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(a) Drawing depicts 3D-CRT, with use of multiple beam angles, for treatment of lung cancer. Use of multiple beams decreases the amount of radiation delivered to normal tissue, while the higher radiation dose is closely targeted and conforms to the tumor itself. (b) Drawing and frontal radiograph show conventional radiation therapy involving a simplified radiation dose distribution. A high radiation dose is delivered to organs proximal and distal to the target, with less sparing of the surrounding normal tissues. (c) Drawing and axial CT image show a simplified radiation dose distribution for 3D-CRT or IMRT, demonstrating how the radiation, seen as a yellow-orange halo-like shading surrounding the tumor, more tightly conforms around the tumor. Yet some of the dose is still delivered proximal and distal to the tumor. (d) Drawing and axial CT image show proton-beam radiation treatment involving a simplified dose distribution. There is a sharp decrease in the dose distal to the tumor. In addition, due to the Bragg peak effect, there is a lower radiation entry dose, with a high therapeutic dose released to the tumor.
Source publication
Radiation therapy is one of the cornerstones for the treatment of thoracic malignancies. Although advances in radiation therapy technology have improved the delivery of radiation considerably, adverse effects are still common. Postirradiation changes affect the organ or tissue treated and the neighboring structures. Advances in external-beam radiat...
Contexts in source publication
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... development occurred first in the form of 3D-CRT and then with techniques such as IMRT and SBRT. The second advancement occurred with the advent of proton-beam therapy, with which the properties of the proton particle are used to better control the depth at which the radiation therapy is delivered (Figs 1, 2). With both of these advancements, the radiation dose delivered to surrounding organs, and thus toxicity, is decreased, and the dose delivered to the tumor itself is increased. ...
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... planned radiation treatments have been performed with two-dimensional techniques in which radiographs are used to delineate anatomic landmarks and a limited number of beams are used to treat the tumor target. This approach often resulted in a heterogeneous treatment plan and the irradiation of a large tissue volume outside of the targeted tumor (Fig 1). The delivery of a large radiation dose to surrounding tissues limits the amount of radiation delivered to the targeted tumor and consequently results in high rates of local tumor progression in the radiation field (2,3). ...
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... secondary to enabling the use of a low exit radiation dose (Figs 1, 2), proton therapy Note.-NSCLC = non-small cell lung cancer, SABR = stereotactic ablative body radiation therapy, 3D = three-dimensional, 2D = two-dimensional. ...
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... cysts are asymptomatic, small, and occult on chest radiographs. On CT scans, they are homogeneous and low attenuating, consistent with fluid, and have thin, well-defined walls (Fig 10) (69). However, these features are sometimes difficult to appreciate at CT. ...
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... this late phase, patients are often asymptomatic clinically, but if the fibrosis leads to a stricture, various degrees of dysphagia may develop. Dysphagia can also occur if chronic ulceration, perforation, or fistulation develops as a late complication (Fig 11) (78). At esophagography, the radiationinduced esophageal stricture is characterized by a smooth and long stenotic segment (Fig 12). ...
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... can also occur if chronic ulceration, perforation, or fistulation develops as a late complication (Fig 11) (78). At esophagography, the radiationinduced esophageal stricture is characterized by a smooth and long stenotic segment (Fig 12). At CT, symmetric esophageal wall thickening extending along the irradiated esophagus is commonly seen in acute and chronic esophagitis. ...
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... the injury persists, veno-occlusive disease develops and can progress to fibrosis of the portal veins, with lobular architecture disorganization characterized macroscopically by marked liver atrophy. CT findings of acute radiation-induced hepatitis Figure 10. Findings seen 4 years after the completion of radiation therapy for diffuse large B-cell lymphoma of the upper chest in a 39-year-old woman. ...
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... include a sharp demarcation at the edge of the radiation portal and decreased attenuation in the radiation treatment field in patients in whom more than 45 Gy of radiation is delivered to a portion of the liver (Fig 13) (79). The acutely involved liver parenchyma in the radiation portal has reduced enhancement compared with the corresponding liver parenchyma during the arterial and portal venous phases (80). ...
