Radiation injury of the lung after stereotactic body radiation therapy (SBRT) for lung cancer: A timeline and pattern of CT changes

Linda, Anna; Trovò, Marco; Bradley, Jeffrey D.

doi:10.1016/j.ejrad.2009.10.029

Cited by 106 publications

(103 citation statements)

References 18 publications

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“…Ground glass appearance is common, and subcategories are recognizable to radiation oncologists and others familiar with CT interpretation [17,18]. The late phase of radiation fibrosis frequently appears as a well-defined area of volume loss with a linear scar or consolidation, parenchymal distortion and traction bronchiectasis that conforms to the treatment portals which may either stabilize or evolve up to 24 months.…”

Section: Discussionmentioning

confidence: 99%

“…Shrinkage of the region of fibrotic consolidation or a more sharply defined demarcation between normal and irradiated lung parenchyma may occur as the process progresses. These findings are sometimes associated with ipsilateral displacement of the mediastinum and adjacent pleural thickening or effusion [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…At this time, neither the NCCN nor ESMO guidelines recommend routine post-SBRT PET scans at a specified interval as part of regular posttreatment surveillance. Incorporation of PET-CT into post-SBRT cancer surveillance is currently the subject of research [7,18].…”

Section: Discussionmentioning

confidence: 99%

“…Repeat CT and PET scans showed the lesion was expanding and demonstrated increasing PET positivity with a maximum SUV of 4.4 making malignancy very likely, and per NCCN guidelines should be resected without biopsy due to it's baseline size and interval enlargement [18]. This approach lacked a tissue confirmation of malignancy but the positive and increasing metabolic activity on PET scan, which are used to aid in the diagnosis of moderate risk lesions in the NCCN algorithm, did provide additional confidence in the diagnosis and course of Volume 4 Issue 4 -2017 action.…”

Section: Case Presentationmentioning

confidence: 99%

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Differentiating Radiation Changes from Local Recurrence after SBRT for Lung Cancer: The Need for Better Decision Guidelines

Weiss

Newman

Shah

2017

IJRRT

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Radiographic lung changes and fibrosis are near ubiquitous observations on CT imaging following the treatment of non-small cell lung cancer with stereotactic body radiation therapy (SBRT). The distinction between these radiographic changes and a local cancer recurrence in a timely and accurate fashion is critical for successful salvage therapy as well as to avoid potentially detrimental overtreatment. Nonetheless, an adequate, widely accepted and validated approach for post-treatment surveillance and identification of recurrences is unavailable. This article relates a case wherein the failure of close follow up imaging and uncertainty in the interpretation of imaging resulted in overtreatment. It also identifies some of the shortcomings in the current attempts to develop an appropriate post-SBRT follow up schedule, examines the physiological and radiographic post-SBRT radiation changes and reviews the pertinent literature.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

See 2 more Smart Citations

Differentiating Radiation Changes from Local Recurrence after SBRT for Lung Cancer: The Need for Better Decision Guidelines

Weiss

Newman

Shah

2017

IJRRT

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“…Benign parenchymal changes after SBRT are different from those observed after 3-dimensional conformal radiotherapy (7) and can mimic the appearance of recurrent disease because of similar size and morphology (8,9). Huang and colleagues after a systematic review of the literature identified radiological patterns of benign (early and late) parenchymal changes and high-risk features (HRFs) for recurrence.…”

Section: Original Articlementioning

confidence: 99%

Radiological differential diagnosis between fibrosis and recurrence after stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer (NSCLC)

Frakulli¹,

Salvi²,

Balestrini³

et al. 2017

Transl. Lung Cancer Res.

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Background: Parenchymal changes after stereotactic body radiation therapy (SBRT) make differential diagnosis between treatment outcomes and disease recurrence often difficult. The purpose of our study was to identify the radiographic features detectable at computed tomography (CT) scan [high-risk features (HRFs)] that allow enough specificity and sensitivity for early detection of recurrence. Methods:We retrospectively evaluated patients who underwent SBRT for inoperable early stage nonsmall cell lung cancer (NSCLC). The median delivered dose performed was 50 Gy in 5 fractions prescribed to 80% isodose. All patients underwent chest CT scan before SBRT and at 3, 6, 12, 18, 24 months after, and then annually. Each CT scan was evaluated and benign and HRFs were recorded.18 F-fluorodeoxyglucose-CT was not used routinely.Results: Forty-five patients were included (34 males, 11 females; median age: 77 years; stage IA: 77.8%, stage IB: 22.2%; median follow-up: 21.7 months). Two year and actuarial local control was 77%. HRFs were identified in 20 patients. The most significant predictor of relapse was an enlarging opacity at 12 months (P<0.001) with 84.6% sensitivity and 71.8% specificity. The presence of ≥2 HRFs demonstrated a high sensibility (92.3%) and specificity (71.9%) (P<0.0001).Conclusions: Detection of HRFs is predictive of relapse with a sensibility that increases with the number of HRFs observed. This observation may allow to better define the diagnostic follow algorithm up suggesting to performing further exams only in patients with >2 HRFs.

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Engineered Lipid Nanoparticles for the Treatment of Pulmonary Fibrosis by Regulating Epithelial‐Mesenchymal Transition in the Lungs

Jin

Jeong

Lee

et al. 2022

Adv Funct Materials

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Pulmonary fibrosis is a chronic and irreversible lung disease with limited therapeutic regimens. Advances in elucidating the pathophysiological mechanism and discovering novel therapeutic interventions are still in urgent need. Here, the engineered lipid nanoparticles (LNPs) are developed for delivering RNA therapeutics to the lungs. Three different types of LNPs (native, cationic, and ligand incorporated) are optimized to facilitate the pulmonary delivery of RNAs. Among them, the mannose incorporated LNPs (Mannose LNPs) outperform the others and show efficient delivery of siRNAs down-regulating the epithelial-mesenchymal transition (EMT) associated protein, G2 and S phaseexpressed protein 1 (GTSE1). Treatment with the mannose LNPs confirms a significant decrease in collagen accumulation and EMT-related proteins in the fibrosis animal models and provides functional recovery from pulmonary fibrosis. This approach demonstrates that engineered LNPs can facilitate the delivery of RNA therapeutics to the lungs and potentially open a new regimen of treatment for pulmonary fibrosis.

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Radiation injury of the lung after stereotactic body radiation therapy (SBRT) for lung cancer: A timeline and pattern of CT changes

Cited by 106 publications

References 18 publications

Differentiating Radiation Changes from Local Recurrence after SBRT for Lung Cancer: The Need for Better Decision Guidelines

Differentiating Radiation Changes from Local Recurrence after SBRT for Lung Cancer: The Need for Better Decision Guidelines

Radiological differential diagnosis between fibrosis and recurrence after stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer (NSCLC)

Engineered Lipid Nanoparticles for the Treatment of Pulmonary Fibrosis by Regulating Epithelial‐Mesenchymal Transition in the Lungs

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