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Radiation Injury of the Lung After Three-Dimensional Conformal Radiation Therapy

¹ Department of Radiology, Division of Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030.
² Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030.

View larger version (77K): [in a new window]   Fig. 1A. —Three-dimensional (3D) conformal radiation therapy treatment-planning images. Note that maximal radiation dose (green area) is limited to area immediately around tumor. As distance from maximal area of exposure (red, orange, yellow, indigo, pink, and dark orange lines) increases, radiation dose to surrounding normal lung decreases. Radiation dose to surrounding lung is asymmetric because multiple angled beams were used to deliver maximal dose to tumor. Anterior view of 3D treatment-plan image shows orientation of five noncoplanar radiation beams (arrows) used for treating right upper lobe carcinoma.

View larger version (64K): [in a new window]   Fig. 1B. —Three-dimensional (3D) conformal radiation therapy treatment-planning images. Note that maximal radiation dose (green area) is limited to area immediately around tumor. As distance from maximal area of exposure (red, orange, yellow, indigo, pink, and dark orange lines) increases, radiation dose to surrounding normal lung decreases. Radiation dose to surrounding lung is asymmetric because multiple angled beams were used to deliver maximal dose to tumor. Axial image shows isodose curves.

View larger version (102K): [in a new window]   Fig. 1C. —Three-dimensional (3D) conformal radiation therapy treatment-planning images. Note that maximal radiation dose (green area) is limited to area immediately around tumor. As distance from maximal area of exposure (red, orange, yellow, indigo, pink, and dark orange lines) increases, radiation dose to surrounding normal lung decreases. Radiation dose to surrounding lung is asymmetric because multiple angled beams were used to deliver maximal dose to tumor. Coronal image shows isodose curves.

View larger version (73K): [in a new window]   Fig. 1D. —Three-dimensional (3D) conformal radiation therapy treatment-planning images. Note that maximal radiation dose (green area) is limited to area immediately around tumor. As distance from maximal area of exposure (red, orange, yellow, indigo, pink, and dark orange lines) increases, radiation dose to surrounding normal lung decreases. Radiation dose to surrounding lung is asymmetric because multiple angled beams were used to deliver maximal dose to tumor. Sagittal image shows isodose curves.

View larger version (136K): [in a new window]   Fig. 2A. —Ground-glass opacities of pneumonitis in 64-year-old woman with adenocarcinoma. Pretreatment CT scan shows spiculated mass (m) in left upper lobe.

View larger version (132K): [in a new window]   Fig. 2B. —Ground-glass opacities of pneumonitis in 64-year-old woman with adenocarcinoma. CT scan obtained 5 weeks after completion of radiation therapy shows ground-glass opacities limited to area adjacent to primary tumor. Note decrease in size of mass (m).

View larger version (118K): [in a new window]   Fig. 3A. —Modified conventional pattern in 81-year-old man with squamous cell carcinoma. Pretreatment CT scan shows cavitary mass in left lower lobe.

View larger version (124K): [in a new window]   Fig. 3B. —Modified conventional pattern in 81-year-old man with squamous cell carcinoma. CT scan obtained 10 months after completion of radiation therapy shows decrease in size of mass and development of consolidation indicating organizing fibrosis.

View larger version (100K): [in a new window]   Fig. 3C. —Modified conventional pattern in 81-year-old man with squamous cell carcinoma. CT scan obtained 22 months after completion of radiation therapy shows well-defined area (arrows) of consolidation, volume loss, and traction bronchiectasis typical of radiation fibrosis. Note lung anterior to fibrosis is normal.

View larger version (103K): [in a new window]   Fig. 4A. —Masslike pattern in 44-year-old woman with adenoid cystic carcinoma. Note right pneumonectomy. Pretreatment CT scan shows well-circumscribed mass (arrow) in left lower lobe.

View larger version (102K): [in a new window]   Fig. 4B. —Masslike pattern in 44-year-old woman with adenoid cystic carcinoma. Note right pneumonectomy. CT scan obtained 21 months after completion of radiation therapy shows consolidation and bronchiectasis at tumor site that resembles mass.

View larger version (89K): [in a new window]   Fig. 5A. —Scarlike pattern in 60-year-old woman with adenocarcinoma. Pretreatment CT scan shows spiculated lesion in right upper lobe.

View larger version (92K): [in a new window]   Fig. 5B. —Scarlike pattern in 60-year-old woman with adenocarcinoma. CT scan obtained 11 months after radiation therapy shows linear area of consolidation (arrows) with volume loss and no evidence of residual tumor.

View larger version (109K): [in a new window]   Fig. 5C. —Scarlike pattern in 60-year-old woman with adenocarcinoma. CT scan obtained 36 months after completion of radiation therapy shows only linear band (arrows) that resembles scar.

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