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Radiation-induced organizing pneumonia after stereotactic body radiotherapy for lung tumor.

Ochiai S, Nomoto Y, Yamashita Y, Murashima S, Hasegawa D, Kurobe Y, Toyomasu Y, Kawamura T, Takada A, Ii N - J. Radiat. Res. (2015)

Bottom Line: A statistically significant association between G2/3 RP in the subacute phase and OP was shown ( P: = 0.040).In two of the five patients who developed OP, the symptoms and radiographic change were improved rapidly by corticosteroid administration.Three patients with minor symptoms were managed without corticosteroid administration and OP resolved without any relapse.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Matsusaka Central Hospital, 102 Kobou Kawai-machi, Matsusaka, Mie, 515-8566, Japan sochiai1981@gmail.com.

No MeSH data available.


Related in: MedlinePlus

Dose distribution of stereotactic body radiotherapy (SBRT) for a tumor in superior (A, B) and in inferior lobe (E, F). Prescribed doses were both 48 Gy in four fractions. Isodose lines of 45 Gy (blue), 40 Gy (green), 30 Gy (purple) and 20 Gy (light blue) are shown. Orange regions represent subpleural region of the lung or pleura. Chest computed tomography (CT) scans at 3 months after SBRT are shown (C, D, G, H). The red lines represent the lesions where the radiation pneumonitis (RP) attached to the pleura. Both patients developed symptomatic RP. Compared with the patient with a tumor in the inferior lobe (G, H), the RP lesion attached more extensively to the pleura in the patient with a tumor in the upper lobe (C, D). The patient with a tumor in the upper lobe developed OP 6 months after SBRT. The RP of another patient with a tumor in the lower lobe was resolved without any relapse.
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RRV049F4: Dose distribution of stereotactic body radiotherapy (SBRT) for a tumor in superior (A, B) and in inferior lobe (E, F). Prescribed doses were both 48 Gy in four fractions. Isodose lines of 45 Gy (blue), 40 Gy (green), 30 Gy (purple) and 20 Gy (light blue) are shown. Orange regions represent subpleural region of the lung or pleura. Chest computed tomography (CT) scans at 3 months after SBRT are shown (C, D, G, H). The red lines represent the lesions where the radiation pneumonitis (RP) attached to the pleura. Both patients developed symptomatic RP. Compared with the patient with a tumor in the inferior lobe (G, H), the RP lesion attached more extensively to the pleura in the patient with a tumor in the upper lobe (C, D). The patient with a tumor in the upper lobe developed OP 6 months after SBRT. The RP of another patient with a tumor in the lower lobe was resolved without any relapse.

Mentions: In our series, tumor location (superior/middle lobe vs inferior lobe) was shown to be a borderline statistically significant factor. Indeed, only patients with tumors in the superior lobe developed OP in our cohort. This result might indicate that the region where the RP occurs is the factor for developing OP. The pleural factor was indicated as the key to understanding the development of OP after PORT for breast cancer in some reports [8, 29]. With PORT for early-breast cancer, tangential fields are used to limit the dose given to the lung in order to reduce the incidence of RP. Tangential fields mainly induce an irradiation of subpleural regions of the lung. Crestani et al. reported that infiltrates of OP after PORT for breast cancer began in the irradiated area then spread to non-irradiated areas of the ipsilateral lung [8]. Oie et al reported an imaging study with CT and that most OP lesions developed in close proximity to the RP lesions [14]. According to these findings, it seems that the damage to subpleural region of the lung and pleura could be the primer for OP. In SBRT, lung tumor is irradiated with multiple non-coplanar beams in fewer fractions. As a result, relatively extensive subpleural region of lung or pleura could be irradiated by a high biological effective dose just like PORT for breast cancer. 50 Gy in 25 fractions approximately equivalent to 26 Gy in 4 fracions or 38 Gy in 8 fractions using the linear quadratic model, with an alpha/beta ratio of 3 Gy (Fig. 4).


