title: Severe Chest Wall Toxicity From Cryoablation in the Setting of Prior Stereotactic Ablative Radiotherapy.
abstract: We present the case of a 42-year-old woman with metastatic synovial sarcoma of parotid origin, treated definitively with chemoradiation, who subsequently developed oligometastatic disease limited to the lungs. She underwent multiple left and right lung wedge resections and left lower lobectomy, followed by right lower lobe stereotactic ablative radiotherapy (SABR), 54 Gy in three fractions to a right lower lobe lesion abutting the chest wall. Two years later, she was treated with cryoablation for a separate right upper lobe nodule abutting the chest wall. Two months later, she presented with acute shortness of breath, pleuritic chest pain, decreased peripheral blood O2 saturation, and productive cough. A computed tomography (CT) scan demonstrated severe chest wall necrosis in the area of recent cryoablation that, in retrospect, also received a significant radiation dose from her prior SABR. This case demonstrates that clinicians should exercise caution in using cryoablation when treating lung tumors abutting a previously irradiated chest wall. Note: Drs. Loo and Shah contributed equally as co-senior authors.
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine.
authors.forename: Aadel A
authors.initials: AA
authors.lastname: Chaudhuri
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Binkley
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine.
authors.forename: Sonya
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine.
authors.forename: Yushen
authors.initials: Y
authors.lastname: Qian
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine.
authors.forename: Justin N
authors.initials: JN
authors.lastname: Carter
authors.affiliation: Department of Interventional Radiology, Stanford University School of Medicine.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Shah
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine ; Stanford Cancer Institute.
authors.forename: Billy W
authors.initials: BW
authors.lastname: Loo
keywords: chest wall necrosis; cryoablation; cryoablation toxicity; interventional oncology; metastatic cancer; oligometastasis; radiation related toxicities; stereotactic ablative radiotherapy (sabr); stereotactic body radiation therapy; synovial sarcoma