PURPOSE: Radiation pneumonitis and fibrosis are common complications of radiation therapy of the chest. Sixty-six patients with lung cancer were studied to evaluate the radiation injury according to radiation dose (total and estimated single dose), time after completion of radiation, overall treatment time, and combined chemotheraphy and chest surgery. METHODS AND MATERIALS: All 66 patients received fractionated radiotherapy (180 to 300 cGy/day) to the thctax with total 1000 to 6660 cGy encompassing primary site and regional lymphatics. RESULTS: Radiation pneumonitis was developed in 40(60%) of 66 patients. Radiation pneumonitis occurred average 11 weeks after completion of therapy in 14(44%) of 32 patients below 4000 cGy, and 6 weeks in 26 (76%) of 34 patients above 4000 cGy. Radiation pneumonitis occurred more frequently when the estimated! single dose was over 1100 units than below 1100 units. Radiation pneumonitis was more frequent when the overall treatment time was over 30 days than within 30 days. All 10 patients undergone Iobectomy or pneumonectomy developed radiation pneumonitis. CONCLUSION: The incidence of radiation induced lung injury is variably dependant on radiation dose, time, from completion of radiation therapy, overall treatment time, and history of surgery such as Iobectomy or pneumonectomy before radiation therapy.
Acute Lung Injury* ; Fibrosis ; Humans ; Incidence ; Lung Injury ; Lung Neoplasms ; Pneumonectomy ; Radiation Injuries ; Radiation Pneumonitis ; Radiography, Thoracic* ; Radiotherapy ; Thorax*

From January 1981 to December 1989, total 42 patients with atelectasis from lung cancer were treated with radiation therapy at the Department of Therapeutic Radiology in Kyung Hee University Hospital. The reexpansion of atelectasis after radiotherapy of the lung was evaluated retrospectively, utilizing treatment records and follow-up chest radiographs. Of the patients with non-small cell carcinoma of the lung, the response rate was 62% (21/34). Patient with small cell carcinoma showed a 75% (6/8) response rate. There appears to be some evidence of a relationship of total tumor dose versus response of atelectasis; radiation dose over 40 gy (1337 ret), had a favorable effect on the rate of response compared with that below 40 gy (1297 ret), 70% (21/30) and 50% (6/12), respectively (p<0.01). Total response rate (partial and complete responses) of all patients was 64% (27/42). Franction size was not contributed to the difference of response rates between small fraction (180~200 cgy) and large fraction (300 cgy), 53% (14/22) and 65% (13/20), respectively. The results of this study suggest that radiation therapy has a definite positive role in management of atelectasis caused by lung cancer, especially in inoperable non-small cell carcinoma.
Carcinoma, Small Cell ; Follow-Up Studies ; Humans ; Lung Neoplasms* ; Lung* ; Pulmonary Atelectasis* ; Radiation Oncology ; Radiography, Thoracic ; Radiotherapy ; Retrospective Studies

PURPOSE: To evaluate the incidences and potential predictive factors for symptomatic radiation pneumonitis (SRP) and radiographic pulmonary toxicity (RPT) following adjuvant radiotherapy (RT) for patients with breast cancer. A particular focus was made to correlate RPT with the dose volume histogram (DVH) parameters based on three-dimensional RT planning (3D-RTP) data. MATERIALS AND METHODS: From September 2003 through February 2006, 171 patients with breast cancer were treated with adjuvant RT following breast surgery. A radiation dose of 50.4 Gy was delivered with tangential photon fields on the whole breast or chest wall. A single anterior oblique photon field for supraclavicular (SCL) nodes was added if indicated. Serial follow-up chest radiographs were reviewed by a chest radiologist. Radiation Therapy Oncology Group (RTOG) toxicity criteria were used for grading SRP and a modified World Health Organization (WHO) grading system was used to evaluate RPT. The overall percentage of the ipsilateral lung volume that received > or =15 Gy (V15), 20 Gy (V20), and 30 Gy (V30) and the mean lung dose (MLD) were calculated. We divided the ipsilateral lung into two territories, and defined separate DVH parameters, i.e., V15 TNGT, V20 TNGT, V30 TNGT, MLD TNGT, and V15 SCL, V20 SCL, V 30SCL, MLD SCL to assess the relationship between these parameters and RPT. RESULTS: Four patients (2.1%) developed SRP (three with grade 3 and one with grade 2, respectively). There was no significant association of SRP with clinical parameters such as, age, pre-existing lung disease, smoking, chemotherapy, hormonal therapy and regional RT. When 137 patients treated with 3D-RTP were evaluated, 13.9% developed RPT in the tangent (TNGT) territory and 49.2% of 59 patients with regional RT developed RPT in the SCL territory. Regional RT (p<0.001) and age (p=0.039) was significantly correlated with RPT. All DVH parameters except for V15 TNGT showed a significant correlation with RPT (p<0.05). MLDTNGT was a better predictor for RPT for the TNGT territory than V15 SCL for the SCL territory. CONCLUSION: The incidence of SRP was acceptable with the RT technique that was used. Age and regional RT were significant factors to predict RPT. The DVH parameter was good predictor for RPT for the SCL territory while MLD TNGT was a better predictor for RPT for the TNGT territory.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Follow-Up Studies ; Humans ; Incidence ; Lung ; Lung Diseases ; Radiation Pneumonitis ; Radiography, Thoracic ; Radiotherapy ; Radiotherapy, Adjuvant* ; Smoke ; Smoking ; Thoracic Wall ; Thorax ; World Health Organization

