title: Patterns of CT lung injury and toxicity after stereotactic radiotherapy delivered with helical tomotherapy in early stage medically inoperable NSCLC.
abstract: OBJECTIVE
  To evaluate toxicity and patterns of radiologic lung injury on CT images after hypofractionated image-guided stereotactic body radiotherapy (SBRT) delivered with helical tomotherapy (HT) in medically early stage inoperable non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  28 elderly patients (31 lesions) with compromised pulmonary reserve were deemed inoperable and enrolled to undergo SBRT. Patterns of lung injury based on CT appearance were assessed at baseline and during follow up. Acute (6 months or less) and late (more than 6 months) events were classified as radiation pneumonitis and radiation fibrosis (RF), respectively.
  
  
  RESULTS
  After a median follow-up of 12 months (range, 4-20 months), 31 and 25 lesions were examined for acute and late injuries, respectively. Among the former group, 25 (80.6%) patients showed no radiological changes. The CT appearance of RF revealed modified conventional, mass-like and scar-like patterns in three, four and three lesions, respectively. No evidence of late lung injury was demonstrated in 15 lesions. Five patients developed clinical pneumonitis (four patients, grade 2 and one patient, grade 3, respectively), and none of whom had CT findings at 3 months post-treatment. No instance of symptomatic RF was detected. The tumour response rate was 84% (complete response + partial response). Local control was 83% at 1 year.
  
  
  CONCLUSIONS
  Our findings show that HT-SBRT can be considered an effective treatment with a mild toxicity profile in medically inoperable patients with early stage NSCLC. No specific pattern of lung injury was demonstrated.
  
  
  CONCLUSIONS
  Our study is among the few showing that HT-SBRT represents a safe and effective option in patients with early stage medically inoperable NSCLC, and that it is not associated with a specific pattern of lung injury.
authors: 1 Department of Radiotherapy, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
authors: S
authors: S
authors: Arcangeli
authors: L
authors: L
authors: Agolli
authors: L
authors: L
authors: Portalone
authors: M R
authors: MR
authors: Migliorino
authors: M G
authors: MG
authors: Lopergolo
authors: A
authors: A
authors: Monaco
authors: J
authors: J
authors: Dognini
authors: M C
authors: MC
authors: Pressello
authors: S
authors: S
authors: Bracci
authors: V
authors: V
authors: Donato
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D008297:Male; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D011832:Radiation Injuries / Q000000981:diagnostic imaging* / Q000209:etiology*; D017564:Radiation Pneumonitis / Q000000981:diagnostic imaging* / Q000209:etiology*; D016634:Radiosurgery / Q000009:adverse effects*; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome
references: Eur J Cancer. 2009 Jan;45(2):228-47
references: 19097774
references: AJR Am J Roentgenol. 1988 Apr;150(4):765-70
references: 3258086
references: Clin Lung Cancer. 2013 Jan;14(1):1-5
references: 22846581
references: Med Dosim. 2008 Autumn;33(3):215-21
references: 18674686
references: Technol Cancer Res Treat. 2014 Feb;13(1):37-45
references: 23819496
references: Int J Radiat Oncol Biol Phys. 2010 Feb 1;76(2):548-56
references: 20117290
references: Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):457-62
references: 21035956
references: Semin Radiat Oncol. 1999 Jan;9(1):108-17
references: 10196402
references: Int J Radiat Oncol Biol Phys. 1991 May 15;21(1):109-22
references: 2032882
references: Int J Radiat Oncol Biol Phys. 2009 Jul 15;74(4):1002-5
references: 19545785
references: AJR Am J Roentgenol. 2002 Jun;178(6):1383-8
references: 12034601
references: Int J Radiat Oncol Biol Phys. 2010 Nov 1;78(3):651-8
references: 20207499
references: J Radiat Res. 2014 Jan 1;55(1):105-12
references: 23757513
references: Int J Radiat Oncol Biol Phys. 2012 Jul 15;83(4):e545-9
references: 22436782
references: Int J Radiat Oncol Biol Phys. 2013 Jan 1;85(1):190-5
references: 22929858
references: J Radiat Res. 2014 May;55(3):575-82
references: 24457315
references: Radiother Oncol. 2008 Oct;89(1):89-96
references: 18524401
references: Radiother Oncol. 2007 Dec;85(3):435-42
references: 18053602
references: Clin Lung Cancer. 2013 Nov;14(6):699-703
references: 23886798
references: Am J Respir Crit Care Med. 2007 Sep 15;176(6):532-55
references: 17507545
references: Int J Radiat Oncol Biol Phys. 2005 Nov 15;63(4):1010-5
references: 16115740
references: Front Radiat Ther Oncol. 2011;43:165-180
references: 21625153
references: Semin Surg Oncol. 2003;21(2):74-84
references: 14508857
references: Acta Oncol. 2013 Jun;52(5):910-8
references: 23106174
references: Int J Radiat Oncol Biol Phys. 2011 Jun 1;80(2):506-13
references: 20584582
references: J Oncol Pract. 2016 Mar;12(3):e270-80, 245-6
references: 26907453
references: Int J Radiat Oncol Biol Phys. 2010 Aug 1;77(5):1369-74
references: 19932943
references: Acta Oncol. 2006;45(7):890-6
references: 16982555
references: Lung Cancer. 2010 Jul;69(1):77-85
references: 19910075
references: J Clin Oncol. 2007 May 10;25(14):1924-9
references: 17488992
references: Int J Radiat Oncol Biol Phys. 2008 Nov 15;72(4):967-71
references: 18954709
references: Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):974-8
references: 20932655
references: Int J Clin Oncol. 2007 Oct;12(5):356-62
references: 17929117
references: Cancer. 2002 May 15;94(10):2766-92
references: 12173348
references: J Clin Oncol. 2010 Dec 10;28(35):5153-9
references: 21041709
references: Radiother Oncol. 2010 Jan;94(1):1-11
references: 20074823
references: Cancer Res Treat. 2013 Dec;45(4):295-302
references: 24454002
references: Lung Cancer. 2014 Jun;84(3):248-53
references: 24681279
references: PLoS One. 2013;8(4):e59729
references: 23577071
references: Radiat Oncol. 2013 Mar 21;8:69
references: 23518013
references: Radiother Oncol. 2012 Mar;102(3):335-42
references: 22305958
references: Int J Radiat Oncol Biol Phys. 2009 Nov 1;75(3):703-10
references: 19419818
references: Clin Transl Oncol. 2013 Jun;15(6):484-91
references: 23143953
references: Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S155-60
references: 20171512
references: Int J Radiat Oncol Biol Phys. 2009 Feb 1;73(2):442-8
references: 18990507
references: AJR Am J Roentgenol. 2004 May;182(5):1123-8
references: 15100106
references: Anticancer Res. 2013 Feb;33(2):655-60
references: 23393363
references: Tumori. 2014 Jan-Feb;100(1):42-8
references: 24675490
references: Int J Radiat Oncol Biol Phys. 2006 Oct 1;66(2):483-91
references: 16904838
references: J Thorac Oncol. 2011 Jul;6(7):1221-8
references: 21623237
references: Radiother Oncol. 2010 Oct;97(1):65-70
references: 20605245