Suggestion for a New Grading Scale for Radiation Induced Pneumonitis Based on Radiological Findings of Computerized Tomography: Correlation with Clinical and Radiotherapeutic Parameters in Lung Cancer Patients

Vassilios Kouloulias,Anna Zygogianni,Oikonomopoulou Victoria,John Kouvaris,Efstathios Efstathopoulos,Athanasios Gouliamos,Nikolaos Kelekis,Panagiotis Sandilos,Ilknur Aytas,Karaiskos Pantelis,Vassilios Koutoulidis,Antypas Christos,Maria Varela

doi:10.7314/apjcp.2013.14.5.2717

Vassilios Kouloulias, Anna Zygogianni + Show 11 more

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https://doi.org/10.7314/apjcp.2013.14.5.2717

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Abstract

The objective of this research is the computed axial tomography (CT) imaging grading of radiation induced pneumonitis (RP) and its correlation with clinical and radiotherapeutic parameters. The chest CT films of 20 patients with non-small cell lung cancer who have undergone three- dimensional conformal radiation therapy were reviewed. The proposed CT grading of RP is supported on solely radiological diagnosis criteria and distinguishes five grades. The manifestation of RP was also correlated with any positive pre-existing chronic obstructive pulmonary disease (COPD) history, smoking history, the FEV1 value, and the dosimetric variable V20. The CT grading of RP was as follows: 3 patients (15%) presented with ground glass opacity (grade 1), 9 patients (45%) were classified as grade 2, 7 patients (35%) presented with focal consolidation, with or without elements of fibrosis (grade 3), and only one patient (5%) presented with opacity with accompanying atelectasis and loss of pulmonary volume (grade 4). Both univariate and multivariate analysis revealed as prognostic factors for the radiological grading of RP the reduction of FEV1 and the V20 (P=0.026 and P=0.003, respectively). There was also a significant (P<0.001) correlation of radiological grading of RP with FEV1 and V20 (spearman rho 0.92 and 0.93, respectively). The high correlation of the proposed radiological grading with the FEV1 and the V20 is giving a satisfactory clinical validity. Although the proposed grading scale seems relevant to clinical practice, further studies are needed for the confirmation of its validity and reliability.

Highlights

Radiation induced pneumonitis (RP) is a common and explicit complication caused by radiotherapy in patients with breast, lung, oesophagus, lymphoma or other thoracic and mediastinal cancers
Cicatrisation atelectasis, 100.0 correlation coefficient; the potential impact of age, performance status (PS), FEV1, V20 and chronic obstructive pulmonary disease (COPD) to the radiological grading or radiation induced pneumonitis (RP) was assessed with the linear aerobronchogram and bronchial extension, significant pulmonary q
Radiation-induced lung injury is divided into two phases: the early phase of RP and the late phase of radiation-induced fibrosis

Summary

Introduction

Radiation induced pneumonitis (RP) is a common and explicit complication caused by radiotherapy in patients with breast, lung, oesophagus, lymphoma or other thoracic and mediastinal cancers. Results: The CT grading of RP was as follows: 3 patients (15%) presented with ground glass opacity (grade 1), 9 patients (45%) were classified as grade 2, 7 patients (35%) presented with focal consolidation, with or without elements of fibrosis (grade 3), and only one patient (5%) presented with opacity with accompanying atelectasis and loss of pulmonary volume (grade 4). Both univariate and multivariate analysis revealed as prognostic factors for the radiological grading of RP the reduction of FEV1 and the V20 (P=0.026 and P=0.003, respectively). The proposed grading scale seems relevant to clinical practice, further studies are needed for the confirmation of its validity and reliability

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