Safety and efficacy of stereotactic ablative brachytherapy as a salvage therapy for recurrent chest wall cancer: A retrospective, multicenter study

Bin Huo; Zhe Ji; Chuang He; Wanying Yang; Yanli Ma; Xiaodong Huo; Zhe Wang; Xinxin Zhao; Jinchao Dai; Haitao Wang; Guanglie Chen; Ruoyu Wang; Yuqing Song; Kaixian Zhang; Xuequan Huang; Shude Chai; Junjie Wang

doi:10.3389/fonc.2022.957497

Safety and efficacy of stereotactic ablative brachytherapy as a salvage therapy for recurrent chest wall cancer: A retrospective, multicenter study

Front Oncol. 2023 Feb 7:12:957497. doi: 10.3389/fonc.2022.957497. eCollection 2022.

Authors

Bin Huo¹, Zhe Ji², Chuang He³, Wanying Yang⁴, Yanli Ma⁵, Xiaodong Huo¹, Zhe Wang⁶, Xinxin Zhao⁷, Jinchao Dai⁸, Haitao Wang¹, Guanglie Chen⁷, Ruoyu Wang⁶, Yuqing Song⁵, Kaixian Zhang⁴, Xuequan Huang³, Shude Chai¹, Junjie Wang²

Affiliations

¹ Department of Oncology, The Second Hospital of Tianjin Medical University, Tianjin, China.
² Department of Radiation Oncology, Peking University Third Hospital, Beijing, China.
³ Center of Minimally Invasive Intervention, Southwest Hospital of Army Medical University, Chongqing, China.
⁴ Department of Oncology, Tengzhou Central People's Hospital, Tengzhou, China.
⁵ Department of Oncology, Staff Hospital of Chengde Iron and Steel Group Co. Ltd., Chengde, China.
⁶ Department of Radiation Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
⁷ Department of Oncology Radiotherapy, The First People's Hospital of Kerqin District, Tongliao, China.
⁸ Department of Nuclear Medicine, Qingdao Central Hospital, Qingdao, China.

Abstract

Purpose: To evaluate the safety and efficacy of stereotactic ablative brachytherapy (SABT) as a salvage therapy for patients with recurrent chest wall cancer (rCWC) who have previously received external beam radiotherapy (EBRT) or surgery.

Materials and methods: Between November 2013 and October 2020, a total of 130 patients (including 75 men with a median age of 63 years) with rCWC treated with SABT were enrolled in this multicenter retrospective study. There were 97 cases of non-small-cell lung carcinoma, 24 cases of breast cancer, and 9 cases of thymic cancer. Of the patients included, 102 patients previously received surgery and 58 patients received EBRT, with systemic treatment progressing after recurrence. None of them were suitable or refused to undergo salvage EBRT or surgery again.

Results: During the 22 (4-70)-month median patient follow-up, 59 patients died. The local control (LC) rates at 6, 12, 24, and 36 months were 88.3%, 74.3%, 50.4%, and 36.7%, respectively. The 1-, 2- and 3-year survival rates were 85%, 56%, and 42%, respectively. The median overall survival was 26 months (95% CI, 18.9-33.1 months). The pain relief rate was 81%, and the median to remission time was 10 days. Univariate and multivariate analyses showed that independent prognostic factors for LC included tumor size and postoperative D90. On the other hand, independent prognostic factors for survival include the Karnofsky performance status (KPS) score, tumor size, and D90 19 patients (14.6%) developed grade I/II skin reaction complications. No grade III or severer complications occurred.

Conclusion: SABT is safe and effective as a salvage therapy for rCWC following EBRT/surgery. For patients with a KPS score greater than 80, prescribed dose greater than 130 Gy, and tumor size less than 4 cm may bring better results.

Keywords: external beam radiotherapy (EBRT); recurrent chest wall cancer; reirradiation; salvage therapy; stereotactic ablative brachytherapy.