Brett Wilson Carter MD, Presenter: Author, Reed Elsevier Consultant, St. Jude Medical, Inc

1) Understand the role of imaging in the evaluation of patients who have been treated for thoracic malignancies. 2) Recognize the manifestations of radiation therapy in the chest and be able to differentiate expected changes from residual or recurrent disease. 3) Identify intrathoracic complications from radiation therapy, chemotherapy, and surgery.

Imaging plays an important role in the evaluation of patients who have been treated with radiation therapy, chemotherapy, and/or surgery for intrathoracic malignancies such as lung cancer, esophageal cancer, malignant pleural mesothelioma, and thymoma.  Following thoracic radiation therapy, radiation pneumonitis (1-6 months following therapy) and radiation fibrosis (6-12 months following therapy) are typically identified in the lungs.  However, complications such as esophagitis, esophageal ulceration, and radiation-induced cardiovascular disease may develop.  Patients treated with chemotherapy may develop pulmonary and cardiovascular complications such as drug toxicity, organizing pneumonia, thromboembolic disease, vasculitis, and cardiomyopathy.  Knowledge of the spectrum of expected treatment-related changes, potential treatment complications and the appearance of tumor recurrence is critical in order to properly monitor patients, identify iatrogenic complications, and avoid misinterpretation.    

Carter, B, Thoracic Oncologic Imaging: Treatment Effects and Complications.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14000767.html