Single lung resection of second primary after pneumonectomy for lung cancer

Stereotactic body radiation therapy for a new lung cancer arising after pneumonectomy: dosimetric evaluation and pulmonary toxicity

OBJECTIVE

To evaluate the tolerance of stereotactic body radiation therapy (SBRT) for the treatment of secondary lung tumours in patients who underwent previous pneumonectomy.

METHODS

12 patients were retrospectively analysed. The median maximum tumour diameter was 2.1 cm (1-4.5 cm). The median planning target volume was 20.7 cm(3) (2.4-101.2 cm(3)). Five patients were treated with a single fraction of 26 Gy and seven patients with fractionated schemes (3 × 10 Gy, 4 × 10 Gy, 4 × 12 Gy). Lung toxicity, correlated with volume (V) of lung receiving >5, >10 and >20 Gy, local control and survival rate were assessed. Median follow-up was 28 months.

RESULTS

None of the patients experienced pulmonary toxicity > grade 2 at the median dosimetric lung parameters of V5, V10 and V20 of 23.1% (range 10.7-56.7%), 7.3% (2.2-27.2%) and 2.7% (0.7-10.9%), respectively. No patients required oxygen or had deterioration of the performance status during follow-up if not as a result of clinical progression of disease. The local control probability at 2 years was 64.5%, and the overall survival at 2 years was 80%.

CONCLUSION

SBRT appears to be a safe and effective modality for treating patients with a second lung tumour after pneumonectomy.

ADVANCES IN KNOWLEDGE

Our results and similar literature results show that when keeping V5, V10 V20 <50%, <20% and <7%, respectively, the risk of significant lung toxicity is acceptable. Our experience also shows that biologically effective dose 10 >100 Gy, necessary for high local control rate, can be reached while complying with the dose constraints for most patients.

[Surgical treatment of pulmonary lesions in a single lung]

We performed surgery on 4 patients who had previously undergone left pneumonectomy and presented a second pulmonary lesion (3 lung cancers; 1 metastasis from colon cancer). Patients were aged between 52 and 79 years; 3 were men. Wedge resection was performed in 3 patients and segmentectomy in the other. Preoperative forced expiratory volumes in the first second were 1940 mL (72%), 576 mL (29%), 1390 mL (63%), and 2370 mL (63%). There was no perioperative mortality; 1 patient presented an air leak for 7 days. Two patients were alive and disease-free at 12 and 15 months, and 2 died from causes unrelated to the tumor at 52 and 183 months. There was no deterioration in the quality of life. In selected cases, patients with a second tumor in a single lung can be treated surgically with little or no mortality and with a prolonged survival.