title: 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?
abstract: OBJECTIVE
  The purpose of this study was to analyze the computed tomographic (CT) appearance of radiation injury to the lung and clinical symptoms after stereotactic body radiation therapy (SBRT) and evaluate the difference by the presence of pulmonary emphysema (PE) for small lung cancers.
  
  
  METHODS
  In this analysis, 45 patients with 52 primary or metastatic lung cancers were enrolled. We evaluated the CT appearance of acute radiation pneumonitis (within 6 months) and radiation fibrosis (after 6 months) after SBRT. Clinical symptoms were evaluated by Common Terminology Criteria for Adverse Events, version 3.0. We also evaluated the relationship between CT appearance, clinical symptoms, and PE.
  
  
  RESULTS
  CT appearance of acute radiation pneumonitis was classified as follows: (1) diffuse consolidation, 38.5%; (2) patchy consolidation and ground-glass opacities (GGO), 15.4%; (3) diffuse GGO, 11.5%; (4) patchy GGO, 2.0%; (5) no evidence of increasing density, 32.6%. CT appearance of radiation fibrosis was classified as follows: (1) modified conventional pattern, 61.5%; (2) mass-like pattern, 17.3%; (3) scar-like pattern, 21.2%. Patients who were diagnosed with more than Grade 2 pneumonitis showed significantly less no evidence of increased density pattern and scar-like pattern than any other pattern (p=0.0314, 0.0297, respectively). Significantly, most of these patients with no evidence of increased density pattern and scar-like pattern had PE (p=0.00038, 0.00044, respectively).
  
  
  CONCLUSIONS
  Computed tomographic appearance after SBRT was classified into five patterns of acute radiation pneumonitis and three patterns of radiation fibrosis. Our results suggest that SBRT can be also safely performed even in patients with PE.
authors.affiliation: Department of Radiology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan. tkkimura@med.kawawa-u.ac.jp
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kimura
authors.forename: Kanji
authors.initials: K
authors.lastname: Matsuura
authors.forename: Yuji
authors.initials: Y
authors.lastname: Murakami
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kenjo
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kaneyasu
authors.forename: Koichi
authors.initials: K
authors.lastname: Wadasaki
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hirokawa
authors.forename: Katsuhide
authors.initials: K
authors.lastname: Ito
authors.forename: Motoomi
authors.initials: M
authors.lastname: Okawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging*; D017564:Radiation Pneumonitis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed