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Correspondence |

Treatment of Peripheral Lung Tumors Arising After a Prior PneumonectomyPostpneumonectomy Stereotactic Radiotherapy FREE TO VIEW

Sashendra Senthi, MBChB; Naomi E. Verstegen, BSc; Suresh Senan, PhD, FRCR
Author and Funding Information

From the Department of Radiation Oncology, VU University Medical Center.

Correspondence to: Sashendra Senthi, MBChB, Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; e-mail: s.senthi@vumc.nl

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: The Department of Radiation Oncology, VU University Medical Center, has a research agreement with Varian Medical Systems, Inc. Dr Senan has received speakers honoraria from Varian Medical Systems, Inc. Dr Senthi and Ms Verstegen have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: The Department of Radiation Oncology, VU University Medical Center, has a research agreement with Varian Medical Systems, Inc. Dr Senan has received speakers honoraria from Varian Medical Systems, Inc. Dr Senthi and Ms Verstegen have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(1):263. doi:10.1378/chest.12-0378
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To the Editor:

We read with interest the report from Yamauchi et al1 in an issue of CHEST (December 2011) on the use of percutaneous cryoablation to manage lung tumors arising in the contralateral lung postpneumonectomy. The authors indicated they were unaware of reported outcomes for the use of stereotactic radiotherapy (SRT) in this group of patients. In 2009, we reported such outcomes for 15 patients presenting with a new primary lung cancer after prior pneumonectomy.2 One-half of these patients had severe COPD, with maximum tumor diameters ranging between 8 and 38 mm and no local failures after a median follow-up of 16.5 months (range, 4-55 months). In contrast to percutaneous cryoablation, SRT is performed as an outpatient treatment, typically in a few minutes using modern delivery units and with high accuracy, as on-table CT scans permit verification of target position prior to delivery.3 Additionally, SRT delivery does not always require percutaneous insertion of fiducial makers, eliminating the accompanying risk of morbidity and mortality in patients with a single lung.

The authors previously reported a 60% incidence of pneumothorax, 17% of which required chest tube drainage, and 70% and 35% incidence of pleural effusion and hemoptysis, respectively, after 193 sessions of percutaneous cryoablation.4 Similarly, a population-based analysis of complications following transthoracic lung biopsy of peripheral lung nodules reported the risk for any pneumothorax was 15.0% (95% CI, 14.0%-16.0%), with a 6.6% (95% CI, 6.0%-7.2%) overall risk of chest tube insertion.5 Because local control rates in excess of 90% have been reported for patients undergoing SRT in prospective multicenter settings,3 we suggest that SRT should be offered as a standard treatment option in all patients presenting with a new lung tumor postpneumonectomy. In patients who are at a lower risk of complications arising from pneumothorax, we would agree that comparative trials among modalities such as cryoablation, radiofrequency ablation, and SRT merit study.

Yamauchi Y, Izumi Y, Yashiro H, et al. Percutaneous cryoablation for pulmonary nodules in the residual lung after pneumonectomy: report of two cases. Chest. 2011;140(6):1633-1637. [PubMed] [CrossRef]
 
Haasbeek CJ, Lagerwaard FJ, de Jaeger K, Slotman BJ, Senan S. Outcomes of stereotactic radiotherapy for a new clinical stage I lung cancer arising postpneumonectomy. Cancer. 2009;115(3):587-594.
 
Palma D, Senan S. Stereotactic radiation therapy: changing treatment paradigms for stage I nonsmall cell lung cancer. Curr Opin Oncol. 2011;23(2):133-139.
 
Inoue M, Nakatsuka S, Yashiro H, et al. Percutaneous cryoablation of lung tumors: feasibility and safety. J Vasc Interv Radiol. 2012;23(3):295-302.
 
Wiener RS, Schwartz LM, Woloshin S, Welch HG. Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records. Ann Intern Med. 2011;155(3):137-144.
 

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References

Yamauchi Y, Izumi Y, Yashiro H, et al. Percutaneous cryoablation for pulmonary nodules in the residual lung after pneumonectomy: report of two cases. Chest. 2011;140(6):1633-1637. [PubMed] [CrossRef]
 
Haasbeek CJ, Lagerwaard FJ, de Jaeger K, Slotman BJ, Senan S. Outcomes of stereotactic radiotherapy for a new clinical stage I lung cancer arising postpneumonectomy. Cancer. 2009;115(3):587-594.
 
Palma D, Senan S. Stereotactic radiation therapy: changing treatment paradigms for stage I nonsmall cell lung cancer. Curr Opin Oncol. 2011;23(2):133-139.
 
Inoue M, Nakatsuka S, Yashiro H, et al. Percutaneous cryoablation of lung tumors: feasibility and safety. J Vasc Interv Radiol. 2012;23(3):295-302.
 
Wiener RS, Schwartz LM, Woloshin S, Welch HG. Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records. Ann Intern Med. 2011;155(3):137-144.
 
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