Lung SBRT after pneumonectomy
Lung SBRT after pneumonectomy
Angela Botticella1, Antonin Levy1, Olaf Mercier2, Guillaume Auzac1, Aicha Traore-Diallo3, Maxime Frelaut4, Pauline Pradere2, Caroline Caramella5, Ines Kasraoui6, Benjamin Besse4, David Planchard4, Cécile Le Pechoux1
1Gustave Roussy, Radiation Oncology, Villejuif, France; 2Marie-Lannelongue Hospital, Thoracic and Vascular Surgery and Heart-Lung Transplantation Department, Plessis Robinson, France; 3Gustave Roussy , Radiation Oncology, Villejuif, France; 4Gustave Roussy, Oncology Department, Villejuif, France; 5Marie-Lannelongue Hospital, Radiology Department, Plessis Robinson, France; 6Gustave Roussy, Radiology Department, Villejuif, France
Purpose or Objective
The objective of this retrospective study was
to assess the efficacy and the safety of the SBRT in patients with prior
pneumonectomy and a new lung malignancy.
Material and Methods
We retrospectively identified the patients who
received SBRT post-pneumonectomy from a single institution database of patients
treated with SBRT from January 2013 and June 2021.
Image-guided SBRT was delivered either with a
Cyberknife or with a linear accelerator (in VMAT or with static coplanar
beams). Lesions localised in the inferior lobes were treated using deep-inspiration
breath-hold (DIBH). The prescription
dose was 26-60 Gy in 7.5- to 26-Gy fractions delivered to the PTV (according to
a risk-adapted approach).
All patients underwent a restaging 18F-PET-CT
scan before SBRT. A biopsy of the lung lesion was not mandatory, if the lesion
was hyper-metabolic at a 18F-PET-CT scan and growing on multiple CT
scans. Each patient was discussed in a multidisciplinary team before SBRT.
primary endpoint was toxicity (lung, cardiac, oesophageal), graded using the
Common Toxicity Criteria (CTC) v. 4.03. The secondary endpoints were local control,
distant metastases-free survival and overall survival (OS). Dosimetric parameters
Twenty-eight patients with prior pneumonectomy,
treated with SBRT on 32 metastatic lesions, were identified. Median age was 62.3 years
(range: 48-85). Twenty-four patients (86%) had a previous pneumonectomy for non-small
cell lung cancer (NSCLC), 1 for a kidney cancer, 1 for a thymoma, 1 for a
sarcoma and 1 for a colon cancer. The median time between pneumonectomy and
SBRT was 70.34 months (SD: 143.16). Four patients had previous thoracic
adjuvant radiotherapy, with doses ranging from 45 to 66 Gy in 20 to 33
fractions. Only one lesion was confirmed by biopsy. Median GTV was 4.06 mL (range:
0.39-110.65), median PTV was 16.32 mL (range: 3.6-231.35). Median MLD was 3 Gy
The median follow-up time was 28.9 months (SD:
11). No grade >3 toxicity was observed.
Twenty-one lesions (36.6%) were treated with
static coplanar fields, 8 lesions (25%) were treated with VMAT and 2 lesions
(6%) with static non-coplanar fields with a Cyberknife. Motion management was
obtained in 18 lesions (56%) with a 4D-CT scan, in 12 lesions (37.5%) with DIBH
and in 2 lesions with a tracking system (Cyberknife).
One local failure was registered. There were 2
regional failures and 10 distant failures. The median OS was 33.6 months
(range: 3-73 months). The median
OS was 33.6 months [CI95% :
2-73] and 1-, 2- and 5-years OS rates were respectively of 85%, 72% and 42%.
This study (the largest cohort to date) shows
that local-control and long-term survival can be achieved with acceptable
toxicity in this population with limited therapeutic options. An accurate
motion management (with 40% of the lesions being treated with either DIBH or
tracking) is mandatory.