Hostname: page-component-848d4c4894-wzw2p Total loading time: 0 Render date: 2024-05-11T03:10:56.992Z Has data issue: false hasContentIssue false
  • English
  • Français

Radiographic findings after stereotactic body radiation therapy for stage I non-small cell lung carcinomas: retrospective analysis of 90 patients

Published online by Cambridge University Press:  22 November 2019

I. Menoux Open the ORCID record for I. Menoux [Opens in a new window] ,
D. Antoni ,
N. Santelmo ,
P. Truntzer ,
C. Schumacher ,
A. Labani  and
G. Noël
I. Menoux*
Affiliation:
Department of Radiotherapy, Paul Strauss Center, Strasbourg Cedex, France
D. Antoni
Affiliation:
Department of Radiotherapy, Paul Strauss Center, Strasbourg Cedex, France Laboratory of Radiobiology, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg University, Strasbourg, France
N. Santelmo
Affiliation:
Department of Thoracic surgery
P. Truntzer
Affiliation:
Department of Radiotherapy, Paul Strauss Center, Strasbourg Cedex, France
C. Schumacher
Affiliation:
Department of Radiotherapy, Paul Strauss Center, Strasbourg Cedex, France
A. Labani
Affiliation:
Department of radiology, Nouvel Hôpital Civil, Strasbourg, France
G. Noël
Affiliation:
Department of Radiotherapy, Paul Strauss Center, Strasbourg Cedex, France Laboratory of Radiobiology, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg University, Strasbourg, France
*
Author for correspondence: Inès Menoux, Department of Radiotherapy, Paul Strauss Center, 3, rue de la porte de l’hôpital, BP 42, 67065 Strasbourg Cedex, France Tel: +33388252478. Fax: +33388258508, E-mail: imenoux@strasbourg.unicancer.fr
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim:

Stereotactic body radiation therapy for lung tumours can expose patients to radiation pneumonitis (RP) (<6 months after irradiation) and lung fibrosis (beyond 6 months). The aim of this study was to describe post-irradiation radiographics appearances.

Materials and methods:

This retrospective study of 90 patients with a stage I non-small cell lung carcinoma reports a detailed description of the computed tomography (CT) or positron emission tomography/CT changes that can be observed after treatment, according to modified Kimura score for RP and Koenig’s classification for fibrosis. This evaluation was realised at 1 month and then every 3–4 months, with a median follow-up of 35 months.

Results:

The most common radiological RP pattern was diffuse consolidation. It appears in a mean time of 4 months and reaches its maximum at 9 months after radiotherapy. Seventy-three per cent of the RP evolved to fibrosis. Most of these findings were encompassed in the 35 Gy isodose.

Findings:

Radiological parenchymal changes are frequent in the treatment region, which renders the tumour response monitoring by tumour size, particularly by response evaluation criteria in solid tumours, unsuitable.

