagitis, respectively. Conclusion Salvage IMRT provides a viable treatment option for patients with postoperative recurrence of NSCLC, with manageable although not negligible toxicity. Combined chemotherapy may further improve survival outcomes. The role of targeted therapy or immunotherapy in this setting warrants further investigation, as only 18 patients in our cohort received TKIs and none received immunotherapy.