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... and MRI findings during the late stage may indicate liver atrophy. One should use caution when interpreting FDG PET/ CT findings during the acute phase of radiationinduced hepatitis, as the inflamed liver regions are FDG avid (Fig 13). The area of FDG uptake corresponds to the low-attenuation region seen during the CT portion of the study. ...
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... after radiation, the breast may have diffuse skin thickening in the radiation portal owing to edema. Fat necrosis and dystrophic calcifications also may be seen (Fig 14) (85). Skin retraction with decreased breast size may occur late after the treatment (85). ...
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... most readily depicts the bone abnormalities that occur after radiation therapy. Initially, only days after the radiation therapy, the T2-weighted MR images obtained in skel- Figure 13. Findings after neoadjuvant chemotherapy and proton radiaton therapy for stage III adenocarcinoma of the distal esophagus in a 57-year-old man. ...
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... is because radiation impairs osteoblast function, resulting in decreased matrix production. This may cause weakening of the bone that leads to pathologic fractures (Fig 15). Nonunion fractures and delayed bone healing are common findings. ...
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... radiation-induced malignant pleural mesothelioma and esophageal cancers have been reported (95,96). Radiation-induced sarcomas can originate in the irradiated bone, with osteosarcomas being the most common of these, or in soft tissue, with malignant fibrous histiocytomas being the most common of these (Fig 16) (97). The radiation-induced sarcoma typically develops 5-20 years after the radiation therapy and is indistinguishable from sporadic sarcomas. ...
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... be considered a radiation-induced sarcoma, the following criteria must be met: (a) history of irradiation, with the sarcoma arising in an area Figure 16. Findings after multimodality treatment, including neoadjuvant chemotherapy, surgery, and postoperative radiation therapy, for right-breast invasive ductal carcinoma in a 54-year-old woman. ...
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... et al (105) and other groups reported an increased incidence of lung cancer among patients with breast cancer (Fig 17) who had received a higher total radiation dose and had a larger radiation field (106)(107)(108). The detection of a new lung opacity or mass in or at the border of the irradiated area after thoracic radiation therapy in long-term survivors should raise suspicion of radiation-induced lung cancer ( Fig 17). ...
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... et al (105) and other groups reported an increased incidence of lung cancer among patients with breast cancer (Fig 17) who had received a higher total radiation dose and had a larger radiation field (106)(107)(108). The detection of a new lung opacity or mass in or at the border of the irradiated area after thoracic radiation therapy in long-term survivors should raise suspicion of radiation-induced lung cancer ( Fig 17). Knowledge of the radiation treatment field is important for assessment of radiation-induced thoracic malignancies. ...
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... development occurred first in the form of 3D-CRT and then with techniques such as IMRT and SBRT. The second advancement occurred with the advent of proton-beam therapy, with which the properties of the proton particle are used to better con- trol the depth at which the radiation therapy is delivered (Figs 1, 2). With both of these advance- ments, the radiation dose delivered to surround- ing organs, and thus toxicity, is decreased, and the dose delivered to the tumor itself is increased. ...
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... planned radiation treat- ments have been performed with two-dimensional techniques in which radiographs are used to delineate anatomic landmarks and a limited num- ber of beams are used to treat the tumor target. This approach often resulted in a heterogeneous treatment plan and the irradiation of a large tissue volume outside of the targeted tumor (Fig 1). The delivery of a large radiation dose to sur- rounding tissues limits the amount of radiation delivered to the targeted tumor and consequently results in high rates of local tumor progression in the radiation field (2,3). ...
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... secondary to enabling the use of a low exit radiation dose (Figs 1, 2), proton therapy Note.-NSCLC = non-small cell lung cancer, SABR = stereotactic ablative body radiation therapy, 3D = three-dimensional, 2D = two-dimensional. ...
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... cysts are asymptomatic, small, and occult on chest radiographs. On CT scans, they are homoge- neous and low attenuating, consistent with fluid, and have thin, well-defined walls (Fig 10) (69). However, these features are sometimes difficult to appreciate at CT. ...
