title: Lung-conserving treatment of a pulmonary oligometastasis with a wedge resection and 131Cs brachytherapy.
abstract: OBJECTIVE
  Soft-tissue sarcomas most frequently metastasize to the lung. Surgical resection of pulmonary metastases is the primary treatment modality. Although lobectomy is widely acknowledged as the standard procedure to treat primary pulmonary tumors, the standard for pulmonary metastases is not well defined; furthermore, compromised lung function may tip the scales in favor of a less invasive approach. Here, we report the results of a patient treated with wedge resection and intraoperative cesium-131 ((131)Cs).
  
  
  METHODS
  A 58-year-old African American female was diagnosed with the American Joint Committee on Cancer Stage IIA mixed uterine leiomyosarcoma and underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by adjuvant external beam radiotherapy to a total dose of 45 Gy and vaginal brachytherapy to a total dose of 20 Gy. At 2 years, a routine CT scan of the chest revealed metastasis to right upper lobe of the lung. The patient's poor pulmonary function, related to a 45 pack-year smoking history and chronic emphysema, precluded a lobectomy.
  
  
  RESULTS
  After the patient underwent a lung-sparing wedge resection of the pulmonary right upper lobe metastasis and intraoperative brachytherapy with (131)Cs seeds to a total dose of 80 Gy, she remained disease free in the implanted area. At a 2-year followup, imaging continued to reveal 100% local control of the area treated with wedge resection and intraoperative (131)Cs brachytherapy. The patient had no complications from this treatment.
  
  
  CONCLUSIONS
  Such treatment approach may become an attractive option in patients with oligometastatic disease and compromised pulmonary function.
authors.affiliation: Department of Stich Radiation Oncology, Weill Medical College of Cornell University, New York, NY. Electronic address: gaw9008@med.cornell.edu.
authors.forename: A Gabriella
authors.initials: AG
authors.lastname: Wernicke
authors.forename: Apurva
authors.initials: A
authors.lastname: Parikh
authors.forename: Menachem
authors.initials: M
authors.lastname: Yondorf
authors.forename: Samuel
authors.initials: S
authors.lastname: Trichter
authors.forename: Divya
authors.initials: D
authors.lastname: Gupta
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Port
authors.forename: Bhupesh
authors.initials: B
authors.lastname: Parashar
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007890:Leiomyosarcoma / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D012509:Sarcoma / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014594:Uterine Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery
keywords: Brachytherapy; Cesium-131; Lung-conserving surgery; Pulmonary oligometastasis; Wedge resection