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Kawamoto N, Furukawa M, Okita R, Okada M, Hayashi M, Inokawa H, Okabe K, Kawata K. Contralateral pulmonary resection using selective bronchial blockade in postpneumonectomy patients. Thorac Cancer 2020; 11:3528-3535. [PMID: 33052015 PMCID: PMC7705631 DOI: 10.1111/1759-7714.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Pulmonary resection is occasionally performed in postpneumonectomy patients with contralateral lung lesions, such as metachronous or metastatic lung cancer. Careful intraoperative respiratory management is essential in such patients. This study evaluated the respiratory management of postpneumonectomy patients who underwent contralateral pulmonary resection with selective bronchial blockade of the lobe or segment to be resected. METHODS We retrospectively analyzed the surgical findings and safety of surgery in six patients who underwent contralateral pulmonary resection with selective bronchial blockade after pneumonectomy for non-small cell lung cancer (NSCLC). RESULTS The percutaneous oxygen saturation did not decrease in any of the patients during bronchial blockade under high oxygen concentration. The median blockade time was 57.5 minutes. The operative field was tolerable secured under conditions of partial lung collapse, and partial pulmonary resection was performed as planned. Postoperatively, one patient developed acute respiratory distress syndrome due to acute exacerbation of interstitial pneumonia; however, no patients died within one month postoperatively. Two patients underwent pulmonary resection in order to obtain adequate tissue specimens to evaluate the biomarkers of multiple lung metastases. On histopathology, one patient tested positive for anaplastic lymphoma kinase (ALK) and was subsequently administered an ALK inhibitor, which prolonged survival. CONCLUSIONS In all patients, intraoperative respiratory condition under partial lung collapse remained stable, and all partial pulmonary resections were safely performed. However, surgical indications should be carefully reviewed preoperatively in patients with interstitial pneumonia. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: Contralateral partial pulmonary resection was performed using selective bronchial blockade in postpneumonectomy patients. Percutaneous oxygen saturation did not decrease during the bronchial blockade under high oxygen concentration, and the operative field was tolerable secured under conditions of partial lung collapse. WHAT THIS STUDY ADDS Oxygen concentration can be set to the minimum level, sufficient to maintain oxygenation, during contralateral partial pulmonary resection with selective bronchial blockade.
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Affiliation(s)
- Nobutaka Kawamoto
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
| | - Masashi Furukawa
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
| | - Riki Okita
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
| | - Masanori Okada
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
| | - Masataro Hayashi
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
| | - Hidetoshi Inokawa
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
| | - Kazunori Okabe
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
| | - Keisuke Kawata
- Department of Anesthesiology, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
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Aoki S, Yamashita H, Haga A, Ota T, Takahashi W, Ozaki S, Nawa K, Imae T, Abe O, Nakagawa K. Stereotactic body radiotherapy for centrally-located lung tumors with 56 Gy in seven fractions: A retrospective study. Oncol Lett 2018; 16:4498-4506. [PMID: 30214585 PMCID: PMC6126178 DOI: 10.3892/ol.2018.9188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/03/2018] [Indexed: 12/25/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) for centrally-located lung tumors remains a challenge because of the increased risk of treatment-related adverse events (AEs), and uncertainty around prescribing the optimal dose. The present study reported the results of central tumor SBRT with 56 Gy in 7 fractions (fr) at the University of Tokyo Hospital. A total of 35 cases that underwent SBRT with or without volumetric-modulated arc therapy consisting of 56 Gy/7 fr for central lung lesions between 2010 and 2016 at the University of Tokyo Hospital were reveiwed. A central lesion was defined as a tumor within 2 cm of the proximal bronchial tree (RTOG 0236 definition) or within 2 cm in all directions of any critical mediastinal structure. Local control (LC), overall survival (OS), and AEs were investigated. The Kaplan-Meier method was used to estimate LC and OS. AEs were scored per the Common Terminology Criteria for Adverse Events Version 4.0. Thirty-five patients with 36 central lung lesions were included. Fifteen lesions were primary non-small cell lung cancer (NSCLC), 13 were recurrences of NSCLC, and 8 had oligo-recurrences from other primaries. Median tumor diameter was 29 mm. Eighteen patients had had prior surgery. At a median follow-up of 13.1 months for all patients and 18.3 months in surviving patients, 22 patients had died, ten due to primary disease (4 NSCLC), while three were treatment-related. The 1- and 2-year OS were 57.3 and 40.4%, respectively, and median OS was 15.7 months. Local recurrence occurred in only two lesions. 1- and 2-year LC rates were both 96%. Nine patients experienced grade ≥3 toxicity, representing 26% of the cohort. Two of these were grade 5, one pneumonitis and one hemoptysis. Considering the background of the subject, tumor control of our central SBRT is promising, especially in primary NSCLC. However, the safety of SBRT to central lung cancer remains controversial.
