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J Korean Soc Ther Radiol > Volume 11(2); 1993 > Article
Journal of the Korean Society for Therapeutic Radiology 1993;11(2): 321-330.
Radiation-induced Pulmonary Damage in Lung Cancer Patients
Su Mi Chung, Ihl Bohng Choi, Ki Mun Kang, In Ah Kim, Kyung Sub Shinn
Department of Therapeutic Radiology, St. Mary's Hpsital, Catholic University Medical College, Seoul, Korea.
A retrospective analysis was performed to evaluate the incidence of radiation induced lung damage after the radiation therapy for the patients with carcinoma of the lung. MATHOD AND MATERIALS: Sixty-six patients with lung cancer (squamous cell carcinoma 27, adenocarcinDma 14, large cell carcinoma 2, small cell carcinoma 13, unknown 10) were treated with definitive, postoperative or palliative radiation therapy with or without chemotherapy between July 1987 and December 1991. There were 50 males and 16 females with median age of 63 years(range: 33~80 years). Total lung doses ranged from 500 to 6,660 cGy (median 3960 cGy) given in 2 to 38 fractions (median 20) over a range of 2 to 150 days (median 40 days) using 6 MV or 15 MV linear accelerator. To represent different fractionation schedules of equivalent biological effect, the estimated single dose(ED) model, ED=D.N-0.377.T-0.058 was used in which D was the lung dose in cGy, N was the number of fractions, and T was the overall treatment time in days. The range of ED was 370 to 1357. The endpoint was a visible increase in lung density within the irradiated volume on chest X-ray as observed independently by three diagnostic radiologists. Patients were grouped according to ED, treatment duration, treatment modality and age, and the percent incidence of pulmonary damage for each group was determined.
In 40 of 66 patients, radiation induced change was seen on chest radiographs between 11 days and 314 days after initiation of radiation therapy. The incidence of radiation pneumonitis was increased according to increased ED, which was statistically significant (p=0.001). Roentgenographic charges consistent with radiation pneumonitis were seen in 100% of patients receiving radiotherapy after lobectomy or pneumonectomy, which was not statistically significant. In 32 patients who also received chemotherapy, there was no difference in the incidence of radiation induced charge between the group with radiation alone and the group with radiation and chemotherapy, among the sequence of chemotherapy. No correlation was seen between incidence of radiation pneumonitis and age or sex. CONCOUSIONS: The occurrence cf radiation pneumonitis varies. The incidence of radiation pneumonitis depends on radiation total dose, nature of fractionation, duration of therapy, and modifying factors such as lobectomy or pneumonectomy.
Key Words: Radiation pneumonitis, Lung carcinoma
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