Stereotactic body radiation therapy (SBRT) is considered the standard of care for treatment of inoperable early stage non-small cell carcinoma of the lung. SBRT delivers a very high dose of ionizing radiation to a relatively small region encompassing the tumor and spares a significant portion of the remaining lung from high doses. However, the conformal high dose comes at the expense of treating a larger volume of normal lung to lower doses. In general, this has been deemed to be acceptable with an overall lower risk of radiation pneumonitis. However, in the face of predisposing factors, the higher doses delivered by this technique may lead to an increase in radiation pneumonitis. We report on two patients being treated with SBRT in which severe radiation pneumonitis developed in spite of our radiation dosimetry being significantly below the acceptable limit for lung toxicity. Both patients developed a “fulminant” form of radiation pneumonitis with radiographic abnormalities well beyond the treated volume. In one patient, the disease proved fatal. Both patients were on amiodarone at the time SBRT was administered. Given the rarity of fulminant radiation pneumonitis, especially with the relatively small fields treated by SBRT, we suspect that amiodarone enhanced the pulmonary toxicity.
PurposeThe Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) reported that the risks of breast cancer treatment in woman smokers may outweigh the benefits. The data used doses from published reports using a variety of treatment techniques. In our study, the risks of lung cancer and heart disease were determined from a modern era tangential-only technique.Methods and materialsDoses to the lung and heart were obtained for tangential radiotherapy to the breast or chest wall. The risk of lung cancer incidence and cardiac mortality were calculated by taking the ratio of our doses to those published by the EBCTG.ResultsA total of 77 women were identified meeting our inclusion criteria. The mean combined whole lung dose was 2·0 Gy. The mean whole heart dose was 0·9 Gy. The estimated risk of lung cancer and cardiac mortality in a 50-year-old life-long smoker was estimated to be 1·5 and <1%, respectively.ConclusionsTangential only radiotherapy delivered substantially lower doses to the combined whole lung and whole heart than those reported by the EBCTCG. In this cohort, the risks of radiation induced lung cancer and heart disease are outweighed by the benefits of radiotherapy even in those that are smokers.
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