Belarus
Republic of Belarus
@.By
Area : 207,600 sq. km.
Population: 10,366,719 (July 2000)
Ethnic groups: Byelorussian 77.9%,
Russian 13.2%, Polish 4.1%, Ukrainian
2.9%, other 1.9%
Languages: Byelorussian, Russian
Capital City: Minsk (pop 1.7 million)
Currency: Byelorussian ruble
Belarus
Republic of Belarus
@.By
Belarus
Republic of Belarus
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Red Catholic
church in
Minsk
Belarus
Republic of Belarus
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Castle in the
Mir Settlement,
Minsk Region
Belarus
Republic of Belarus
@.By
Farny
Catholic church
in Grodno
Belarus
Republic of Belarus
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Street
in Grodno
Belarus
Republic of Belarus
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Grodno
Dramatic
theater
Belarus
Republic of Belarus
@.By
Zubr (bison)
In Belovezhskaja
virgin forest
We are radiologists…
Dr. Serguey A Khoruzhik MD,
Computed Tomography Unit, Grodno Regional
Clinical Hospital, Grodno, Belarus
CT Imaging of
Radiotherapy Induced
Pulmonary Changes
Hammersmith Hospital, London, October 18th, 2001
Lung Cancer Statistics in Belarus
1990
1994
1999
Number of new lung
cancer cases
26 627
30 290
33 152
Incidence rates per
100 000 population
37,7
44,2
42,7
Cancer mortality rates
per 100 000 population
29,5
31,3
34,5
Lung Cancer Statistics in Belarus
(continued)
Distribution of new cancer cases according to the disease
stage in 1999: I - 13,6%, II - 23,7%, III - 33,5%, IV 20,2%, ? - 9,0%
Lung cancer treatment in 1999:
• Surgery alone - 39,4 %
• Chemotherapy alone or in combined regimens - 19,6%
•
Radiotherapy (RT) alone - 41,0%
Radiotherapy regimen
Split-course (Sp-RT):
•
First RT stage: 28 Gy in 2 Gy fractions twice daily 5
days a week
•
4 weeks of rest
•
Second RT stage: 30 in 1 Gy fractions twice daily 5
days a week
Computed tomography of the thorax
Dynamic CT scans:
•
First CT - before RT
•
Second CT scan - before second RT stage
•
Follow-up CT scans - from 4 weeks to 1 year after RT
To study:
• Tumor response
• Radiation-induced lung injury
Radiation-induced lung injury timing
•
Before 3 months - acute (radiation pneumonitis)
•
Before 9 month - late (organizing) pneumonitis or
fibrosis
•
9-12 month - established fibrosis but...
it still may evolve before 2 years
•
After 2 years - no any change usually observed
Radiation-induced lung injury CT patterns
(1) A homogeneous slight increase in attenuation, uniformly
involving irradiated portion of the lung
(2) Patchy consolidation within irradiated lung, not necessarily
conforming to the shape of the portal
(3) Discrete consolidation, conforming to the shape of the
portal, but not uniformly outlining it
(4) Solid consolidation, conforming and totally involving the
irradiated region of the lung
Libshitz HI et al. JCAT 1984; 8: 15-19
Radiation pneumonitis after
first RT stage (35 patients)
•
Slight increase in attenuation - in 1 patient
•
Minimal patchy consolidation - in 1
Earliest radiation-induced lung injury was seen 4 weeks
after 28 Gy delivered
Khoruzhik SA et al. Proceedings of Republican Conference "Modern
Diagnostic Technologies in Medicine", Minsk 2000. - p. 40
Radiation pneumonitis after
first RT stage (continued)
4 weeks after 28 Gy
Earliest radiation-induced diffusely increased attenuation in lung
tissue
Radiation pneumonitis after
first RT stage (continued)
4 weeks after 28 Gy
Minimal patchy consolidation
Radiation pneumonitis after
the end of RT (16 patients)
•
No radiation-induced lung injury were detected - in 5
•
Slight increase in attenuation - 6 patients
•
Patchy consolidation - 2 patient
•
Discrete consolidation - 2 patients
Pneumonitis was seen in 10 of 16 patients (63%) 4 to 11
weeks after Sp-RT
Khoruzhik SA et al. Lung Cancer 2000; 29 (Supplement 1): 249
Radiation pneumonitis after
the end of RT(continued)
8 weeks after RT
Patchy consolidation in the left lung
Radiation pneumonitis after
the end of RT(continued)
5 weeks after RT
Discreet consolidation with clearly defined lateral margin and
mediastinum border traction from the left
Radiation pneumonitis after
the end of RT(continued)
Other radiotherapy induced pulmonary changes seen before 3
months after RT:
•
Solid consolidation - 2 patients
•
Fluid collection in pleural cavity – 1
•
Pleural thickening - 1
Khoruzhik SA et al. European Society of Thoracic Imaging 8th Annual
Meeting, Salzburg 2000. - Final Program and Abstracts. - p. 69
Radiation pneumonitis after
the end of RT (continued)
5 weeks after RT
Both discrete and solid consolidations seen in the left lung
Radiation pneumonitis after
the end of RT (continued)
4 weeks after RT
Streaky densities in left near-mediastinum region along with
minimal fluid accumulation in the main pleural fissure from the
left
Evolution of radiation pneumonitis
3 to 8 months after RT (11 patients)
In 8 patients who presented with pneumonitis initially:
•
Fibrosis starts to develop - in 5 patients
•
Pneumonitis changed it`s radiological appearance - in 3
In 3 patients who had no pneumonitis initially:
•
No radiation-induced lung injury was seen - in 1
•
Pneumonitis developed - in 1
•
Fibrosis starts to develop - in 1 patient
Khoruzhik SA et al. International Conference on Non-Small
Cell Lung Cancer, Bialystok 2001, Proceedings, p. 56
Evolution of radiation pneumonitis
(continued)
A
B
(A) Slight increase of lung attenuation from the right 4 weeks after
RT. (B) 4 months later fibrosis starts to develop in the right lung.
Gross tumor recurrence is seen from the left.
Late radiation changes in the lungs
Radiation fibrosis 7 months after RT
Conclusions
•
Radiation pneumonitis might be seen on CT in more then
half of patients treated with radiotherapy
•
Some changes in attenuation values of lung tissue may be
seen as early as 4 weeks after 28 Gy
•
Radiation pneumonitis may change its radiological
appearance and in most of cases evolve to fibrosis
Contact
Dr. Serguey A. Khoruzhik MD,
Computed Tomography,
Grodno Regional Clinical Hospital,
BLK 52, 230025 Grodno, Belarus
Phone: + (375 152) 772156, 331320
[email protected]
http://nld.unibel.by/e/personal/cv.htm
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