CT appearance of radiation injury of the lung and clinical symptoms after stereotactic body radiation therapy (SBRT) for lung cancers: Are patients with pulmonary emphysema also candidates for SBRT for lung cancers?

Kimura, Tomoki; Matsuura, K.; Murakami, Yuji; Hashimoto, Yasutoshi; Kenjo, Masahiro; Kaneyasu, Yuko; Wadasaki, Koichi; Hirokawa, Yutaka; Ito, Katsuhide; Okawa, Motoomi

doi:10.1016/j.ijrobp.2006.05.008

Cited by 113 publications

(74 citation statements)

References 13 publications

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“…These findings replicate those obtained from a smaller series by the use of the same technique 31 and are in agreement with a similar study that investigated radiological changes in 45 patients (52 tumours) treated with non-HT-SABR. 32 Our study, however, has several limitations: as a matter of fact, only half of the patients received a prescription dose which is consistent with recommended guidelines supporting a BED 10 used for SABR treatment of at least 100 Gy. [33][34][35] Our practice has been to treat frail patients with large target volumes and/or central tumours with a less-intensive dose-fractionation schedule, which is reflected in the delivery of a lower BED 10 .…”

Section: Discussionmentioning

confidence: 94%

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

Arcangeli

Falcinelli²,

Bracci

et al. 2017

The British Journal of Radiology

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Cite this article as: Arcangeli S, Falcinelli L, Bracci S, Greco A, Monaco A, Dognini J, et al. Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours. Objective: To evaluate treatment outcomes and patterns of CT lung injury after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) in a series of inoperable lung lesions. Methods: 68 patients who were medically inoperable (69 lesions) without evidence of viable extrathoracic disease were included. Dose prescription was driven by tumour location (hilar/pericentral vs peripheral) and/or target volume.

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Section: Discussionmentioning

confidence: 94%

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

Arcangeli

Falcinelli²,

Bracci

et al. 2017

The British Journal of Radiology

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“…Kimura et al [31] reported that most of their patients with no evidence of increased density patterns and scar-like patterns had significant pulmonary emphysema. Other reports have also suggested that poor pulmonary function or comorbidity of pulmonary emphysema did not lead to poor outcome in toxicity.…”

Section: Clinical Factors With Cfrt and Sbrtmentioning

confidence: 99%

Comparison of clinical, tumour-related and dosimetric factors in grade 0–1, grade 2 and grade 3 radiation pneumonitis after stereotactic body radiotherapy for lung tumours

Takeda

Ohashi²,

Kunieda

et al. 2012

BJR

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Objective: The aim of this study was to investigate significant clinical, tumour-related and dosimetric factors among patients with grade 0-1, grade 2 and grade 3 radiation pneumonitis (RP) after stereotactic body radiotherapy (SBRT) for lung tumours. Methods: Patients (n5128) with a total of 133 lung tumours treated with SBRT of 50 Gy in 5 fractions were analysed. RP was graded according to the Common Terminology Criteria for Adverse Events v.3.0. Significant factors were identified by univariate and multivariate analyses. Threshold dose-volume histograms (DVHs) were constructed to identify the incidence of RP. Results: The median follow-up period was 12 months (range, 6-45 months). In univariate analyses, gender, operability, forced expiratory volume in 1 s (FEV1), internal target volume, lung volumes treated with doses .5-30 Gy (V5-30) and mean lung dose were significant factors differentiating between grade 0-1 and grade 2 RP, and V15-30 were significant factors differentiating between grade 2 and grade 3. However, no factors were significant between grade 0-1 and grade 3 RP. Multivariate analysis showed that female gender, high FEV1 and high V15 were significant factors differentiating between grade 0-1 and grade 2 RP. Threshold DVH curves were created based on #5% and #15% risk of grade 2 RP among patients with grade 0-2 RP. Conclusions: Grade 0-2 RP was dose-volume dependent, and female gender and high FEV1 were significant predictive clinical factors for grade 2 RP among patients with grade 0-2 RP. However, incidences of V15-30 in grade 3 RP were significantly lower than those in grade 2 RP, and no significant clinical or tumour-related factors were found. Further studies are needed to identify the mechanism underlying the development of grade 3 RP after SBRT for lung tumours. Previously, we investigated the clinical and dosimetric factors that correlate with severe radiation pneumonitis (RP) in patients with lung tumours treated with stereotactic body radiotherapy (SBRT) [1]. We found that, among a variety of factors, only a short latent period was a significant correlate of severe RP.Other reports [2][3][4][5][6] have also analysed the clinical and dosimetric factors correlated with RP after SBRT. Various dosimetric factors were reported to significantly correlate with RP after SBRT, which included the mean dose in the ipsilateral lung, V7 and V10 by Kyas et al [2], normal tissue complication probability (NTCP) by Ricardi et al [3], lung volumes treated with doses higher than 2.5-50 Gy (V2.5-50) by Guckenberger et al [4], mean lung dose by Barriger et al [5] and contralateral V5 by Ong et al [6].We found a discrepancy in the significant clinical and dosimetric factors between the results of these five studies on low-grade RP [2-6] and our study on severe RP [1]. We speculated that the mechanism underlying the development of grade $3 RP might be different from that of grade 2 RP. Additionally, the treatment of grade $3 RP was much more critical than that of grade 2 RP. Most patients with grade $3 RP nee...