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... this late phase, patients are often asymptomatic clinically, but if the fibrosis leads to a stricture, various degrees of dysphagia may develop. Dysphagia can also occur if chronic ulceration, perforation, or fistulation develops as a late complication (Fig 11) (78). At esophagography, the radiation- induced esophageal stricture is characterized by a smooth and long stenotic segment (Fig 12). ...
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... can also occur if chronic ulceration, perforation, or fistulation develops as a late complication (Fig 11) (78). At esophagography, the radiation- induced esophageal stricture is characterized by a smooth and long stenotic segment (Fig 12). At CT, symmetric esophageal wall thickening extending along the irradiated esophagus is com- monly seen in acute and chronic esophagitis. ...
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... the injury persists, veno-occlusive disease develops and can progress to fibrosis of the portal veins, with lobular architecture disorganization character- ized macroscopically by marked liver atrophy. CT findings of acute radiation-induced hepatitis Figure 10. Findings seen 4 years after the completion of radiation therapy for diffuse large B-cell lymphoma of the upper chest in a 39-year-old woman. ...
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... include a sharp demarcation at the edge of the radiation portal and decreased attenua- tion in the radiation treatment field in patients in whom more than 45 Gy of radiation is deliv- ered to a portion of the liver (Fig 13) (79). The acutely involved liver parenchyma in the radiation portal has reduced enhancement compared with the corresponding liver parenchyma during the arterial and portal venous phases (80). ...
Context 25
... and MRI findings during the late stage may indicate liver atrophy. One should use caution when interpreting FDG PET/ CT findings during the acute phase of radiation- induced hepatitis, as the inflamed liver regions are FDG avid (Fig 13). The area of FDG uptake corresponds to the low-attenuation region seen during the CT portion of the study. ...
Context 26
... after radiation, the breast may have diffuse skin thick- ening in the radiation portal owing to edema. Fat necrosis and dystrophic calcifications also may be seen (Fig 14) (85). Skin retraction with decreased breast size may occur late after the treatment (85). ...
Context 27
... most readily depicts the bone abnormalities that occur after radiation therapy. Initially, only days after the radiation therapy, the T2-weighted MR images obtained in skel- Figure 13. Findings after neoadjuvant chemotherapy and proton radiaton therapy for stage III adenocarcinoma of the distal esophagus in a 57-year-old man. ...
Context 28
... is because radiation impairs osteoblast function, resulting in decreased matrix produc- tion. This may cause weakening of the bone that leads to pathologic fractures (Fig 15). Nonunion fractures and delayed bone healing are common findings. ...
Context 29
... radiation-induced malignant pleural mesothelioma and esophageal cancers have been reported (95,96). Radiation-induced sarcomas can originate in the irradiated bone, with osteosarcomas being the most common of these, or in soft tissue, with malignant fibrous histiocytomas being the most common of these (Fig 16) (97). The radiation-induced sarcoma typically develops 5-20 years after the radiation therapy and is indistinguishable from sporadic sarcomas. ...
Context 30
... be considered a radiation-induced sarcoma, the following criteria must be met: (a) history of irradiation, with the sarcoma arising in an area Figure 16. Findings after multimodality treatment, in- cluding neoadjuvant chemotherapy, surgery, and postop- erative radiation therapy, for right-breast invasive ductal carcinoma in a 54-year-old woman. ...
Context 31
... et al (105) and other groups reported an increased incidence of lung cancer among patients with breast cancer (Fig 17) who had received a higher total radiation dose and had a larger radiation field (106)(107)(108). The detection of a new lung opacity or mass in or at the bor- der of the irradiated area after thoracic radia- tion therapy in long-term survivors should raise suspicion of radiation-induced lung cancer ( Fig 17). ...
Context 32
... et al (105) and other groups reported an increased incidence of lung cancer among patients with breast cancer (Fig 17) who had received a higher total radiation dose and had a larger radiation field (106)(107)(108). The detection of a new lung opacity or mass in or at the bor- der of the irradiated area after thoracic radia- tion therapy in long-term survivors should raise suspicion of radiation-induced lung cancer ( Fig 17). Knowledge of the radiation treatment field is important for assessment of radiation-induced thoracic malignancies. ...
