Radiation Injury of the Lung After Three-Dimensional Conformal Radiation Therapy

Abstract

Three-dimensional conformal radiation therapy results in three patterns of radiation fibrosis that differ from the conventional radiation-induced lung injury. Knowledge of the full spectrum of these manifestations is useful in the correct interpretation of CT scans after 3D CRT.

Suggestion for a New Grading Scale for Radiation Induced Pneumonitis Based on Radiological Findings of Computerized Tomography: Correlation with Clinical and Radiotherapeutic Parameters in Lung Cancer Patients

“…International bibliography does not refer to an exact classification-staging of radiation-induced lung injury's CT imaging following a 3DCRT on the pulmonary parenchyma (Libshitz and Shuman, 1984;Koenig et al, 2002;Aoki et al, 2004). The staging that this research refers to was supported by the imaging features of both the early and the late radiation-induced injury ( Figure 3).…”

“…This development of the radiological image conforms to other studies as well. In effect, Aoki et al (2004) identified elements of radiation-induced injury in the chest CT in 2 to 6 months following radiation therapy, Ikezoe et al (1988) in 16 weeks, and Koenig et al (2002) from the 3 rd month following the chest wall's radiation.…”

Pulmonary function and quality of life after VMAT-based stereotactic ablative radiotherapy for early stage inoperable NSCLC: a prospective study

“…Acute radiological toxicity was scored using a five-point scoring system developed by Vrije University, modified from Kimura et al [16] (1 = diffuse consolidation, 2 = patchy consolidation, 3 = diffuse "ground glass opacity", 4 = patchy "ground glass opacity", 5 = no changes) [17]. Late radiological toxicity was scored according to the Koenig's Scale (0 = absence of changes, 1 = modified conventional pattern, 2 = mass like pattern, 3 = scar like pattern) [18].…”

Non-small cell lung cancer after surgery and chemoradiotherapy: follow-up and response assessment

“…The modified conventional pattern of radiation fibrosis consists of a well-defined consolidation with volume loss and traction bronchiectasis. This pattern is different from conventional radiation fibrosis, which involves the total irradiated lung tissue from the anterior to the posterior pleural surface, whereas modified conventional radiation fibrosis is less extensive (41). When consoli- dation with traction and bronchiectasis is focal and confined to a 2 cm margin around the original tumor, CT shows a mass-like area larger than the original tumor, and this pattern is therefore described as mass-like (41).…”

“…By contrast, stereotactic body radiation therapy-related radiation pneumonitis abnormalities are usually limited, strictly conforming to the shape of the tumor (40). Radiologic imaging manifestations of radiation fibrosis after both 3D conformal radiation therapy and stereotactic body radiation therapy have been classified according to one of three patterns: modified conventional, mass-like, or scar-like (41). The modified conventional pattern of radiation fibrosis consists of a well-defined consolidation with volume loss and traction bronchiectasis.…”