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Radiation Injury After Hypofractionated Stereotactic Radiotherapy for Peripheral Small Lung Tumors: Serial Changes on CT

¹ Department of Radiology, Tokyo Metropolitan Hiro-o General Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo 150-0013, Japan.
² Department of Radiology, School of Medicine, Keio University, 35 Shinanomachi, Shinkuku-ku, Tokyo 160-8582, Japan.
³ Department of Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan.

View larger version (144K): [in a new window]   Fig. 1A. —59-year-old man with lung metastasis from rectal carcinoma. Typical characteristics of radiation pneumonitis and fibrosis after hypofractionated stereotactic radiotherapy are seen on serial lung CT scans after irradiation. Axial unenhanced CT scan obtained before treatment shows tumor in right upper lobe. PTV = planned target volume.

View larger version (108K): [in a new window]   Fig. 2A. —85-year-old man with squamous cell cancer. Axial unenhanced CT scan obtained before treatment shows cavitated tumor in left upper lobe. PTV = planned target volume.

View larger version (85K): [in a new window]   Fig. 3A. —70-year-old man with lung metastasis of oropharyngeal carcinoma. Axial unenhanced CT scan obtained before treatment shows metastatic tumor in right lower lobe. PTV = planned target volume.

View larger version (134K): [in a new window]   Fig. 1B. —59-year-old man with lung metastasis from rectal carcinoma. Typical characteristics of radiation pneumonitis and fibrosis after hypofractionated stereotactic radiotherapy are seen on serial lung CT scans after irradiation. CT scan at 1 month after irradiation shows decrease in tumor size.

View larger version (168K): [in a new window]   Fig. 1C. —59-year-old man with lung metastasis from rectal carcinoma. Typical characteristics of radiation pneumonitis and fibrosis after hypofractionated stereotactic radiotherapy are seen on serial lung CT scans after irradiation. CT scan at 4 months reveals appearance of dense consolidation and its surrounding ground-glass opacity.

View larger version (158K): [in a new window]   Fig. 1D. —59-year-old man with lung metastasis from rectal carcinoma. Typical characteristics of radiation pneumonitis and fibrosis after hypofractionated stereotactic radiotherapy are seen on serial lung CT scans after irradiation. CT scan at 8 months shows shrinkage of dense consolidation and its movement toward hilum.

View larger version (135K): [in a new window]   Fig. 1E. —59-year-old man with lung metastasis from rectal carcinoma. Typical characteristics of radiation pneumonitis and fibrosis after hypofractionated stereotactic radiotherapy are seen on serial lung CT scans after irradiation. CT scan at 11 months shows presence of dilated bronchi within opacity.

View larger version (138K): [in a new window]   Fig. 1F. —59-year-old man with lung metastasis from rectal carcinoma. Typical characteristics of radiation pneumonitis and fibrosis after hypofractionated stereotactic radiotherapy are seen on serial lung CT scans after irradiation. CT scan at 22 months shows fixation of opacity. Subsequent CT characteristics remained unchanged.

View larger version (135K): [in a new window]   Fig. 2B. —85-year-old man with squamous cell cancer. CT scan at 1 month after irradiation shows almost no change.

View larger version (135K): [in a new window]   Fig. 2C. —85-year-old man with squamous cell cancer. CT scan at 4 months shows presence of ground-glass opacity distributed in planned target volume.

View larger version (154K): [in a new window]   Fig. 2D. —85-year-old man with squamous cell cancer. CT scan at 6 months shows conversion of ground-glass opacity to dense consolidation and shift toward hilum. Tumor has almost disappeared.

View larger version (129K): [in a new window]   Fig. 2E. —85-year-old man with squamous cell cancer. CT scan at 10 months shows shrinkage of opacity and further movement toward hilum.

View larger version (118K): [in a new window]   Fig. 2F. —85-year-old man with squamous cell cancer. CT scan at 12 months shows further decrease in size. Subsequently, opacity remained unchanged.

View larger version (143K): [in a new window]   Fig. 3B. —70-year-old man with lung metastasis of oropharyngeal carcinoma. CT scan at 1 month after irradiation shows decrease in tumor size.

View larger version (133K): [in a new window]   Fig. 3C. —70-year-old man with lung metastasis of oropharyngeal carcinoma. CT scan at 3 months reveals appearance of dense consolidation in subpleural space of planned target volume.

View larger version (119K): [in a new window]   Fig. 3D. —70-year-old man with lung metastasis of oropharyngeal carcinoma. CT scan at 6 months shows increase in size of dense consolidation and onset of movement. Center of tumor is now located more cranially.

View larger version (146K): [in a new window]   Fig. 3E. —70-year-old man with lung metastasis of oropharyngeal carcinoma. CT scan at 9 months shows decrease in tumor size, thinning of dense consolidation, and movement of lesion toward hilum.

View larger version (140K): [in a new window]   Fig. 3F. —70-year-old man with lung metastasis of oropharyngeal carcinoma. CT scan at 12 months shows presence of linear opacity surrounding tumor and fixation of lesion.

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