title: Efficacy and safety of stereotactic ablative radiotherapy in patients with previous pneumonectomy.
abstract: BACKGROUND
  Thoracic surgery for a newly diagnosed primary lung tumor following a previous pneumonectomy is rarely indicated. Stereotactic ablative radiotherapy (SABR) might represent a curative option. This report focuses on outcomes, toxicity and quality of life (QoL) after SABR.
  
  
  METHODS
  Nine patients were treated with SABR between 2004 and 2011; median time since surgery was 8.4 years. In 4 cases, a histological confirmation was possible with bronchoscopy. In 5 cases, the clinical proof of malignancy was based on radiological criteria. Forced expiratory volume in 1 second (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) were tested in all patients. A SABR biologically equivalent dose of &gt;100 Gy was prescribed in all cases. QoL questionnaire forms were administered before SABR and during follow-up.
  
  
  RESULTS
  Median follow-up was 41.8 months. We did not observe grade ≥3 acute toxicity, and concerning late toxicity, we registered 2 cases. QoL was decreased during the first 12 months of follow-up, followed by a progressive improvement after this time. One patient had a local relapse at 7.4 years; 1 developed a new nodule at 5.5 years, associated with metastases; and 1 developed a new nodule without any systemic disease at 3 years. There were 2 cancer-related deaths (18.2%) at 3 and 12 months after progression.
  
  
  CONCLUSIONS
  Data support efficacy and safety of SABR in patients with a new primary lung cancer following previous pneumonectomy, with acceptable acute, late toxicity profile and without significant impairment of QoL. Our results were comparable to those in the literature.
authors.affiliation: Department of Oncology, Radiation Oncology Unit, University of Torino, Torino - Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Giaj Levra
authors.forename: Andrea Riccardo
authors.initials: AR
authors.lastname: Filippi
authors.forename: Alessia
authors.initials: A
authors.lastname: Guarneri
authors.forename: Serena
authors.initials: S
authors.lastname: Badellino
authors.forename: Cristina
authors.initials: C
authors.lastname: Mantovani
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy / Q000601:surgery*; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011788:Quality of Life; D017564:Radiation Pneumonitis / Q000209:etiology; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D011795:Surveys and Questionnaires; D016896:Treatment Outcome