Stereotactic reirradiation for in-field lung cancer recurrence after stereotactic ablative radiotherapy: A systematic review and meta-analysis

作者：Jang K, Cross S, Yeghiaian-Alvandi R · 发表于：Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 年份：2025 · DOI：10.1016/j.radonc.2025.110898 · 研究领域：Radiosurgery、Lung Neoplasms、Re-Irradiation、Neoplasm Recurrence, Local、Humans、Salvage Therapy

PURPOSE: There is paucity of data for thoracic in-field reirradiation with two courses of stereotactic ablative radiotherapy (SABR). This meta-analysis evaluates the safety and efficacy of repeat SABR as salvage therapy for in-field failures after definitive SABR. MATERIALS AND METHODS: A systematic search of PubMed, Cochrane Library, MEDLINE, and EMBASE databases was conducted in accordance with PRISMA guidelines. Studies were included if they involved adult patients treated with salvage SABR for in-field recurrences of lung cancer following prior SABR. To address varying definitions of local failure, studies were included if recurrence occurred within the original planning target volume (PTV). Studies with out-of-field failures (>1 cm from PTV) or those using non-SABR techniques were excluded. Pooled 1- and 2-year local control (LC) rates, overall survival (OS), and toxicities were calculated using a random-effects model. Population-weighted linear regression was employed to assess the relationship between dosimetric and clinico-pathologic variables and patient outcomes. RESULTS: Twelve studies involving 197 patients were included in the quantitative analysis. All patients received two courses of SABR, with a median total dose of 50 Gy in 5 fractions. Pooled 1- and 2-year LC rates were 78.2 % (95 % CI: 66-87 %) and 68.0 % (95 % CI: 55-79 %), respectively. Patients receiving a cumulative biologically effective dose (BED) ≥ 200 Gy had significantly higher LC rates (84.9 %, ...