Citations
... The use of radiotherapy may improve the survival of some patients, especially in life-threatening situations such as SVC syndrome, but the potential complications of radiation must always be considered. Radiation therapy-induced pericardial disease can manifest acutely or chronically [3] . Mechanisms of pericardial infection include direct spread from lung, pleura, or mediastinum or hematogenous spread, and Streptococcus and Staphylococcus species are the most common responsible. ...
Background: Small cell lung cancer is an aggressive tumor with a poor prognosis that requires prompt treatment. While radiotherapy may enhance survival when superior vena cava syndrome is present, radiation therapy–induced pericardial disease can be a potential complication. Case Report: A 55-year-old man, who recently underwent radiotherapy for stage IV small-cell lung cancer complicated by superior vena cava syndrome, presented with chest pain and dyspnea. In the emergency room, he was dyspneic, hypotensive, and tachycardic. Pulmonary auscultation revealed the absence of lung sounds on the right. The initial electrocardiogram showed ST-segment elevation in lateral leads and in lead DII, with reciprocal changes in lead DIII. A bedside transthoracic echocardiogram revealed cardiac tamponade and emergent pericardiocentesis was performed, removing 500 ml of purulent fluid, resulting in an immediate clinical improvement. Thoracentesis was also performed, showing no empyema. Large spectrum empirical antibiotic therapy was started. Cultures from the pericardial fluid and peripheral blood grew multi-sensitive Streptococcus pneumoniae. Cytological analysis of the pericardial fluid was consistent with infection. The patient improved after 2 weeks of targeted antibiotic therapy and underwent the first cycle of chemotherapy. He was discharged with an early scheduled pulmonology appointment. Conclusions: Although the most common causes of pericardial effusion in lung cancer are malignant, non-malignant etiologies should also be considered. This patient had an infectious pericardial effusion most probably due to a pericardial-mediastinal mass fistula caused by radiotherapy. This was a diagnostic challenge, both in the emergency room as well in the inpatient setting.
... Aside from lung cancer, several other malignancies may potentially be induced in chest radiotherapy patients [66]. These include sarcomas, osteosarcomas (the most common type from irradiated bones), and malignant fibrous histiocytomas that typically arise from soft tissues [67]. Breast cancer, pleural mesothelioma, and esophageal cancer are also among the potential malignancies that can be induced due to chest radiotherapy [67]. ...
... These include sarcomas, osteosarcomas (the most common type from irradiated bones), and malignant fibrous histiocytomas that typically arise from soft tissues [67]. Breast cancer, pleural mesothelioma, and esophageal cancer are also among the potential malignancies that can be induced due to chest radiotherapy [67]. ...
Radioactivity is a process in which the nuclei of unstable atoms spontaneously decay, producing other nuclei and releasing energy in the form of ionizing radiation in the form of alpha (α) and beta (β) particles as well as the emission of gamma (γ) electromagnetic waves. People may be exposed to radiation in various forms, as casualties of nuclear accidents, workers in power plants, or while working and using different radiation sources in medicine and health care. Acute radiation syndrome (ARS) occurs in subjects exposed to a very high dose of radiation in a very short period of time. Each form of radiation has a unique pathophysiological effect. Unfortunately, higher organisms—human beings—in the course of evolution have not acquired receptors for the direct “capture” of radiation energy, which is transferred at the level of DNA, cells, tissues, and organs. Radiation in biological systems depends on the amount of absorbed energy and its spatial distribution, particularly depending on the linear energy transfer (LET). Photon radiation with low LET leads to homogeneous energy deposition in the entire tissue volume. On the other hand, radiation with a high LET produces a fast Bragg peak, which generates a low input dose, whereby the penetration depth into the tissue increases with the radiation energy. The consequences are mutations, apoptosis, the development of cancer, and cell death. The most sensitive cells are those that divide intensively—bone marrow cells, digestive tract cells, reproductive cells, and skin cells. The health care system and the public should raise awareness of the consequences of ionizing radiation. Therefore, our aim is to identify the consequences of ARS taking into account radiation damage to the respiratory system, nervous system, hematopoietic system, gastrointestinal tract, and skin.