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Affiliation(s)
- Shuri Aoki
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Akihiro Haga
- Medical and Dentistry Laboratory, University of Tokushima, Tokushima 770-8501, Japan
| | - Takeshi Ota
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Wataru Takahashi
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Sho Ozaki
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kanabu Nawa
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Toshikazu Imae
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Keiichi Nakagawa
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
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Pöttgen C, Abu Jawad J, Gkika E, Freitag L, Lübcke W, Welter S, Gauler T, Schuler M, Eberhardt WEE, Stamatis G, Stuschke M. Accelerated radiotherapy and concurrent chemotherapy for patients with contralateral central or mediastinal lung cancer relapse after pneumonectomy. J Thorac Dis 2015; 7:264-72. [PMID: 25922702 DOI: 10.3978/j.issn.2072-1439.2015.01.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/13/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Treatment options are very limited for patients with lung cancer who experience contralateral central or mediastinal relapse following pneumonectomy. We present results of an accelerated salvage chemoradiotherapy regimen. METHODS Patients with localized contralateral central intrapulmonary or mediastinal relapse after pneumonectomy were offered combined chemoradiotherapy including concurrent weekly cisplatin (25 mg/m(2)) and accelerated radiotherapy [accelerated fractionated (AF), 60 Gy, 8×2 Gy per week] to reduce time for repopulation. Based on 4D-CT-planning, patients were irradiated using multifield intensity-modulated radiotherapy (IMRT) or helical tomotherapy. RESULTS Between 10/2011 and 12/2012, seven patients were treated. Initial stages were IIB/IIIA/IIIB: 3/1/3; histopathological subtypes scc/adeno/large cell: 4/1/2. Tumour relapses were located in mediastinal nodal stations in five patients with endobronchial tumour in three patients. The remaining patients had contralateral central tumour relapses. All patients received 60 Gy (AF), six patients received concurrent chemotherapy. Median dose to the remaining contralateral lung, esophagus, and spinal cord was 6.8 (3.3-11.4), 8.0 (5.1-15.5), and 7.6 (2.8-31.2) Gy, respectively. With a median follow-up of 29 [17-32] months, no esophageal or pulmonary toxicity exceeding grade 2 [Common terminology criteria for adverse events (CTC-AE) v. 3] was observed. Median survival was 17.2 months, local in-field control at 12 months 80%. Only two local recurrences were observed, both in combination with out-field metastases. CONCLUSIONS This intensified accelerated chemoradiotherapy schedule was safely applicable and offers a curative chance in these pretreated frail lung cancer patients.
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Affiliation(s)
- Christoph Pöttgen
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Jehad Abu Jawad
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Eleni Gkika
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Lutz Freitag
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Wolfgang Lübcke
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Stefan Welter
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Thomas Gauler
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Martin Schuler
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Wilfried Ernst Erich Eberhardt
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Georgios Stamatis
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Martin Stuschke
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
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Xiong W, Xu Q, Xu Y, Sun C, Li N, Zhou L, Liu Y, Zhou X, Wang Y, Wang J, Bai S, Lu Y, Gong Y. Stereotactic body radiation therapy for post-pulmonary lobectomy isolated lung metastasis of thoracic tumor: survival and side effects. BMC Cancer 2014; 14:719. [PMID: 25260301 PMCID: PMC4189164 DOI: 10.1186/1471-2407-14-719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 09/24/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT) has emerged as an alternative treatment for patients with early stage non-small cell lung cancer (NSCLC) or metastatic pulmonary tumors. However, for isolated lung metastasis (ILM) of thoracic malignances after pulmonary lobectomy, reported outcomes of SBRT have been limited. This study evaluates the role of SBRT in the treatment of such patients. METHODS A retrospective search of the SBRT database was conducted in three hospitals. The parameters analyzed in the treated patients were local control, progression-free survival (PFS), overall survival (OS), and the treatment-related side-effects. RESULTS In total, 23 patients with single ILM after pulmonary lobectomy treated with SBRT were identified and the median follow-up time was 14 months (range: 6.0-47.0 months). Local recurrences were observed in two patients during follow-up and the 1-year local control rate was 91.3%. Median PFS and OS for the studied cohort were 10.0 months [95% confidence interval (CI) 5.1-14.9 months] and 21.0 months (95% CI 11.4-30.6 months), respectively. Acute radiation pneumonitis (RP) of grade 2 or worse was observed in five (21.7%) and three (13.0%) patients, respectively. Other treatment-related toxicities included chest wall pain in one patient (4.3%) and acute esophagitis in two patients (8.7%). By Pearson correlation analysis, the planning target volume (PTV) volume and the volume of the ipsilateral lung exposed to a minimum dose of 5 Gy (IpV5) were significantly related to the acute RP of grade 2 or worse in present study (p < 0.05). The optimal thresholds of the PTV and IpV5 to predict RP of acute grade 2 or worse RP were 59 cm3 and 51% respectively, according to the receiver-operating characteristics curve analysis, with sensitivity/specificity of 75.0%/80.0% and 62.5%/80.0%. CONCLUSIONS SBRT for post-lobectomy ILM was effective and well tolerated. The major reason for disease progression was distant failure but not local recurrence. The PTV and IpV5 are potential predictors of acute RP of grade 2 or higher and should be considered in treatment planning for such patients.
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Affiliation(s)
- Weijie Xiong
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
- />Chengdu Fifth People’s Hospital and Chengdu Third People’s Hospital, Chengdu, China
| | - Qingfeng Xu
- />Radiation Physics Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Yong Xu
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Changjin Sun
- />Department of Radiation Oncology, The Second People’s Hospital of Sichuan Province, Chengdu, 610031 PR China
- />Chengdu Fifth People’s Hospital and Chengdu Third People’s Hospital, Chengdu, China
| | - Na Li
- />Department of Oncology, Second Affiliated Hospital of Anhui Medical University, Hefei, 230601 PR China
| | - Lin Zhou
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Yongmei Liu
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Xiaojuan Zhou
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Yongsheng Wang
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Jin Wang
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Sen Bai
- />Radiation Physics Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - You Lu
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Youling Gong
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
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