Keywords

non-small cell lung carcinomaradiation fibrosisradiation-induced lung toxicityradiation pneumonitisstereotactic radiotherapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 19 , Issue 4 , December 2020 , pp. 333 - 340
Check for updates
Copyright
© Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Chang, J Y, Senan, S, Paul, M A et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol 2015; 16: 630–637. doi: 10.1016/S1470-2045(15)70168-3.CrossRefGoogle Scholar
Ball, D, Mai, G T, Vinod, S et al. Stereotactic ablative radiotherapy versus standard radiotherapy in stage 1 non-small-cell lung cancer (TROG 09.02 CHISEL): a phase 3, open-label, randomised controlled trial. Lancet Oncol 2019; 20: 494–503. doi: 10.1016/S1470-2045(18)30896-9.CrossRefGoogle ScholarPubMed
Wall, R J, Schnapp, L M. Radiation pneumonitis. Respir Care 2006; 51: 1255–1260.Google ScholarPubMed
Ghafoori, P, Marks, L B, Vujaskovic, Z, Kelsey, C R. Radiation-induced lung injury. Assessment, management, and prevention. Oncology (Williston Park, NY) 2008; 22: 37–47; discussion 52–53.Google Scholar
McDonald, S, Rubin, P, Phillips, T L, Marks, L B. Injury to the lung from cancer therapy: clinical syndromes, measurable endpoints, and potential scoring systems. Int J Radiat Oncol Biol Phys 1995; 31: 1187–1203. doi: 10.1016/0360-3016(94)00429-O.Google ScholarPubMed
Shapiro, D L, Finkelstein, J N, Rubin, P, Penney, D P, Siemann, D W. Radiation induced secretion of surfactant from cell cultures of type II pneumocytes: an in vitro model of radiation toxicity. Int J Radiat Oncol Biol Phys 1984; 10: 375–378.CrossRefGoogle Scholar
Hassaballa, H A, Cohen, E S, Khan, A J, Ali, A, Bonomi, P, Rubin, D B. Positron emission tomography demonstrates radiation-induced changes to nonirradiated lungs in lung cancer patients treated with radiation and chemotherapy. Chest 2005; 128: 1448–1452. doi: 10.1378/chest.128.3.1448.CrossRefGoogle ScholarPubMed
Choi, Y W, Munden, R F, Erasmus, J J et al. Effects of radiation therapy on the lung: radiologic appearances and differential diagnosis. Radiogr Rev Publ Radiol Soc N Am Inc 2004; 24: 985–997; discussion 998. doi: 10.1148/rg.244035160.Google ScholarPubMed
Ikezoe, J, Takashima, S, Morimoto, S et al. CT appearance of acute radiation-induced injury in the lung. AJR Am J Roentgenol 1988; 150: 765–770. doi: 10.2214/ajr.150.4.765.CrossRefGoogle ScholarPubMed
Libshitz, H I, Shuman, L S. Radiation-induced pulmonary change: CT findings. J Comput Assist Tomogr 1984; 8: 15–9.CrossRefGoogle ScholarPubMed
Waissi, W, Noël, G, Giraud, P. Surveillance après radiothérapie stéréotaxique des tumeurs pulmonaires. Cancer/Radiothérapie 2015; 19: 566–572. doi: 10.1016/j.canrad.2015.05.004.CrossRefGoogle Scholar
Linda, A, Trovo, M, Bradley, J D. Radiation injury of the lung after stereotactic body radiation therapy (SBRT) for lung cancer: a timeline and pattern of CT changes. Eur J Radiol 2011; 79: 147–154. doi: 10.1016/j.ejrad.2009.10.029.CrossRefGoogle ScholarPubMed
Larici, A R, del Ciello, A, Maggi, F et al. Lung abnormalities at multimodality imaging after radiation therapy for non-small cell lung cancer. RadioGraphics 2011; 31: 771–789. doi: 10.1148/rg.313105096.CrossRefGoogle ScholarPubMed
Knoll, M A, Salvatore, M, Sheu, R D et al. The use of isodose levels to interpret radiation induced lung injury: a quantitative analysis of computed tomography changes. Quant Imaging Med Surg 2016; 6: 35–41. doi: 10.3978/j.issn.2223-4292.2016.02.07.Google ScholarPubMed
Bibault, J-E, Ceugnart, L, Prevost, B, Mirabel, X, Lartigau, E. CT appearance of pulmonary carcinomas after stereotactic radiation therapy. Diagn Interv Imaging 2013; 94: 255–262. doi: 10.1016/j.diii.2012.06.006.CrossRefGoogle ScholarPubMed
Guckenberger, M, Heilman, K, Wulf, J, Mueller, G, Beckmann, G, Flentje, M. Pulmonary injury and tumour response after stereotactic body radiotherapy (SBRT): results of a serial follow-up CT study. Radiother Oncol 2007; 85: 435–442. doi: 10.1016/j.radonc.2007.10.044.CrossRefGoogle ScholarPubMed