... Plevral efüzyon da olgularda görülebilecek ek bir bulgu olarak tanımlanmıştır (Resim 8) [33,36]. Diğer BT paternleri arasında buzlu cam opasitesinin çevrelediği nodül/konsolidasyon alanı ve radyoterapi sahasında nodüler opasitelerin gelişmesi ile karakterize "nodül benzeri radyasyon pnömoniti" gibi paternler yer almaktadır (Resim 9) [37,38]. ...
... As the tumor decreases, air bronchograms become evident. 34 Less frequently, there may be superimposed septal thickening creating a "crazy paving" pattern ( Fig. 6). 35 Over time, opacities that may be consolidative, reticular, or nodular in pattern may develop (Figs. 7 and 8). ...
... 56 Sarcomas, often osteosarcoma and malignant fibrous histiocytomas, are the most common arising from the chest wall, with esophageal cancers, breast cancers, and malignant pleural mesothelioma potentially occurring as well. 34 The most common imaging findings of radiationinduced sarcomas are soft tissue mass, bone destruction, tumor matrix mineralization, and periosteal reaction. 57 ...
Lung cancer is the third most common cancer in the United States after breast and prostate cancer and the leading cause of cancer-related death.1 The overall 5-year survival rate from 2012 to 2018 was 23%, lower (7%) for distant metastatic disease and higher (61%) for locoregional disease. Up to 86% of lung cancers are non–small cell lung cancer (NSCLC), which consists mainly of adenocarcinoma and squamous cell carcinoma. Small cell carcinoma is the least common subtype with the lowest 5-year survival rates of 7% compared with 29% for NSCLC.2
In patients with lung cancer, radiotherapy has a major role in treating locally advanced and metastatic disease and providing an alternative to surgery in patients who are not candidates or opt not to undergo surgery. Radiation therapy (RT) techniques used in treating lung cancer include conformal RT (CRT) or stereotactic body RT (SBRT), also known as stereotactic ablative radiotherapy.
Awareness of the expected and the unexpected imaging findings in the post-RT patient, including the time course for development of post-RT pneumonitis and fibrosis, is essential. A brief overview of RT techniques and indications is discussed. In addition, a differential diagnostic approach is presented, with a focus on computed tomography (CT) imaging examples, to distinguish alternative complications, such as infection, local recurrence, or radiation-induced malignancy.
... Whereas it is recommended to have a short interval between the last PET and surgery in diagnostic studies [26], to prevent falsely negative results, it is not always possible due to logistics. SUV measurement errors are influenced by many factors, which include time required for FDG uptake, blood glycemic levels, reconstruction algorithm used, and the pixels sampled which further shakes the strength of our results [27]. ...
Purpose
Esophageal cancer is among the leading causes of cancer-related mortality worldwide. Patients presenting with localized and loco-regionally advanced cancer without distant metastases have reasonable survival with multimodality management. Adequate and comprehensive staging is the backbone for proper selection of patients fit for curative treatment. Positron emission tomography (PET) in combination with contrast-enhanced computed tomography (CECT) is utilized as the standard staging modality. Multimodality treatment has been able to achieve evaluable tumor responses including pathological complete response (pCR). It is, therefore, necessary to understand whether the impact of neoadjuvant therapy can be evaluated on imaging, i.e., standardized uptake value (SUV) on PET scan done for response assessment and if this can be correlated with histopathological response and later, with survival. Squamous cell carcinoma (SCC) is more common globally and in the Indian subcontinent; hence, we chose this subgroup to evaluate our hypothesis.
Methods
This is a single institution, retrospective study. Out of the 1967 patients who were treated between 2009 and 2019, 1369 (78.54%) patients had SCC. Out of these, 44 received NACTRT, whereas 1325 received NACT followed by curative surgery. The standardized uptake value (SUV) of 18-fluorodeoxyglucose was recorded during pre- and post-neoadjuvant treatment (NAT) using positron emission tomography (PET). The histopathology of the final resection specimen was evaluated using the Mandard tumor regression grade (TRG) criteria with response being graded from 0 to 5 as no residual tumor (NRT), scanty residual tumor (SRT), and residual tumor We attempted to find a cut-off value of the post neoadjuvant SUV of the primary tumor site which correlated with achievement of better histopathological response.