BACKGROUND AND PURPOSE: Radioopaque lesions are commonly seen in patients who received thoracic radiotherapy for various kinds of thoracic neoplasm, But therir exact diagnos are sometimes uncertain. PATIENTS AND METHODS: We examined simple chest radiograph and computed tomogram(CT) of 69 patients who received thoracic radiotherapy for lung cancer and were follow up at least 6 months in Yeungnam University Medical Center. RESULTS: Of the 69 patients. thirty-eight patients showed radioopaque lesions in their chest radiographs except radiation fibrosis; radiation pneumonitis was witnessed in 24 patients. infectious pneumonia in 8 patients, and recurrence in 6 patients. In radiateionpneumonitis patients, the pneumonitis occurred usually between 50 to 130 days after receiving radiation therapy, and interval between pneumonitis and fibrosis is 21 to 104 days. Simple chest radiographs of radiation pneumonitis(24 patients) represented ground glass opacities or consolidation in 4 cases(type I, 17%), reticular of reticulonodular opacities in 10 cases(type II, 42%), irregular patichy consolidations in 2 cases( type III, 8%), and consolidation with fibrosis in 8 cases(type IV, 33%), CT represent ground glass opacities or consolidation in 5 cases(type I, 29%), irregular nodular opacities in 3 cases(type II, 19%), irregular opacity beyond radiation fields in 3 cases(type III, 18%), and consolidation with fibrosis in 6 cased(typeIV, 35%). The CT of four patients who represented type II on simple chest radiographs reveal type I and III, and CT of two patients with clinical symptoms who had no abnormal finding on simple radiograph revealed type I. CONCLUSIONS: In conclusion, computed tomogram is superior to the simple radiograph when trying to understand the pathologic process of radiation pneumonitis and provide confidence in the diagnosis of radiation induced lung disease.
Academic Medical Centers ; Diagnosis ; Fibrosis ; Follow-Up Studies ; Glass ; Humans ; Lung Diseases* ; Lung Neoplasms ; Lung* ; Pneumonia ; Radiation Pneumonitis ; Radiography, Thoracic ; Radiotherapy ; Recurrence ; Thoracic Neoplasms

PURPOSE: The aim of this study is to present the incidence of radiation pneumonitis (RP) reported within 6 months after treatment for breast cancer with or without internal mammary node irradiation (IMNI). METHODS: In the Korean Radiation Oncology Group (KROG) 08-06 phase III randomized trial, patients who were node-positive after surgery were randomly assigned to receive radiotherapy either with or without IMNI. A total of 747 patients were enrolled, and three-dimensional treatment planning with computed tomography simulation was performed for all patients. Of the 747 patients, 722 underwent chest X-rays before and within 6 months after radiotherapy. These 722 patients underwent evaluation, and RP was diagnosed on the basis of chest radiography findings and clinical symptoms. The relationship between the incidence of RP and clinical/dosimetric parameters was analyzed. RESULTS: RP developed in 35 patients (4.8%), including grade 1 RP in 26 patients (3.6%), grade 2 RP in nine patients (1.2%); there was no incidence of grade 3 or higher RP. Grade 2 RP cases were observed in only the IMNI group. The risk of developing RP was influenced by IMNI treatment; pneumonitis occurred in 6.5% of patients (n=23/356) who underwent IMNI and in 3.3% of patients (n=12/366) who did not (p=0.047). The differences in lung dosimetric parameters (mean lung dose, V10–40) were statistically significant between the two groups. CONCLUSION: IMNI treatment resulted in increased radiation exposure to the lung and a higher rate of RP, but the incidence and severity of RP was minimal and acceptable. This minor impact on morbidity should be balanced with the impact on survival outcome in future analyses.
Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Lung ; Lymphatic Irradiation ; Pneumonia ; Radiation Exposure ; Radiation Oncology ; Radiation Pneumonitis* ; Radiography ; Radiotherapy ; Thorax

