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Abstract
Purpose: To present the multi-institutional data on patterns of recurrence, treatment approaches, and clinical outcomes for regional lymph node (LN) recurrence after stereotactic body radiation therapy (SBRT) for primary lung cancer.

Materials and methods: The medical records of 114 patients who experienced regional LN recurrence as the first recurrence after lung SBRT were retrospectively reviewed. Patterns of recurrence were classified as local recurrence, regional recurrence, and distant metastasis. Clinical outcomes including progression-free survival (PFS) and overall survival (OS) were analyzed.

Results: Half of the patients had regional LN recurrence only. The most common simultaneous recurrence was distant metastasis (38.6 %). Common sites of regional recurrence were ipsilateral hilar (47.2 %), ipsilateral upper mediastinal (40.6 %), and subcarinal (42.5 %) LN stations. 24 (21.1 %) patients underwent salvage radiation therapy (RT), and 44 (38.6 %) patients underwent palliative treatment. Better OS was observed in the salvage RT group (p = 0.025). The 1-year PFS and OS rates were 27.7 % and 55.2 %, respectively, with salvage RT, 14.0 % and 39.9 %, respectively, with palliative treatment, and 22.8 % and 26.8 %, respectively, with no additional treatment. Multivariate analysis showed that salvage RT (PFS, HR 0.463, p = 0.050; OS, HR 0.312, p = 0.002), palliative treatment (PFS, HR 0.436, p = 0.013; OS, HR 0.553, p = 0.050), and simultaneous distant metastasis (PFS, HR 2.335, p = 0.005; OS, HR 1.726, p = 0.054) affected clinical outcomes.

Conclusion: Many cases of regional LN recurrence are confined to the locoregional area of patients, and appropriate treatment can improve the prognosis of these patients.

- SBRT 후 림프절 재발 패턴의 도식화

- 림프절 재발 후 추가 치료에 따른 생존율의 차이

Affiliations

Tae Hoon Lee 1, Hyunju Shin 2, Yong Chan Ahn 2, Min Kyu Kang 3, Changhoon Song 4, Woo Chul Kim 5, Sung Ho Moon 6, Jin Hee Kim 7, Jaeho Cho 8, Hae Jin Park 9, Heui Kwan Lee 10, Byoung Hyuck Kim 11, Hak Jae Kim 12
1Department of Radiation Oncology, Cancer Research Insititute, Seoul National University Hospital, Seoul, Republic of Korea.
2Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
3Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
4Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
5Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea.
6Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
7Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.
8Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
9Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Republic of Korea.
10Department of Radiation Oncology, Presbyterian Medical Center, Jeonju, Republic of Korea.
11Department of Radiation Oncology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: karlly71@snu.ac.kr.
12Department of Radiation Oncology, Cancer Research Insititute, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: khjae@snu.ac.kr.