title: Prescreening based on the presence of CT-scan abnormalities and biomarkers (KL-6 and SP-D) may reduce severe radiation pneumonitis after stereotactic radiotherapy.
abstract: OBJECTIVE
  To determine the risk factors of severe radiation pneumonitis (RP) after stereotactic body radiation therapy (SBRT) for primary or secondary lung tumors.
  
  
  METHODS
  From January 2003 to March 2009, SBRT was performed on 117 patients (32 patients before 2005 and 85 patients after 2006) with lung tumors (primary = 74 patients and metastatic/recurrent = 43 patients) in our institution. In the current study, the results on cases with severe RP (grades 4-5) were evaluated. Serum Krebs von den Lungen-6 (KL-6) and serum Surfactant protein-D (SP-D) were used to predict the incidence of RP. A shadow of interstitial pneumonitis (IP) on the CT image before performing SBRT was also used as an indicator for RP. Since 2006, patients have been prescreened for biological markers (KL-6 & SP-D) as well as checking for an IP-shadow in CT.
  
  
  RESULTS
  Grades 4-5 RP was observed in nine patients (7.7%) after SBRT and seven of these cases (6.0%) were grade 5 in our institution. A correlation was found between the incidence of RP and higher serum KL-6 & SP-D levels. IP-shadow in patient's CT was also found to correlate well with the severe RP. Severe RP was reduced from 18.8% before 2005 to 3.5% after 2006 (p = 0.042). There was no correlation between the dose volume histogram parameters and these severe RP patients.
  
  
  CONCLUSIONS
  Patients presenting with an IP shadow in the CT and a high value of the serum KL-6 & SP-D before SBRT treatment developed severe radiation pneumonitis at a high rate. The reduction of RP incidence in patients treated after 2006 may have been attributed to prescreening of the patients. Therefore, pre-screening before SBRT for an IP shadow in CT and serum KL-6 & SP-D is recommended in the management and treatment of patients with primary or secondary lung tumors.
authors.affiliation: Department of Radiology, University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo, Japan. yamashitah-rad@h.u-tokyo.ac.jp
authors.forename: Hideomi
authors.initials: H
authors.lastname: Yamashita
authors.forename: Shino
authors.initials: S
authors.lastname: Kobayashi-Shibata
authors.forename: Atsuro
authors.initials: A
authors.lastname: Terahara
authors.forename: Kae
authors.initials: K
authors.lastname: Okuma
authors.forename: Akihiro
authors.initials: A
authors.lastname: Haga
authors.forename: Reiko
authors.initials: R
authors.lastname: Wakui
authors.forename: Kuni
authors.initials: K
authors.lastname: Ohtomo
authors.forename: Keiichi
authors.initials: K
authors.lastname: Nakagawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018396:Mucin-1 / Q000378:metabolism*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery; D037663:Pulmonary Surfactant-Associated Protein D / Q000378:metabolism*; D017564:Radiation Pneumonitis / Q000209:etiology / Q000517:prevention & control*; D016634:Radiosurgery / Q000009:adverse effects*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; C060192:MUC1 protein, human; D018396:Mucin-1; D037663:Pulmonary Surfactant-Associated Protein D
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