Results
Out of 1325 patients of SCC esophagus who underwent surgery, 943 patients had available data of TRG, and it was categorized into the 0–2 category which had 325 patients (34.5%) and 3–5 category, 618 patients (65.5%). The SUV was taken only from the PET scans done at our institution, so as to achieve a more homogenous cohort, and this was available for 186 patients, 151 from the NACT group and 35 from the NACTRT group. The ROC method was used to find the cut-off for SUV (5.05) in the NACT cohort, which depicted significant difference in the outcome. Out of these, 93 patients who underwent NACT had SUV > 5.05 and 58 had SUV < 5.05. It was found that the subjective and objective histopathological scores correlated at a p value of < 0.0001. Specifically, the majority of cases with SRT tended to be in the 3–5 category of TRG, whereas cases with NRT are predominantly in the 0–2 category. In the ≥ 5.05 category of SUV, there were 76 cases with SRT. In the NACT cohort, the < 5.05 category of SUV, there are 26 cases with SRT and 32 cases with NRT. Among cases with SRT, 74.5% had SUV ≥ 5.05, while 25.5% had SUV < 5.05. Among cases with NRT, 34.7% had SUV ≥ 5.05, while 65.3% had SUV < 5.05 (p value 0.007). No significant association was found in the radio-pathological correlation in the NACTRT group.
Conclusion
Our study confirms the correlation of post neoadjuvant chemotherapy PET SUV with histopathological response, the cut-off of SUV being 5.05 in our cohort. This confirms the predictive value of FDG PET as demonstrated in other studies. Furthermore, its prognostic value with respect to survival has been verified in multiple other studies. With larger scale randomized studies, we may be able to identify the group of patients who have borderline operability anatomically as well as physiologically, where alternative treatment regimens may be indicated to improve outcomes.
... This may be because the tumor had already infiltrated the pleura and the ribs, anchoring it to the chest wall and preventing the formation of pneumothorax. Additionally, the previous radiotherapy may have induced pulmonary fibrosis [12] , thereby further decreasing the risk of pneumothorax. ...
Percutaneous lung ablation is increasingly used in the treatment of lung malignancies with good outcomes, but recurrence is commonly reported in ablation of lesions size larger than 3 cm. We report a 50-year-old female with a 9 cm nonsmall cell lung cancer involving the right upper lobe and apical chest wall causing severe neuropathic shoulder pain and significantly disturbing her daily activities. CT-guided percutaneous cryoablation was performed using a 4-phase protocol with complete eradication of the tumor. Follow-up imaging showed no evidence of recurrence 6 months after the procedure. The neuropathic pain was significantly improved after the procedure, and she was pain-free until her death due to metastatic disease elsewhere. To our knowledge, this is the first case of successful cryoablation for an exceptionally large lesion.
... [ 18 F]FDG PET/CT 6.5 mo after radiation (Fig. 1C) demonstrated nearly complete resolution of the lung opacities and no abnormal lung or nodal uptake, consistent with resolving postradiation changes. Acute postradiation lung changes can progress to chronic fibrosis starting around 9 mo after radiation or can resolve, as in our patient (1). At 17 mo after radiation, the patient continued to have no evidence of disease. ...
... While PORT reduces locoregional recurrence and increases overall survival (OS) in patients with TET [5][6][7][8][9][10][11][12], mediastinal irradiation can cause several acute and late complications in adjacent normal organs, such as the lungs, esophagus, and heart [13][14][15][16][17]. Various complications including radiation pneumonitis, esophagitis, pericarditis, myocardial infarction, and congestive heart failure have been reported in patients with different malignancies who received chest radiation therapy (RT) [13][14][15][16][17]. ...
