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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

  • Kouloulias, Vassilios (2nd Radiology Department, Medical School, Kapodistrian University of Athens) ;
  • Zygogianni, Anna (1st Radiology Department, Medical School, Kapodistrian University of Athens) ;
  • Efstathopoulos, Efstathios (2nd Radiology Department, Medical School, Kapodistrian University of Athens) ;
  • Victoria, Oikonomopoulou (2nd Radiology Department, Medical School, Kapodistrian University of Athens) ;
  • Christos, Antypas (1st Radiology Department, Medical School, Kapodistrian University of Athens) ;
  • Pantelis, Karaiskos (Radiotherapy-Oncology Dpt, YGEIA Hospital) ;
  • Koutoulidis, Vassilios (1st Radiology Department, Medical School, Kapodistrian University of Athens) ;
  • Kouvaris, John (1st Radiology Department, Medical School, Kapodistrian University of Athens) ;
  • Sandilos, Panagiotis (1st Radiology Department, Medical School, Kapodistrian University of Athens) ;
  • Varela, Maria (Computerized Tomography Department, 251 Hospital of Military Air Force) ;
  • Aytas, Ilknur (Ankara Numune Education and Research Hospital Radiation Oncology Clinic) ;
  • Gouliamos, Athanasios (1st Radiology Department, Medical School, Kapodistrian University of Athens) ;
  • Kelekis, Nikolaos (2nd Radiology Department, Medical School, Kapodistrian University of Athens)
  • Published : 2013.05.30

Abstract

Background: 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. Materials and Methods: The chest CT films of 20 patients with non-small cell lung cancer who have undergone threedimensional 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. 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). 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). Conclusions: 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.

Keywords

Pneumonitis;radiotherapy;toxicity grading scale;computerized tomography;thoracic imaging

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