title: Surgical treatment of local recurrence after stereotactic body radiotherapy for primary and metastatic lung cancers.
abstract: BACKGROUND
  Stereotactic body radiotherapy (SBRT) has been proposed as an alternative to surgery for the treatment of lung cancer. The treatment of local recurrence that occurs after SBRT has not been reported. We present surgical outcomes for local recurrence following SBRT for primary and metastatic lung cancers.
  
  
  METHODS
  Seven of the patients who received SBRT between 2002 and 2008 underwent salvage surgery for local recurrence. These seven patients (two with stage I non-small cell lung cancer and five with metastatic tumors) were operable, although they refused surgery and chose SBRT for the first treatment as a less invasive procedure.
  
  
  RESULTS
  Six of the seven patients underwent lobectomy, and the other patient underwent segmentectomy. None of the seven patients had direct pleural adhesion resulting from SBRT, although, in general, radiation fibrosis occurs after radiotherapy and induces pleural adhesion that makes surgery difficult.
  
  
  CONCLUSIONS
  Our study suggests that SBRT may not be the cause of difficulties encountered during the surgical process, and surgery is a good alternative treatment for local recurrence after SBRT. During follow-up after SBRT, the appearance of tumor regrowth on lung images resembled that of inflammatory changes such as radiation pneumonitis. We suggest that close follow-ups should be mandatory after SBRT.
authors.affiliation: Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan. nerithoracsurg@yahoo.co.jp
authors.forename: Shinya
authors.initials: S
authors.lastname: Neri
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Takuya
authors.initials: T
authors.lastname: Terashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hamakawa
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tomii
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Katakami
authors.forename: Masaki
authors.initials: M
authors.lastname: Kokubo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D049268:Positron-Emission Tomography; D016634:Radiosurgery; D012189:Retrospective Studies; D016879:Salvage Therapy
chemical_list: D019788:Fluorodeoxyglucose F18