... While PORT reduces locoregional recurrence and increases overall survival (OS) in patients with TET [5][6][7][8][9][10][11][12], mediastinal irradiation can cause several acute and late complications in adjacent normal organs, such as the lungs, esophagus, and heart [13][14][15][16][17]. Various complications including radiation pneumonitis, esophagitis, pericarditis, myocardial infarction, and congestive heart failure have been reported in patients with different malignancies who received chest radiation therapy (RT) [13][14][15][16][17]. In addition, considering the relatively younger age of onset of TET compared to that of other cancers [3], radiation-related secondary malignancies should be considered for long-term observation. ...
Purpose: This retrospective study aimed to compare clinical outcomes and dosimetric parameters between radiation therapy (RT) techniques in patients with thymic epithelial tumor (TET).Materials and Methods: From January 2016 to December 2020, 101 patients with TET received adjuvant RT (median, 52.8 Gy; range, 48.4 to 66.0). Three different RT techniques were compared: three-dimensional conformal RT (3D-CRT; n = 59, 58.4%), intensity-modulated RT (IMRT; n = 23, 22.8%), and proton beam therapy (PBT; n = 19, 18.8%).Results: The median age of the patients and the follow-up period were 55 years (range, 28 to 79) and 43.4 months (range, 7.7 to 77.2). Patients in the PBT group were of the youngest age (mean age, 45.4 years), while those in IMRT group had the largest clinical target volume (mean volume, 149.6 mL). Patients in the PBT group had a lower mean lung dose (4.4 Gy vs. 7.6 Gy vs. 10.9 Gy, respectively; p < 0.001), lower mean heart dose (5.4 Gy vs. 10.0 Gy vs. 13.1 Gy, respectively; p = 0.003), and lower mean esophageal dose than patients in the 3D-CRT and IMRT groups (6.3 Gy vs. 9.8 Gy vs. 13.5 Gy, respectively; p = 0.011). Twenty patients (19.8%) showed disease recurrence, and seven patients (6.9%) died. The differences in the survival rates between RT groups were not statistically significant.Conclusion: In patients with TET who underwent adjuvant RT, PBT resulted in a lower dose of exposure to adjacent organs at risk. Survival outcomes for patients in PBT group were not significantly different from those in other groups.
... Radiation pneumonitis is the early phase of RILI and occurs secondary to inflammation and desquamation of the alveolar epithelium and endothelium. Symptoms during this phase can vary in intensity, be non-specific, and usually happen in the first three to 12 weeks following radiation [6,7]. Radiation pneumonitis eventually evolves, causing radiation fibrosis [8]. ...
... Radiation pneumonitis eventually evolves, causing radiation fibrosis [8]. Fibrosis starts six to eight months after exposure to radiation with fibroblast activation, and the process continues over the years [6,7,9]. This effect is further potentiated by some chemotherapy drugs with known direct pulmonary toxicity or radiation-enhancing effects (including cyclophosphamide, doxorubicin, and vincristine) [10]. ...
Vanishing bronchus syndrome (VBS) is the most severe form of bronchial stenosis. It has been described as a complication following a lung transplant (LT). We present a case of VBS in a patient with non-Hodgkin lymphoma in remission status post chemotherapy and radiation therapy and no history of a lung transplant.
... A critical factor in RILI development is the dose of radiation given. Patients who receive doses of radiotherapy of more than 20 Gy are at higher risk of developing RILI [5]. Other important risk factors include the volume of the lung that has been irradiated and the technique used in radiotherapy. ...
We present an unusual case of a geriatric patient with right-sided cardiac displacement and rotation (Pseudo-Dextrocardia) secondary to radiation-induced pulmonary fibrosis (RIPF) after radiation for carcinoma of the right breast. This patient with heart failure with reduced ejection fraction (HFrEF) underwent cardiac resynchronization therapy with a defibrillator (CRT-D) for primary prevention of sudden cardiac death. Cannulization of the coronary sinus ostium was difficult, likely due to the significant cardiac displacement. However, after multiple attempts, it was eventually successful. The clinical manifestations, evaluation, and technical and procedural issues in this patient with an unusual anatomic variant are summarized.
