Radiation injury of the lung after three-dimensional conformal radiation therapy
Radiation injury of the lung after three-dimensional conformal radiation therapy
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DOI：
10.2214/ajr.178.6.1781383
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发表时间：
2002-06-01
影响因子：
5
通讯作者：
Stevens, CW
中科院分区：
文献类型：
--
作者：
Koenig, TR;Munden, RF;Stevens, CW
目标。本研究的目的是描述接受三维（3D）适形放射治疗（CRT）的患者肺部放射损伤的CT模式。材料和方法。在36个月的时间里，我们回顾了19例接受3D CRT治疗的非小细胞肺癌患者的胸部CT扫描。CT检查是否有放射性损伤（毛玻璃混浊、实变、支气管扩张）。体积损失)。这些发现的存在、程度和分布是一致的。在治疗完成后3个月内成像的所有患者（n = 7）均出现局限于肿瘤周围小区域的放射性肺炎。所有患者均发生放射性纤维化（n = 19）。三种不同的纤维化模式一致存在，并将其分类为改良常规、肿块样和瘢痕样。改良的常规纤维化（实变、体积损失和支气管扩张，与常规放射纤维化相似，但范围小于常规放射纤维化）见于5例患者。8例患者可见肿块样纤维化（局灶性实变伴牵引性支气管扩张局限于原肿瘤部位）。6例患者出现瘢痕样纤维化（原肿瘤区域线性混浊，伴中度至重度体积损失）。三维适形放射治疗可导致三种不同于传统放射性肺损伤的放射性纤维化。了解这些表现的全部范围有助于正确解释3D CRT后的CT扫描。
OBJECTIVE.-Me objective of this study is to describe the CT patterns of radiation injury in the lungs of patients who have undergone three-dimensional (3D) conformal radiation therapy (CRT).MATERIALS AND METHODS. Over a 36-month period, the chest CT scans of 19 patients with non-small cell lung cancer who were treated with 3D CRT were reviewed. CT scans were evaluated for findings of radiation injury (ground-glass opacities, consolidation, bronchiectasis. and volume loss). The presence, extent, and distribution of these findings were reached by consensus.RESULTS. Radiation pneumonitis limited to a small area immediately around the tumor was present in all patients who were imaged within 3 months after completion of the treatment (n = 7). Radiation-induced fibrosis occurred in all patients (n = 19). Three distinct patterns of fibrosis were consistently present, and these were classified as modified conventional, masslike, and scarlike. Modified conventional fibrosis (consolidation, volume loss, and bronchiectasis similar to, but less extensive than, conventional radiation fibrosis) was seen in five patients. Masslike fibrosis (focal consolidation with traction bronchiectasis limited to the site of the original tumor) was seen in eight patients. Scarlike fibrosis (linear opacity in the region of the original tumor associated with moderate to severe volume loss) was seen in six patients.CONCLUSION. Three-dimensional conformal radiation therapy results in three patterns of radiation fibrosis that differ from the conventional radiation- induced lung injury. Knowledge of the full spectrum of these manifestations is useful in the correct interpretation of CT scans after 3D CRT.