CT appearance of radiation injury of the lung and clinical symptoms after stereotactic body radiation therapy (SBRT) for lung cancers: Are patients with pulmonary emphysema also candidates for SBRT for lung cancers?

Purpose: The purpose of this study was to analyze the computed tomographic (CT) appearance of radiation injury to the lung and clinical symptoms after stereotactic body radiation therapy (SBRT) and evaluate the difference by the presence of pulmonary emphysema (PE) for small lung cancers. Methods and Materials: In this analysis, 45 patients with 52 primary or metastatic lung cancers were enrolled. We evaluated the CT appearance of acute radiation pneumonitis (within 6 months) and radiation fibrosis (after 6 months) after SBRT. Clinical symptoms were evaluated by Common Terminology Criteria for Adverse Events, version 3.0. We also evaluated the relationship between CT appearance, clinical symptoms, and PE. Results: CT appearance of acute radiation pneumonitis was classified as follows: ( 1 ) diffuse consolidation, 38.5%; ( 2 ) patchy consolidation and ground-glass opacities (GGO), 15.4%; ( 3 ) diffuse GGO, 11.5%; ( 4 ) patchy GGO, 2.0%; ( 5 ) no evidence of increasing density, 32.6%. CT appearance of radiation fibrosis was classified as follows: ( 1 ) modified conventional pattern, 61.5%; ( 2 ) mass-like pattern, 17.3%; ( 3 ) scar-like pattern, 21.2%. Patients who were diagnosed with more than Grade 2 pneumonitis showed significantly less no evidence of increased density pattern and scar-like pattern than any other pattern ( p = 0.0314, 0.0297, respectively). Significantly, most of these patients with no evidence of increased density pattern and scar-like pattern had PE ( p = 0.00038, 0.00044, respectively). Conclusion: Computed tomographic appearance after SBRT was classified into five patterns of acute radiation pneumonitis and three patterns of radiation fibrosis. Our results suggest that SBRT can be also safely performed even in patients with PE.