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Lung cancer: Retreatment of local recurrence after definitive irradiation

Aggressive radiation therapy for the management of inoperable lung cancer has increased tumor control and survival. However, approximately 20% of patients continue to experience local recurrence as the sole manifestation of treatment failure. Seven hundred thirty‐four patients were initially treated by radiation therapy for inoperable lung cancer, for recurrence after resection, or as adjunct postoperative therapy. Twenty‐nine patients were referred for retreatment of cancer that recurred within the original treatment field. Following retreatment, 14 of 29 patients (48%) had a favorable subjective response, and 20 of 27 patients (74%) a favorable objective response. A favorable response was observed for all cell types and over a wide range of retreatment dosages. Symptomatic radiation pneumonitis developed in one patient, rib sclerosis and fracture developed in another. The median survival after onset of retreatment was five months with a range of one month to 54 months. The clinically determined mechanisms of death were persistent intrathoracic disease in 14 of 25 patients (56%), intrathoracic disease and distant metastasis in 7 of 25 (28%), distant metastasis in 3 of 25 (12%), and unknown in 1 of 25 (4%).