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Evaluation of Lung Injury after Three-dimensional Conformal Stereotactic Radiation Therapy for Solitary Lung Tumors: CT Appearance¹

¹ From the Department of Therapeutic Radiology and Oncology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo, Kyoto 606-8507, Japan. Received September 25, 2002; revision requested December 10; final revision received May 17, 2003; accepted June 18. Supported by grants-in-aid no. 09255255, no. 10153231, and no. 13470183 from the Ministry of Education, Culture, Sports, Science, and Technology, and no. 23765293 from the Ministry of Health, Labour, and Welfare in Japan. Address correspondence to Y. Nagata (e-mail: nag@kuhp.kyoto-u.ac.jp).

PURPOSE: To evaluate the computed tomographic (CT) appearance of tumors and lung injury in patients who have undergone stereotactic radiation therapy (SRT) for solitary lung tumors.

MATERIALS AND METHODS: Twenty-seven patients with primary lung cancer and four with metastatic lung cancer who underwent SRT for solitary lung tumors were enrolled for evaluation. SRT was delivered by using a three-dimensional conformal technique with a stereotactic body frame. A total dose of 48 Gy was administered in four fractions during a period of 2 weeks. After SRT, follow-up CT images were obtained every 2–3 months. Radiation-induced pulmonary injuries were classified into four patterns on CT images. The minimal lung dose to areas demonstrating pulmonary injury at CT was evaluated, and the correlation between the dose and the percentage volume of the whole lung irradiated by more than 20 Gy in total (V20) was assessed by using Spearman rank correlation.

RESULTS: Tumor shrinkage continued for 2–15 months after SRT. Asymptomatic changes in the irradiated lung were noted at CT in all patients within 2–6 months (median, 4 months) after SRT. As the pattern at pulmonary CT changed, patchy consolidation was more predominantly seen as an acute change than were slight homogeneous increase in opacity, discrete consolidation, or solid consolidation; solid consolidation was the more predominantly seen late change. The minimal lung dose to the area demonstrating pulmonary injury in each patient ranged between 16 and 36 Gy (median, 24 Gy). The dose was significantly (P < .001) inversely correlated with the V20 in each patient.

CONCLUSION: The reaction to SRT of the lungs seems similar to the reaction to conventional radiation therapy.

© RSNA, 2003

Index terms: Lung neoplasms, CT, 60.12112 • Lung neoplasms, therapeutic radiology, 60.32, 60.33 • Radiations, injurious effects, complications of therapeutic radiology • Stereotaxis • Therapeutic radiology, three-dimensional

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