0
Correspondence |

ResponseResponse FREE TO VIEW

Yotaro Izumi, MD; Yoshikane Yamauchi, MD; Osamu Kawaguchi, MD; Hiroaki Nomori, MD
Author and Funding Information

From the Division of General Thoracic Surgery, Department of Surgery (Drs Izumi, Yamauchi, and Nomori), and Department of Radiation Oncology (Dr Kawaguchi), School of Medicine, Keio University.

Correspondence to: Yotaro Izumi, MD, Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; e-mail: yotaroizumi@a2.keio.jp

Financial/nonfinancial disclosures: The authors have reported to CHEST 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 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):264. doi:10.1378/chest.12-0719
Text Size: A A A
Published online

To the Editor:

We thank Dr Senthi and colleagues for their interest in our CHEST article.1 We agree that the work by Haasbeek et al2 should have been cited in our article. Although the median follow-up of 16.5 months is rather short, the results are impressive with no local failures and only two of 15 ≤ grade 3 lung-associated toxicities. We agree that stereotactic radiotherapy (SRT) is a less invasive procedure in comparison with cryoablation, particularly if it is done without the implantation of fiducial markers.

In terms of safety, pneumothorax after cryoablation can be sufficiently managed by course observation, by chest tube insertion, or, if persistent, by medical pleurodesis. However, in single-lung patients, delayed pneumothorax may have serious consequences if access to medical facilities is limited. We have previously reported that the incidence of delayed pneumothorax after cryoablation occurred in 30 of 193 patients (16%), mostly at 3 days after cryoablation still during admission. However, the incidence could occur as late as 20 days after cryoablation, and eight of these patients were readmitted after being discharged. Therefore, if the incidence of pulmonary toxicities after SRT is actually as low as generally reported (≤ grade 2, 5% ∼10%), we agree that SRT should be offered as a primary treatment option even in single-lung patients.

However, one concern remains. To date, SRT for lung cancer has been evaluated mostly in inoperable patients, many with COPD. A recent report suggests that radiation pneumonitis may be milder in patients with COPD in comparison to patients with normal lung function.3 Another study shows that the decline in pulmonary function after SRT was less in patients with COPD in comparison to patients who underwent SRT primarily because of cardiac comorbidities.4 In a study of SRT in medically operable patients with lung cancer, grade 3 pulmonary toxicity was noted in only one patient (1.1%), but this was a retrospective study, and 38 of 87 patients in this study had underlying chronic lung diseases.5 The majority of patients in the study by Haasbeek et al2 were also patients with COPD. Therefore, we consider that the incidence of pulmonary toxicities after SRT in patients with normal lung function is still unclear. Ongoing prospective studies on SRT in patients with operable lung cancer with normal lung function will provide answers to this issue.

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.
 
Takeda A, Kunieda E, Ohashi T, et al. Severe COPD is correlated with mild radiation pneumonitis following stereotactic body radiotherapy. Chest. 2012;141(4):858-866.
 
Baumann P, Nyman J, Hoyer M, et al. Stereotactic body radiotherapy for medically inoperable patients with stage I non-small cell lung cancer–a first report of toxicity related to COPD/CVD in a non-randomized prospective phase II study. Radiother Oncol. 2008;88(3):359-367.
 
Onishi H, Shirato H, Nagata Y, et al. Stereotactic body radiotherapy (SBRT) for operable stage I non-small-cell lung cancer: can SBRT be comparable to surgery? Int J Radiat Oncol Biol Phys. 2011;81(5):1352-1358.
 

Figures

Tables

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.
 
Takeda A, Kunieda E, Ohashi T, et al. Severe COPD is correlated with mild radiation pneumonitis following stereotactic body radiotherapy. Chest. 2012;141(4):858-866.
 
Baumann P, Nyman J, Hoyer M, et al. Stereotactic body radiotherapy for medically inoperable patients with stage I non-small cell lung cancer–a first report of toxicity related to COPD/CVD in a non-randomized prospective phase II study. Radiother Oncol. 2008;88(3):359-367.
 
Onishi H, Shirato H, Nagata Y, et al. Stereotactic body radiotherapy (SBRT) for operable stage I non-small-cell lung cancer: can SBRT be comparable to surgery? Int J Radiat Oncol Biol Phys. 2011;81(5):1352-1358.
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543