The aim of our study was to describe the radiologic findings of extensive acute lung injury associated with limited thoracic irradiation. Limited thoracic irradiation occasionally results in acute lung injury. In this condition, chest radiograph shows diffuse ground-glass appearance in both lungs and thin-section CT scans show diffuse bilateral ground-glass attenuation with traction bronchiectasis, interlobular septal thickening and intralobular smooth linear opacities.
Acute Disease ; Adenocarcinoma/radiotherapy ; Adenocarcinoma/pathology ; Adenocarcinoma/drug therapy ; Adenocarcinoma/complications* ; Carcinoma, Squamous Cell/radiotherapy ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/drug therapy ; Carcinoma, Squamous Cell/complications* ; Journal Article ; Human ; Lung/radiation effects* ; Lung/pathology ; Lung Neoplasms/radiotherapy ; Lung Neoplasms/pathology ; Lung Neoplasms/drug therapy ; Lung Neoplasms/complications* ; Male ; Middle Age ; Radiation Injuries/radiography ; Radiation Injuries/pathology ; Radiation Injuries/etiology* ; Thorax/radiation effects

BACKGROUND/AIMS: The risk of venous thromboembolism (VTE), which encompasses deep vein thrombosis and pulmonary embolism (PE), increases in patients with cancer. Anticancer treatment is also associated with an increased risk for VTE. We conducted this study to investigate the clinical characteristics of patients with cancer and PE related to anticancer treatment in a tertiary care hospital in Korea. METHODS: We retrospectively reviewed the clinical data of patients with an underlying malignancy who were diagnosed with PE by chest computed tomography (CT) with or without lower extremity CT angiography between January 2006 and December 2007 at Seoul National University Hospital. RESULTS: Overall, 95 patients with malignancies among 168 with PE were analyzed. The median age was 64 years. The median time interval from the malignancy diagnosis to the PE diagnosis was 5.5 months. Lung cancer was the most common malignancy (23.0%), followed by pancreatobiliary cancer, stomach cancer, gynecological cancer, breast cancer, and hepatocellular carcinoma. Platinum-containing and pyrimidine analog-containing chemotherapeutic regimens were common. CONCLUSIONS: PE was diagnosed within 1 year after the cancer diagnosis in almost 70% of patients. Lung cancer was the most common underlying malignancy.
Adult ; Aged ; Aged, 80 and over ; Angiography ; Antineoplastic Agents/*therapeutic use ; Biliary Tract Neoplasms/drug therapy/epidemiology/radiotherapy ; Female ; Humans ; Lung Neoplasms/drug therapy/epidemiology/radiotherapy ; Male ; Middle Aged ; *Neoplasms/drug therapy/epidemiology/radiotherapy ; Pancreatic Neoplasms/drug therapy/epidemiology/radiotherapy ; Pulmonary Embolism/*epidemiology/radiography ; *Radiotherapy ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms/drug therapy/epidemiology/radiotherapy ; Tomography, X-Ray Computed

PURPOSE: A retrospective analysis was performed to evaluate the incidence of radiation induced lung damage after the radiation therapy for the patients with carcinoma of the lung. MATHOD AND MATERIALS: Sixty-six patients with lung cancer (squamous cell carcinoma 27, adenocarcinDma 14, large cell carcinoma 2, small cell carcinoma 13, unknown 10) were treated with definitive, postoperative or palliative radiation therapy with or without chemotherapy between July 1987 and December 1991. There were 50 males and 16 females with median age of 63 years(range: 33~80 years). Total lung doses ranged from 500 to 6,660 cGy (median 3960 cGy) given in 2 to 38 fractions (median 20) over a range of 2 to 150 days (median 40 days) using 6 MV or 15 MV linear accelerator. To represent different fractionation schedules of equivalent biological effect, the estimated single dose(ED) model, ED=D.N-0.377.T-0.058 was used in which D was the lung dose in cGy, N was the number of fractions, and T was the overall treatment time in days. The range of ED was 370 to 1357. The endpoint was a visible increase in lung density within the irradiated volume on chest X-ray as observed independently by three diagnostic radiologists. Patients were grouped according to ED, treatment duration, treatment modality and age, and the percent incidence of pulmonary damage for each group was determined. RESULT: In 40 of 66 patients, radiation induced change was seen on chest radiographs between 11 days and 314 days after initiation of radiation therapy. The incidence of radiation pneumonitis was increased according to increased ED, which was statistically significant (p=0.001). Roentgenographic charges consistent with radiation pneumonitis were seen in 100% of patients receiving radiotherapy after lobectomy or pneumonectomy, which was not statistically significant. In 32 patients who also received chemotherapy, there was no difference in the incidence of radiation induced charge between the group with radiation alone and the group with radiation and chemotherapy, among the sequence of chemotherapy. No correlation was seen between incidence of radiation pneumonitis and age or sex. CONCOUSIONS: The occurrence cf radiation pneumonitis varies. The incidence of radiation pneumonitis depends on radiation total dose, nature of fractionation, duration of therapy, and modifying factors such as lobectomy or pneumonectomy.
Appointments and Schedules ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Drug Therapy ; Female ; Humans ; Incidence ; Lung Neoplasms* ; Lung* ; Male ; Particle Accelerators ; Pneumonectomy ; Radiation Pneumonitis ; Radiography, Thoracic ; Radiotherapy ; Retrospective Studies ; Thorax

