Pulmonary changes after single dose interstitial brachytherapy for lung tumors

Brachytherapy, vol. 25, pp. 794–801

Abstract

PURPOSE: The reaction of lung tissue to extreme single brachytherapy doses have not been analyzed in the past. METHODS: Overall, 46 lung tumors were treated in 32 patients with HDR (high dose rate) brachytherapy (median dose 20Gy). Treatment planning (n = 46) and follow up CT images (n = 154) performed up to 60 months after brachytherapy were evaluated. RESULTS: The long-term local tumor control was 81%. Pneumonitis was classified as grade 1, 2 and 3 in 26 (57%), 4 (9%) and 3 (7%). Early changes include spotted consolidation in the majority and ground glass opacity in about 40% of patients within the first six months. Partial atelectasis or pleural effusion were observed in 10-20%, respectively. In the period after 6 months, streaky or dense consolidation were noted in the majority of follow-up images. The lung tissue consolidation progresses into retraction. Lung atelectasis occurred in about 10% of patients. Pleural effusion was noted more rarely. CONCLUSION: As a result of high focal doses in one fraction, tissue consolidation must be expected in all patients, with progressive retraction predominantly in the second year after brachytherapy. There is a smaller risk of partial atelectasis and pleural effusion.

Authors 7

1. Jafar Al Mansoor Aachen Department of Radiation Oncology

   RWTH Aachen University · WEGE Klinik

   Affiliation as printed

   Department of Radiation Oncology, WEGE Klinik, Bonn, Germany; Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany

2. Ali Rashid

   University of Tübingen

   Affiliation as printed

   Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany

3. Hathal Haddad

   University of Tübingen · German Cancer Research Center · Deutsches Konsortium für Translationale Krebsforschung

   Affiliation as printed

   Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany; German Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site Tübingen, Heidelberg, Germany

4. Horst Hermani

   WEGE Klinik

   Affiliation as printed

   Department of Radiation Oncology, WEGE Klinik, Bonn, Germany

5. P. Bischoff
   Affiliation as printed

   Department of Interventional and Diagnostic Radiology and Neuroradiology, MediClin Robert Janker Klinik, Bonn, Germany

6. Attila Kovács
   Affiliation as printed

   Department of Interventional and Diagnostic Radiology and Neuroradiology, MediClin Robert Janker Klinik, Bonn, Germany

7. Michael Pinkawa corresponding Aachen Department of Radiation Oncology

   RWTH Aachen University · WEGE Klinik

   Affiliation as printed

   Department of Radiation Oncology, WEGE Klinik, Bonn, Germany; Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany. Electronic address: michael.pinkawa@post.rwth-aachen.de