Radiation-induced organizing pneumonia after stereotactic body radiotherapy for lung tumor.

Ochiai S, Nomoto Y, Yamashita Y, Murashima S, Hasegawa D, Kurobe Y, Toyomasu Y, Kawamura T, Takada A, Ii N - J. Radiat. Res. (2015)

Dose distribution of stereotactic body radiotherapy (SBRT) for a tumor in superior (A, B) and in inferior lobe (E, F). Prescribed doses were both 48 Gy in four fractions. Isodose lines of 45 Gy (blue), 40 Gy (green), 30 Gy (purple) and 20 Gy (light blue) are shown. Orange regions represent subpleural region of the lung or pleura. Chest computed tomography (CT) scans at 3 months after SBRT are shown (C, D, G, H). The red lines represent the lesions where the radiation pneumonitis (RP) attached to the pleura. Both patients developed symptomatic RP. Compared with the patient with a tumor in the inferior lobe (G, H), the RP lesion attached more extensively to the pleura in the patient with a tumor in the upper lobe (C, D). The patient with a tumor in the upper lobe developed OP 6 months after SBRT. The RP of another patient with a tumor in the lower lobe was resolved without any relapse.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4628220&req=5

RRV049F4: Dose distribution of stereotactic body radiotherapy (SBRT) for a tumor in superior (A, B) and in inferior lobe (E, F). Prescribed doses were both 48 Gy in four fractions. Isodose lines of 45 Gy (blue), 40 Gy (green), 30 Gy (purple) and 20 Gy (light blue) are shown. Orange regions represent subpleural region of the lung or pleura. Chest computed tomography (CT) scans at 3 months after SBRT are shown (C, D, G, H). The red lines represent the lesions where the radiation pneumonitis (RP) attached to the pleura. Both patients developed symptomatic RP. Compared with the patient with a tumor in the inferior lobe (G, H), the RP lesion attached more extensively to the pleura in the patient with a tumor in the upper lobe (C, D). The patient with a tumor in the upper lobe developed OP 6 months after SBRT. The RP of another patient with a tumor in the lower lobe was resolved without any relapse.
Mentions: In our series, tumor location (superior/middle lobe vs inferior lobe) was shown to be a borderline statistically significant factor. Indeed, only patients with tumors in the superior lobe developed OP in our cohort. This result might indicate that the region where the RP occurs is the factor for developing OP. The pleural factor was indicated as the key to understanding the development of OP after PORT for breast cancer in some reports [8, 29]. With PORT for early-breast cancer, tangential fields are used to limit the dose given to the lung in order to reduce the incidence of RP. Tangential fields mainly induce an irradiation of subpleural regions of the lung. Crestani et al. reported that infiltrates of OP after PORT for breast cancer began in the irradiated area then spread to non-irradiated areas of the ipsilateral lung [8]. Oie et al reported an imaging study with CT and that most OP lesions developed in close proximity to the RP lesions [14]. According to these findings, it seems that the damage to subpleural region of the lung and pleura could be the primer for OP. In SBRT, lung tumor is irradiated with multiple non-coplanar beams in fewer fractions. As a result, relatively extensive subpleural region of lung or pleura could be irradiated by a high biological effective dose just like PORT for breast cancer. 50 Gy in 25 fractions approximately equivalent to 26 Gy in 4 fracions or 38 Gy in 8 fractions using the linear quadratic model, with an alpha/beta ratio of 3 Gy (Fig. 4).

Bottom Line: A statistically significant association between G2/3 RP in the subacute phase and OP was shown ( P: = 0.040).In two of the five patients who developed OP, the symptoms and radiographic change were improved rapidly by corticosteroid administration.Three patients with minor symptoms were managed without corticosteroid administration and OP resolved without any relapse.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Matsusaka Central Hospital, 102 Kobou Kawai-machi, Matsusaka, Mie, 515-8566, Japan sochiai1981@gmail.com.

No MeSH data available.


Related in: MedlinePlus