Although isolated local (LRs) and regional recurrences (RRs) constitute a minority of post-stereotactic ablative radiotherapy (SABR) relapses, their management is becoming increasingly important as the use of SABR continues to expand. However, few evidence-based strategies are available to guide treatment of these potentially curable recurrences. On behalf of the Advanced Radiation Technology Committee (ART) of the International Association for the Study of Lung Cancer (IASLC), this article was written to address management of recurrent disease. Topics discussed include diagnosis and workup, including the roles of volumetric and functional imaging as well as histopathologic methods; clinical outcomes after salvage therapy; patterns of recurrence after salvage therapy; and management options. Our main conclusions are that survival for patients with adequately salvaged LRs is similar to that for patients after primary SABR without recurrence, and survival for those with salvaged RRs (regardless of nodal burden or location) is similar to that of patients with de novo stage III disease. Although more than half of patients who undergo salvage do not develop a second relapse, the predominant pattern of second failure is distant, especially for RRs. Management requires rigorous multidisciplinary coordination. Isolated LRs can be managed with resection and nodal dissection, repeat SABR, thermal ablation, or systemic therapies. RRs can be treated with combined chemoradiotherapy, radiation or chemotherapy alone, or supportive services. Finally, regular and structured follow-up is recommended after post-SABR salvage therapy.

中文翻译：

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早期非小细胞肺癌立体定向消融放疗后局部复发的挽救治疗


尽管孤立性局部复发 (LR) 和区域复发 (RR) 占立体定向消融放射治疗 (SABR) 后复发的少数，但随着 SABR 使用的不断扩大，其管理变得越来越重要。然而，很少有基于证据的策略可以指导这些可能治愈的复发的治疗。代表国际肺癌研究协会 (IASLC) 的先进放射技术委员会 (ART)，撰写本文是为了解决复发性疾病的管理问题。讨论的主题包括诊断和检查，包括体积和功能成像以及组织病理学方法的作用；挽救治疗后的临床结果；挽救治疗后的复发模式；和管理选项。我们的主要结论是，充分挽救 LR 的患者的生存期与初次 SABR 后无复发的患者相似，而挽救 RR 的患者的生存期（无论淋巴结负荷或位置如何）与新发 III 期患者的生存期相似疾病。尽管超过一半接受挽救的患者不会出现第二次复发，但第二次失败的主要模式是遥远的，特别是对于 RR 而言。管理需要严格的多学科协调。孤立的 LR 可以通过切除和淋巴结清扫、重复 SABR、热消融或全身治疗来治疗。 RR 可以采用联合放化疗、单独放疗或化疗或支持性服务进行治疗。最后，建议在 SABR 挽救治疗后进行定期和结构化的随访。