Correlation of long-term pulmonary injury with radiation dose distribution in childhood cancer survivors

Abstract

Advances in cancer treatment have resulted in almost 80 percent of children surviving at least 5 years after cancer diagnosis.1 Childhood cancer survivors are 8.6 times more likely to die from pulmonary complications when compared with the general population.2 Pneumonitis and pulmonary fibrosis are known sequelae of pulmonary radiation therapy (XRT) during childhood. In many instances, the presentation may be subclinical, apparent only on incidental chest radiographs or pulmonary function tests. Pulmonary injury may first become apparent shortly after XRT or it may appear years later. Here we report on 2 patients with XRT-induced pulmonary fibrosis and we describe a technique for correlating radiographic changes of XRT-induced lung injury to dose distribution. We also describe the evolution of lung changes with time and its relationship with radiation dose and location.