title: Pulmonary thermal ablation in patients with prior pneumonectomy.
abstract: OBJECTIVE
  The purpose of this article is to review the safety and efficacy of thermal ablation of lung malignancies after pneumonectomy.
  
  
  METHODS
  We reviewed patients who underwent thermal ablation for malignant lung tumors after pneumonectomy between 1999 and 2009. Patient demographics, complications, procedural success, and oncologic outcomes were recorded. Technique effectiveness was evaluated at imaging 4-6 weeks after ablation. The Kaplan-Meier method was used to evaluate overall survival. A cumulative incidence and competing risk method was used to account for progression-free tumors at the time of patient death.
  
  
  RESULTS
  Of 619 lung ablations, 17 were performed to treat 13 tumors (nine primary and four metastatic) in 12 patients with a single lung. The median tumor size was 2 cm (range, 1.2-4 cm). Technical success was documented in all 17 cases. Technical effectiveness was documented in 10 of 12 patients. Local tumor progression occurred in five lesions within a median of 12 months (range, 10-22 months) after ablation and was treated with repeat ablation in four lesions. Complications included six (35%) of 17 pneumothoraces requiring thoracostomy. Deaths occurred within 2-12 days after three (19%) of 16 ablation sessions. The median time to primary local tumor progression was 18 months (95% CI, 12 months through not reached), and the median time to assisted (after repeat ablation) local tumor progression was 33 months (95% CI, not reached). Median overall survival was 21 months (95% CI, 18-53 months). After excluding the two early deaths complicating the initial ablation procedure, median overall survival was 37 months.
  
  
  CONCLUSIONS
  Thermal ablation can offer local tumor control after pneumonectomy, despite a relatively high postprocedure clinical risk.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. sofoclec@mskcc.org
authors.forename: Constantinos T
authors.initials: CT
authors.lastname: Sofocleous
authors.forename: Benjamin
authors.initials: B
authors.lastname: May
authors.forename: Elena N
authors.initials: EN
authors.lastname: Petre
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: Raymond H
authors.initials: RH
authors.lastname: Thornton
authors.forename: William
authors.initials: W
authors.lastname: Alago
authors.forename: Nabil P
authors.initials: NP
authors.lastname: Rizk
authors.forename: Damian E
authors.initials: DE
authors.lastname: Dupuy
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation; D015331:Cohort Studies; D005240:Feasibility Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D011013:Pneumonectomy; D015641:Radiography, Interventional; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome