Curative radiotherapy for a second primary lung cancer arising after pneumonectomy : techniques and results
Faculty of Medicine and Health Sciences
Radiotherapy and oncology. - Amsterdam
, p. 21-25
Background and purpose: Only limited data exist on the outcome of curative radiotherapy in patients who develop a second primary lung tumour after pneumonectomy. The treatment of eight such patients is described. Materials and methods: The case records of patients who underwent curative radiotherapy for stage I non-small cell lung cancer after a previous pneumonectomy were reviewed. Treatment was delivered using 3D external radiotherapy to a dose of 50-70 Gy, in once-daily fractions of 2-2.5 Gy. An endobronchial brachytherapy boost was used in three patients. Original treatments were re-planned in an attempt to minimize the volume of irradiated lung. Results: A complete remission was achieved in five (of six) evaluable patients, but two patients subsequently developed a local relapse. All patients survived for a minimum of 1 year after treatment. Only one patient developed significant (grade 2) radiation pneumonitis, When treatments were re-planned to optimize beam arrangements. and when customized blocks were used, the mean lung volume receiving greater than or equal to20 Gy (calculated for 70 Gy) decreased from 24.6+/-4.1 (range, 18-31%) to 17.3+/-5.1% (range, 12-26%). Similarly, the radiation conformity index improved from 0.44+/-0.11 to 0.61+/-0.06. Conclusions: Involved-field radiotherapy can be Curative in patients who develop a new lung tumour after pneumonectomy. Recent advances in defining target Volumes. treatment planning and delivery are likely to improve upon these results. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.