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“…Due to the differences in dose delivery and distribution, biologic effects, and overall treatment time, it is reasonable to expect that any CT changes that occur after SBRT will not have the same appearance, geographic extent, and progression timeline as those following CRT for lung cancers [51] . Like CRT-induced CT changes, CT findings after SBRT have two stages: early acute radiation pneumonitis that occurs within 6 mo of treatment and radiation fibrosis that occurs 6 mo or more after treatment [51,52] . In most cases, radiologic changes in normal lung tissue do not occur until at least 3 mo after SBRT.…”

Section: Timeline and Pattern Of Ct Changesmentioning

confidence: 99%

Radiation pneumonitis after stereotactic radiation therapy for lung cancer

Yamashita

Takahashi

Haga

et al. 2014

WJR

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Stereotactic body radiation therapy (SBRT) has a local control rate of 95% at 2 years for non-small cell lung cancer (NSCLC) and should improve the prognosis of inoperable patients, elderly patients, and patients with significant comorbidities who have early-stage NSCLC. The safety of SBRT is being confirmed in international, multi-institutional Phase Ⅱ trials for peripheral lung cancer in both inoperable and operable patients, but reports so far have found that SBRT is a safe and effective treatment for early-stage NSCLC and early metastatic lung cancer. Radiation pneumonitis (RP) is one of the most common toxicities of SBRT. Although most post-treatment RP is Grade 1 or 2 and either asymptomatic or manageable, a few cases are severe, symptomatic, and there is a risk for mortality. The reported rates of symptomatic RP after SBRT range from 9% to 28%. Being able to predict the risk of RP after SBRT is extremely useful in treatment planning. A dose-effect relationship has been demonstrated, but suggested dose-volume factors like mean lung dose, lung V20, and/or lung V2.5 differed among the reports. We found that patients who present with an interstitial pneumonitis shadow on computed tomography scan and high levels of serum Krebs von den Lungen-6 and surfactant protein D have a high rate of severe radiation pneumonitis after SBRT. At our institution, lung cancer patients with these risk factors have not received SBRT since 2006, and our rate of severe RP after SBRT has decreased significantly since then.

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CT appearance of radiation injury of the lung and clinical symptoms after stereotactic body radiation therapy (SBRT) for lung cancers: Are patients with pulmonary emphysema also candidates for SBRT for lung cancers?

Cited by 113 publications

References 13 publications

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

Comparison of clinical, tumour-related and dosimetric factors in grade 0–1, grade 2 and grade 3 radiation pneumonitis after stereotactic body radiotherapy for lung tumours

Radiation pneumonitis after stereotactic radiation therapy for lung cancer

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