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. 2018 Oct 4;13(10):e0204734.
doi: 10.1371/journal.pone.0204734. eCollection 2018.

Assessment and agreement of the CT appearance pattern and its severity grading of radiation-induced lung injury after stereotactic body radiotherapy for lung cancer

Takaya Yamamoto  1 , Noriyuki Kadoya  1 , Yohei Morishita  2 , Yoshinao Sato  2 , Haruo Matsushita  1 , Rei Umezawa  1 , Yojiro Ishikawa  1 , Noriyoshi Takahashi  1 , Yu Katagiri  1 , Ken Takeda  1 , Keiichi Jingu  1
Affiliations

Assessment and agreement of the CT appearance pattern and its severity grading of radiation-induced lung injury after stereotactic body radiotherapy for lung cancer

Takaya Yamamoto et al. PLoS One. .

Abstract

Purpose: Radiographic severity of radiation-induced lung injury (RILI) has not been well-studied. The goal of this study was to assess the CT appearance pattern and severity of RILI without consideration of the clinical presentation.

Material and methods: A total of 49 patients, 41 with primary lung cancer and 8 with metastatic lung cancer, were treated by 4-fraction stereotactic body radiotherapy (SBRT). RILI after SBRT was separately assessed by two observers. The early and late CT appearance patterns and CT-based severity grading were explored.

Results: The median follow-up period was 39.0 months. In the early CT findings of observers 1 and 2, there was diffuse consolidation in 15 and 8, diffuse ground glass opacity (GGO) in 0 and 0, patchy consolidation and GGO in 17 and 20, patchy GGO in 3 and 3, and no changes in 10 and 14, respectively (kappa = 0.61). In late CT findings of observer 1 and 2, there were modified conventional pattern in 28 and 24, mass-like pattern in 8 and 11, scar-like pattern in 12 and 12, and no changes in 1 and 2, respectively (kappa = 0.63). In the results of the CT-based grading by observers 1 and 2, there were grade 0 in 1 and 2, grade 1 in 10 and 14, grade 2 in 31 and 29, grade 3 in 7 and 4, and none of grade 4 or more, respectively (kappa = 0.66). According to multivariate analyses (MVA), the significant predicting factors of grade 2 or more CT-based RILI were age (p = 0.01), oxygen dependence (p = 0.03) and interstitial shadow (p = 0.03).

Conclusions: The agreement of the CT appearance and CT-based grading between two observers was good. These indicators may be able to provide us with more objective information and a better understanding of RILI.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Concordance CT appearance, case 1.
(a) The shadow extends to the right middle and lower lobes beyond the high-dose region; this was diagnosed as diffuse consolidation at 6 months after SBRT. (b) The shadow shows consolidation, volume loss and bronchiectasis; this was diagnosed as the modified conventional pattern at 21 months after SBRT. (c) The shadow remained at 45 months after SBRT.
Fig 2
Fig 2. Concordance CT appearance, case 2.
(a) Before SBRT, the lung tumor was located in the right upper lobe. (b) The consolidation expands beyond the high-dose region; this shadow was diagnosed as diffuse consolidation at 5 months after SBRT. (c) The shadow shrank, and only a linear opacity remained. This shadow was diagnosed as a scar-like pattern at 20 months after SBRT.
Fig 3
Fig 3. Concordance CT appearance, case 3.
(a) Before SBRT, the lung tumor was located in the right upper lobe. (b) Patchy areas of hazy and consolidation are seen; this shadow was diagnosed as patchy consolidation and GGO at 5 months after SBRT. (c) The shadow forms a focal consolidation; this was diagnosed as a mass-like pattern at 17 months after SBRT. (d) The shadow shrank, but a mass-like shadow remained at 35 months after SBRT.
Fig 4
Fig 4. Concordance CT appearance, case 4.
(a) Before SBRT, the lung tumor was located in the left lower lobe. (b) Patchy areas of hazy are seen; this shadow was diagnosed as patchy GGO at 3 months after SBRT.
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References

    1. Nagata Y, Hiraoka M, Mizowaki T, Narita Y, Matsuo Y, Norihisa Y, et al. Survey of Stereotactic Body Radiation Therapy in Japan by the Japan 3-D Conformal External Beam Radiotherapy Group. Int. J. Radiat. Oncol. Biol. Phys. 2009;75:343–347. 10.1016/j.ijrobp.2009.02.087 . - DOI - PubMed
    1. Pan H, Simpson DR, Mell LK, Mundt AJ, Lawson JD. A survey of stereotactic body radiotherapy use in the United States. Cancer. 2011;117:4566–4572. 10.1002/cncr.26067 . - DOI - PMC - PubMed
    1. Dahele M, Hatton M, Slotman B, Guckenberger M. Stereotactic body radiotherapy: A survey of contemporary practice in six selected European countries. Acta Oncol. 2015;54:1237–1241. 10.3109/0284186X.2014.1003961 . - DOI - PubMed
    1. Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA.2010;303:1070–1076. 10.1001/jama.2010.261 . - DOI - PMC - PubMed
    1. Graves PR, Siddiqui F, Anscher MS, Movsas B. Radiation pulmonary toxicity:from mechanisms to management. Semin Radiat Oncol. 2010;20:201–207. 10.1016/j.semradonc.2010.01.010 . - DOI - PubMed