OBJECTIVE: To measure the intra-fraction displacements of the mediastinal metastatic lymph nodes by using four-dimensional CT (4D-CT) in non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Twenty-four patients with NSCLC, who were to be treated by using three dimensional conformal radiation therapy (3D-CRT), underwent a 4D-CT simulation during free breathing. The mediastinal metastatic lymph nodes were delineated on the CT images of 10 phases of the breath cycle. The lymph nodes were grouped as the upper, middle and lower mediastinal groups depending on the mediastinal regions. The displacements of the center of the lymph node in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were measured. RESULTS: The mean displacements of the center of the mediastinal lymph node in the LR, AP, and SI directions were 2.24 mm, 1.87 mm, and 3.28 mm, respectively. There were statistically significant differences between the displacements in the SI and LR, and the SI and AP directions (p < 0.05). For the middle and lower mediastinal lymph nodes, the displacement difference between the AP and SI was statistically significant (p = 0.005; p = 0.015), while there was no significant difference between the LR and AP directions (p < 0.05). CONCLUSION: The metastatic mediastinal lymph node movements are different in the LR, AP, and SI directions in patients with NSCLC, particularly for the middle and lower mediastinal lymph nodes. The spatial non-uniform margins should be considered for the metastatic mediastinal lymph nodes in involved-field radiotherapy.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/*radiography/radiotherapy ; Contrast Media/diagnostic use ; Female ; Four-Dimensional Computed Tomography/*methods ; Humans ; Iohexol/analogs & derivatives/diagnostic use ; Lung Neoplasms/*radiography/radiotherapy ; Lymphatic Metastasis/*radiography ; Male ; Mediastinum/radiography ; Middle Aged ; Radiographic Image Interpretation, Computer-Assisted ; Statistics, Nonparametric

PURPOSE: The determine the chest CT findings in breast cancer patients who have undergone postoperative irradiation. MATERIALS AND METHODS: The chest CT findings in 36 female patients who underwent breast surgery and radiotherapy between May 1996 and March 2000 were retrospectively analysed. Prior to radiotherapy, baseline chest CT depicted normal parenchyma in all cases. In 11 patients, the ipsilateral breast and chest wall were irradiated using opposed tangential fields, while 25 were treated by the four fields method (opposed tangential fields plus anterior and posterior supraclavicular/high axillary fields), with a total dose of 5040-5400 cGy for 5-9 weeks. RESULTS: CT after radiotherapy demonstrated reticular opacity (n=24), perpendicular linear opacity (n=15), traction bronchiectasis (n=7), consolidation (n=6), ground glass attenuation (n=3), pathologic rib fractures (n=3), pleural effusion (n=2), and pleural thickening (n=1), while in five patients no abnormality was observed. In addition, in the anterolateral lung area of 23 (64%) of 36 patients who underwent tangential beam irradiation, CT demonstrated peripheral opacities. When supraclavicular and axillary portals were used, radiation-induced lung changes mostly occurred at the apex of the lung (n=24). Chest radiographs were abnormal in 26 patients and normal in ten; in five of these ten, CT demonstrated reticular opacity. CONCLUSION: Depending on the irradiation CT findings of radiation-induced lung injury in breast cancer include areas of increased opacity with or without fibrosis, in apical and/or anterior subpleural regions. CT may help differentiate radiation-induced parenchymal change from superimposed or combined lung disease.
Breast Neoplasms* ; Breast* ; Bronchiectasis ; Female ; Fibrosis ; Glass ; Humans ; Lung ; Lung Diseases ; Lung Injury ; Pleural Effusion ; Radiography, Thoracic ; Radiotherapy ; Retrospective Studies ; Rib Fractures ; Thoracic Wall ; Thorax* ; Tomography, X-Ray Computed* ; Traction