Ricardi, U, Filippi, A R, Guarneri, A et al. Dosimetric predictors of radiation-induced lung injury in stereotactic body radiation therapy. Acta Oncol 2009; 48: 571–577. doi: 10.1080/02841860802520821.CrossRefGoogle ScholarPubMed
Nagata, Y, Hiraoka, M, Shibata, T et al. Prospective trial of stereotactic body radiation therapy for both operable and inoperable T1N0M0 non-small cell lung cancer: Japan Clinical Oncology Group Study JCOG0403. Int J Radiat Oncol 2015; 93: 989–996. doi: 10.1016/j.ijrobp.2015.07.2278.CrossRefGoogle ScholarPubMed
Takeda, A, Ohashi, T, Kunieda, E et al. 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. Br J Radiol 2012; 85: 636–642. doi: 10.1259/bjr/71635286.Google ScholarPubMed
Turzer, M, Brustugun, O T, Waldeland, E, Helland, Å. Stereotactic body radiation therapy is effective and safe in patients with early-stage non-small cell lung cancer with low performance status and severe comorbidity. Case Rep Oncol 2011; 4: 25–34. doi: 10.1159/000324113.CrossRefGoogle ScholarPubMed
Menoux, I, Antoni, D, Truntzer, P, Keller, A, Massard, G, Noël, G. Stereotactic body radiation therapy for stage I non-small cell lung carcinomas: moderate hypofractionation optimizes outcome. Lung Cancer 2018; 126: 201–207. doi: 10.1016/j.lungcan.2018.11.013.CrossRefGoogle Scholar
Eisenhauer, E A, Therasse, P, Bogaerts, J et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer (Oxford, England: 1990) 2009; 45: 228–247. doi: 10.1016/j.ejca.2008.10.026.CrossRefGoogle Scholar
Palma, D A, van Sörnsen de Koste, J, Verbakel, W F A R, Vincent, A, Senan, S. Lung density changes after stereotactic radiotherapy: a quantitative analysis in 50 patients. Int J Radiat Oncol 2011; 81: 974–978. doi: 10.1016/j.ijrobp.2010.07.025.CrossRefGoogle ScholarPubMed
Dahele, M, Palma, D, Lagerwaard, F, Slotman, B, Senan, S. Radiological changes after stereotactic radiotherapy for stage I lung cancer. J Thorac Oncol 2011; 6: 1221–1228. doi: 10.1097/JTO.0b013e318219aac5.CrossRefGoogle ScholarPubMed
Koenig, T R, Munden, R F, Erasmus, J J et al. Radiation injury of the lung after three-dimensional conformal radiation therapy. AJR Am J Roentgenol 2002; 178: 1383–1388. doi: 10.2214/ajr.178.6.1781383.CrossRefGoogle ScholarPubMed
Huang, K, Senthi, S, Palma, D A et al. High-risk CT features for detection of local recurrence after stereotactic ablative radiotherapy for lung cancer. Radiother Oncol 2013; 109: 51–57. doi: 10.1016/j.radonc.2013.06.047.CrossRefGoogle ScholarPubMed
Henderson, M A, Hoopes, D J, Fletcher, J W et al. A pilot trial of serial 18F-fluorodeoxyglucose positron emission tomography in patients with medically inoperable stage I non-small-cell lung cancer treated with hypofractionated stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 2010; 76: 789–795. doi: 10.1016/j.ijrobp.2009.02.051.CrossRefGoogle Scholar
Clarke, K, Taremi, M, Dahele, M et al. Stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC): is FDG-PET a predictor of outcome? Radiother Oncol J Eur Soc Ther Radiol Oncol 2012; 104: 62–66. doi: 10.1016/j.radonc.2012.04.019.CrossRefGoogle ScholarPubMed
Takeda, A, Yokosuka, N, Ohashi, T et al. The maximum standardized uptake value (SUVmax) on FDG-PET is a strong predictor of local recurrence for localized non-small-cell lung cancer after stereotactic body radiotherapy (SBRT). Radiother Oncol J Eur Soc Ther Radiol Oncol 2011; 101: 291–297. doi: 10.1016/j.radonc.2011.08.008.CrossRefGoogle Scholar
Erb, C T, Su, K W, Soulos, P R, Tanoue, L T, Gross, C P. Surveillance practice patterns after curative intent therapy for stage I non-small-cell lung cancer in the medicare population. Lung Cancer (Amsterdam, Netherlands) 2016; 99: 200–207. doi: 10.1016/j.lungcan.2016.07.017.CrossRefGoogle Scholar