Curative radiotherapy for a second primary lung cancer arising after pneumonectomy -- techniques and results.
OBJECTIVE
Only limited data exist on the outcome of curative radiotherapy in patients who develop a second primary lung tumour after pneumonectomy. The treatment of eight such patients is described.


METHODS
The case records of patients who underwent curative radiotherapy for stage I non-small cell lung cancer after a previous pneumonectomy were reviewed. Treatment was delivered using 3D external radiotherapy to a dose of 50-70 Gy, in once-daily fractions of 2-2.5 Gy. An endobronchial brachytherapy boost was used in three patients. Original treatments were re-planned in an attempt to minimize the volume of irradiated lung.


RESULTS
A complete remission was achieved in five (of six) evaluable patients, but two patients subsequently developed a local relapse. All patients survived for a minimum of 1 year after treatment. Only one patient developed significant (grade 2) radiation pneumonitis. When treatments were re-planned to optimize beam arrangements, and when customized blocks were used, the mean lung volume receiving > or = 20 Gy (calculated for 70 Gy) decreased from 24.6+/-4.1 (range, 18-31%) to 17.3+/-5.1% (range, 12-26%). Similarly, the radiation conformity index improved from 0.44+/-0.11 to 0.61+/-0.06.


CONCLUSIONS
Involved-field radiotherapy can be curative in patients who develop a new lung tumour after pneumonectomy. Recent advances in defining target volumes, treatment planning and delivery are likely to improve upon these results.
Lagerwaard
Frank J
FJ
University Hospital Rotterdam, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands.
Voet
Peter W J
PW
van Meerbeeck
Jan P
JP
Burgers
Sjaak A
SA
Senan
Suresh
S
D000368:Aged; D001918:Brachytherapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000532:radiotherapy*; D011013:Pneumonectomy; D011183:Postoperative Complications