Chaudhuri Aadel A, Binkley Michael S, Aggarwal Sonya, Qian Yushen, Carter Justin N, Shah Rajesh, Loo Billy W
Department of Radiation Oncology, Stanford University School of Medicine.
Department of Interventional Radiology, Stanford University School of Medicine.
Cureus. 2016 Feb 2;8(2):e477. doi: 10.7759/cureus.477.
We present the case of a 42-year-old woman with metastatic synovial sarcoma of parotid origin, treated definitively with chemoradiation, who subsequently developed oligometastatic disease limited to the lungs. She underwent multiple left and right lung wedge resections and left lower lobectomy, followed by right lower lobe stereotactic ablative radiotherapy (SABR), 54 Gy in three fractions to a right lower lobe lesion abutting the chest wall. Two years later, she was treated with cryoablation for a separate right upper lobe nodule abutting the chest wall. Two months later, she presented with acute shortness of breath, pleuritic chest pain, decreased peripheral blood O2 saturation, and productive cough. A computed tomography (CT) scan demonstrated severe chest wall necrosis in the area of recent cryoablation that, in retrospect, also received a significant radiation dose from her prior SABR. This case demonstrates that clinicians should exercise caution in using cryoablation when treating lung tumors abutting a previously irradiated chest wall. Note: Drs. Loo and Shah contributed equally as co-senior authors.
我们报告了一例42岁女性，患有腮腺来源的转移性滑膜肉瘤，接受了放化疗的根治性治疗，随后出现局限于肺部的寡转移疾病。她接受了多次左右肺楔形切除术和左肺下叶切除术，随后对右肺下叶与胸壁相邻的病变进行了立体定向消融放疗（SABR），分三次给予54 Gy。两年后，她因右肺上叶一个与胸壁相邻的独立结节接受了冷冻消融治疗。两个月后，她出现急性气短、胸膜炎性胸痛、外周血氧饱和度降低和咳痰。计算机断层扫描（CT）显示，在最近冷冻消融的区域出现严重胸壁坏死，回顾发现该区域之前也接受了来自SABR的高剂量辐射。该病例表明，临床医生在治疗与先前接受过放疗的胸壁相邻的肺部肿瘤时，使用冷冻消融应谨慎。注意：卢医生和沙阿医生作为共同资深作者贡献相同。
