Stereotactic body radiation therapy for a new lung cancer arising after pneumonectomy: dosimetric evaluation and pulmonary toxicity.
OBJECTIVE
To evaluate the tolerance of stereotactic body radiation therapy (SBRT) for the treatment of secondary lung tumours in patients who underwent previous pneumonectomy.


METHODS
12 patients were retrospectively analysed. The median maximum tumour diameter was 2.1 cm (1-4.5 cm). The median planning target volume was 20.7 cm(3) (2.4-101.2 cm(3)). Five patients were treated with a single fraction of 26 Gy and seven patients with fractionated schemes (3 × 10 Gy, 4 × 10 Gy, 4 × 12 Gy). Lung toxicity, correlated with volume (V) of lung receiving >5, >10 and >20 Gy, local control and survival rate were assessed. Median follow-up was 28 months.


RESULTS
None of the patients experienced pulmonary toxicity > grade 2 at the median dosimetric lung parameters of V5, V10 and V20 of 23.1% (range 10.7-56.7%), 7.3% (2.2-27.2%) and 2.7% (0.7-10.9%), respectively. No patients required oxygen or had deterioration of the performance status during follow-up if not as a result of clinical progression of disease. The local control probability at 2 years was 64.5%, and the overall survival at 2 years was 80%.


CONCLUSIONS
SBRT appears to be a safe and effective modality for treating patients with a second lung tumour after pneumonectomy.


CONCLUSIONS
Our results and similar literature results show that when keeping V5, V10 V20 <50%, <20% and <7%, respectively, the risk of significant lung toxicity is acceptable. Our experience also shows that biologically effective dose 10 >100 Gy, necessary for high local control rate, can be reached while complying with the dose constraints for most patients.
1 Department of Radiation Oncology, Policlinico Abano Terme, Padua, Italy.
Alessandro
A
Testolin
2 Department of Radiation Oncology, San Bortolo Hospital, Vicenza, Italy.
Maria Silvia
MS
Favretto
3 Department of Medical Physics, San Bortolo Hospital, Vicenza, Italy.
Stefania
S
Cora
4 Department of Medical Physics, University of Verona, Borgo Trento Hospital, Verona, Italy.
Carlo
C
Cavedon
D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000601:surgery*; D011013:Pneumonectomy; D011874:Radiometry; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome