Resection of second primary lung tumors that arise after previous pneumonectomy is associated with a high risk of complications. In this study, the authors reviewed outcomes after stereotactic radiation therapy (SRT) for such patients.  SRT was undergone by 15 patients who developed a new clinical stage I lung cancer at a median of 8.9 years postpneumonectomy, half of whom had severe chronic obstructive pulmonary disorder (COPD). SRT target volumes encompassed all respiratory motion using 4-dimensional computed tomography (CT) scans, and risk-adapted radiation schemes that ranged from 3 × 20 grays (Gy) to 8 × 7.5 Gy were used, depending on tumor size, location, and overlap with prior radiation treatment. All schemes had a biologic effective dose >100 Gy. Follow-up CT scans were obtained at 3 months, 6 months, and 12 months after SRT and yearly thereafter.|

RESULTS:At a median follow-up of 16.5 months, no local failures were observed, and only 2 patients experienced grade 3 toxicity. One patient had transient pneumonitis that required steroids, and another patient required an increase in oxygen use. The 1-year actuarial disease-free survival rate was 92%. One patient died 10 months post-SRT after developing regional and distant metastases, and 1 patient developed an isolated regional failure. All other patients remained alive and disease free.  SRT was a safe and effective treatment for stage I lung tumors that arose after prior pneumonectomy, even in patients who had severe COPD. SRT was tolerated well, and the current findings suggest that surveillance for second tumors is indicated in all patients after pneumonectomy.