Prognostic Value of Gross Tumor Volume for Definitive Radiation Therapy in Patients With Locoregionally Recurrent Non-Small-Cell Lung Cancer After Surgical Resection

This study was performed on 38 patients with locoregionally recurrent non-small-cell lung cancer after surgical resection. We hypothesized that smaller gross tumor volume (GTV) would be associated with better survival outcomes in these patients. The prognosis of patients with small GTV and isolated local or regional recurrence was favorable. GTV was a better predictor of overall survival than stage at recurrence and may be useful for risk stratification of patients with postsurgically recurrent non-small-cell lung cancer. Purpose: To investigate the prognostic value of gross tumor volume (GTV) for predicting survival outcomes and to present the results of definitive radiation therapy (RT) in patients with postsurgical locoregionally recurrent non-small-cell lung cancer (NSCLC). Materials and Methods: Between April 2001 and September 2009, 38 patients with postsurgical locoregionally recurrent NSCLC underwent definitive RT with curative intent. Median follow-up time for surviving patients was 54.9 months. The primary endpoint was postrecurrence overall survival (OS). The effect of tumor volume on clinical outcome was assessed by using 2 cutoff values of GTV, 20 and 80 cm(3). Results: Median postrecurrence survival time was 27.9 months, and the 2-, 3-, and 5-year estimated OS rates were 56.0%, 39.8% and 33.2%, respectively. The median GTV was 26.8 cm(3). Patients with a GTV <20 cm(3) had significantly higher 2-year (69.0% vs. 28.6%) and 3-year (61.4% vs. 14.3%) OS rates than patients with a GTV >= 80 cm(3) (P = .004). Patients with isolated local or regional recurrence had significantly better OS than patients with combined local and regional recurrence (P = .001). Multivariate analysis showed that smaller GTV and isolated local or regional recurrence were independent favorable prognostic factors for OS. Conclusions: Postrecurrence OS of patients with postsurgical locoregionally recurrent NSCLC treated with definitive RT was excellent compared with previous findings. The GTV as a continuous variable was a better predictor of OS than stage at recurrence and may be useful for stratifying the risk in patients with postsurgical recurrent NSCLC. (C) 2013 Elsevier Inc. All rights reserved.