Testing Repeat Radiation Therapy for Recurrent Non-small Cell Lung Cancer

You may be eligible if

• History of stage II-III NSCLC treated with fractionated (≤ 4 Gy per fraction) curative-intent (total dose ≥ 45 Gy) thoracic radiotherapy, completed ≥ 12 months before study entry
• Participants must have recurrent/progressive disease in the lung and/or regional lymph nodes that is not suitable for treatment with stereotactic body radiation therapy (SBRT) and for which palliative thoracic radiotherapy is not required at the time of study entry
• Biopsy to confirm recurrent/progressive disease at some point after the previous course of thoracic radiotherapy and before entering this study is required
• A portion of the disease that would be treated with radiotherapy on Arm 2 of this protocol must fall within the 50% isodose cloud of the radiotherapy plan
• New systemic lung cancer therapy initiated within 12 weeks prior to study entry that is still ongoing is not permitted
• Participants must not have definitive clinical or radiographic evidence of distant metastatic NSCLC at present or in the past
• Age ≥ 18
• Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-2
• Not Pregnant and Not Nursing
• * Negative urine or serum pregnancy test (in persons of childbearing potential) within 14 days prior to registration. Childbearing potential is defined as any person who has experienced menarche and who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or who is not postmenopausal
• Prior thoracic radiotherapy for NSCLC must have been delivered as definitive treatment, as opposed to in the preoperative or postoperative setting. One prior radiotherapy course must meet the specifications, and the radiotherapy plan from that course must be available in Digital Imaging and Communications in Medicine (DICOM) format
• Patients who have received additional prior radiotherapy (i.e., more than one prior radiotherapy course) may be enrolled, provided that only one prior radiotherapy course is deemed to affect the risks associated with treatment with radiotherapy on this study. As examples, prior radiotherapy for an extrathoracic malignancy would likely not affect the risks associated with reirradiation on this study. Prior radiotherapy for breast cancer may be permissible, depending on the extent of lung irradiation. Similarly, prior SBRT for a peripheral lung tumor may be permissible
• No prior SBRT for a central lung tumor, hilar lymph node, or mediastinal lymph node
• Prior lobar and sublobar lung resections are allowed, but prior pneumonectomy is not allowed
• Prior chemotherapy, targeted therapy, and/or immunotherapy for lung cancer is allowed
• No history of CTCAE version (v.) 5.0 grade 2-4 RT pneumonitis or ongoing CTCAE v. 5.0 grade 2-4 pneumonitis from any cause
• No clinically significant interstitial lung disease