Tadamasa Yoshitake MD, Presenter: Nothing to Disclose

Katsumasa Nakamura MD, PhD, Abstract Co-Author: Nothing to Disclose

Tomonari Sasaki MD, PhD, Abstract Co-Author: Nothing to Disclose

Saiji Ohga MD, Abstract Co-Author: Nothing to Disclose

Kotaro Terashima, Abstract Co-Author: Nothing to Disclose

Kaori Asai, Abstract Co-Author: Nothing to Disclose

Yoshio Matsuo, Abstract Co-Author: Nothing to Disclose

Takeshi Kamitani MD, Abstract Co-Author: Nothing to Disclose

Hideki Hirata, Abstract Co-Author: Nothing to Disclose

Hiroshi Honda MD, Abstract Co-Author: Nothing to Disclose

Purpose:Interstitial pneumonia is considered to be one of risk factors of severe radiation pneumonitis. However, the incidence of radiation pneumonitis after stereotactic body radiation therapy (SBRT) for lung cancer patients with pulmonary interstitial change is not well known. The purpose of the present study is to evaluate the incidence of radiation pneumonitis after SBRT for lung cancer patients with pulmonary interstitial change.Materials/Methods:Between November 2003 and August 2012, 489 patients with primary or metastatic lung cancer were treated with SBRT in Kyushu University Hospital. In those patients, 18 patients who had pulmonary interstitial changes on thin-section CT were selected. The median age of these 18 patients was 76 years (range 60-85 years). Sixteen patients were male, and two were female. The median tumor size was 27 mm (range 14-44 mm). Thirteen patients were diagnosed as interstitial pulmonary diseases (idiopathic pulmonary fibrosis, 2; interstitial pneumonia, 8; drug-induced pneumonitis, 3). The median pretreatment serum KL-6 levels was 535 U/mL (range 185-1853 U/mL). SBRT was given in 7-8 fields with an isocenter dose of 48 Gy in 4 fractions in all patients. The median lung V20, V10, V5 and mean lung dose were 6.2 %, 12.3 %, 18.8 %, and 4.2 Gy.Results:Median follow-up was 12.5 months (range 2.7-38.0 months). Grade 2, 3, and 5 radiation pneumonitis was observed in 2, 3, and 3 patients, respectively. Three patients with grade 5 radiation pneumonitis died at 2.7, 4.3 and 8.5 months after treatment. By univariate analysis, pretreatment serum KL-6 levels, lung V10, V5 were significant predictive factors of grade ≥ 2 radiation pneumonitis (P value < 0.05 by t-test). Recurrence was observed in 8 patients (local failure, 5; distant metastases, 3). One patient died of recurrence and one patient died from other diseases. Overall survival at 1 and 2 years were 77 % and 58 %, respectively.Conclusions:Pulmonary interstitial changes was considered to be a potential risk of fatal radiation pneumonitis. Pretreatment serum KL-6 levels, lung V10, and V5 may be predictive factors of radiation pneumonitis.

Yoshitake, T, Nakamura, K, Sasaki, T, Ohga, S, Terashima, K, Asai, K, Matsuo, Y, Kamitani, T, Hirata, H, Honda, H, Incidence of Radiation Pneumonitis after Stereotactic Body Radiation Therapy for Lung Cancer Patients with Pulmonary Interstitial Changes.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13041790.html