title: Organizing pneumonia after stereotactic ablative radiotherapy of the lung.
abstract: BACKGROUND
  Organizing pneumonia (OP), so called bronchiolitis obliterans organizing pneumonia after postoperative irradiation for breast cancer has been often reported. There is little information about OP after other radiation modalities. This cohort study investigated the clinical features and risk factors of OP after stereotactic ablative radiotherapy of the lung (SABR).
  
  
  METHODS
  Patients undergoing SABR between 2004 and 2010 in two institutions were investigated. Blood test and chest computed tomography were performed at intervals of 1 to 3 months after SABR. The criteria for diagnosing OP were: 1) mixture of patchy and ground-glass opacity, 2) general and/or respiratory symptoms lasting for at least 2 weeks, 3) radiographic lesion in the lung volume receiving < 0.5 Gy, and 4) no evidence of a specific cause.
  
  
  RESULTS
  Among 189 patients (164 with stage I lung cancer and 25 with single lung metastasis) analyzed, nine developed OP. The incidence at 2 years was 5.2% (95% confidence interval; 2.6-9.3%). Dyspnea were observed in all patients. Four had fever. These symptoms and pulmonary infiltration rapidly improved after corticosteroid therapy. Eight patients had presented with symptomatic radiation pneumonitis (RP) around the tumor 2 to 7 months before OP. The prior RP history was strongly associated with OP (hazard ratio 61.7; p = 0.0028) in multivariate analysis.
  
  
  CONCLUSIONS
  This is the first report on OP after SABR. The incidence appeared to be relatively high. The symptoms were sometimes severe, but corticosteroid therapy was effective. When patients after SABR present with unusual pneumonia, OP should be considered as a differential diagnosis, especially in patients with prior symptomatic RP.
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. taro8864@yahoo.co.jp
authors.forename: Taro
authors.initials: T
authors.lastname: Murai
authors.forename: Yuta
authors.initials: Y
authors.lastname: Shibamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishiyama
authors.forename: Fumiya
authors.initials: F
authors.lastname: Baba
authors.forename: Akifumi
authors.initials: A
authors.lastname: Miyakawa
authors.forename: Shiho
authors.initials: S
authors.lastname: Ayakawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ogino
authors.forename: Shinya
authors.initials: S
authors.lastname: Otsuka
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Iwata
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018549:Cryptogenic Organizing Pneumonia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D017564:Radiation Pneumonitis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D055815:Young Adult