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1.
Radiat Oncol ; 16(1): 131, 2021 Jul 15.
Article in English | MEDLINE | ID: mdl-34266462

ABSTRACT

BACKGROUND: Symptomatic radiation pneumonitis (RP) may be a serious complication after thoracic radiation therapy (RT) for non-small cell lung cancer (NSCLC). This prospective observational study sought to evaluate the utility of a novel radiation-induced lung injury (RILI) grading scale (RGS) for the prediction of RP. MATERIALS AND METHODS: Data of 41 patients with NSCLC treated with thoracic RT of 60-66 Gy were analysed. CT scans were scheduled before RT, one month post-RT, and every three months thereafter for one year. Symptomatic RP was defined as Common Terminology Criteria for Adverse Events grade ≥ 2. RGS grading ranged from 0 to 3. The inter-observer variability of the RGS was assessed by four senior radiologists. CT scans performed 28 ± 10 days after RT were used to analyse the predictive value of the RGS. The change in the RGS severity was correlated to dosimetric parameters. RESULTS: The CT obtained one month post-RT showed RILI in 36 (88%) of patients (RGS grade 0 [5 patients], 1 [25 patients], 2 [6 patients], and 3 [5 patients]). The inter-observer agreement of the RGS grading was high (Kendall's W coefficient of concordance = 0.80, p < 0.01). Patients with RGS grades 2-3 had a significantly higher risk for development of RP (relative risk (RR): 2.4, 95% CI 1.6-3.7, p < 0.01) and RP symptoms within 8 weeks after RT (RR: 4.8, 95% CI 1.3-17.6, p < 0.01) compared to RGS grades 0-1. The specificity and sensitivity of the RGS grades 2-3 in predicting symptomatic RP was 100% (95% CI 80.5-100%) and 45.4% (95% CI 24.4-67.8%), respectively. Increase in RGS severity correlated to mean lung dose and the percentage of the total lung volume receiving 5 Gy. CONCLUSIONS: The RGS is a simple radiologic tool associated with symptomatic RP. A validation study is warranted.


Subject(s)
Carcinoma, Non-Small-Cell Lung/radiotherapy , Image Processing, Computer-Assisted/methods , Lung Injury/pathology , Lung Neoplasms/radiotherapy , Organs at Risk/radiation effects , Radiation Pneumonitis/pathology , Radiotherapy, Intensity-Modulated/adverse effects , Adult , Aged , Carcinoma, Non-Small-Cell Lung/pathology , Female , Humans , Lung Injury/etiology , Lung Neoplasms/pathology , Male , Middle Aged , Observer Variation , Prognosis , Prospective Studies , Radiation Pneumonitis/etiology , Radiometry/methods , Radiotherapy Dosage
2.
Tidsskr Nor Laegeforen ; 141(3)2021 02 23.
Article in English, Norwegian | MEDLINE | ID: mdl-33624964

ABSTRACT

BACKGROUND: Most cases of thoracic injury are the result of minor trauma, treated out of hospital. Approximately 10 % of patients with minor thoracic trauma develop delayed haemothorax, with risk of fibrosis and empyema. Traumatic diaphragmatic injury following blunt trauma can be difficult to diagnose, and is a rare condition associated with high-energy trauma. CASE PRESENTATION: A 63-year-old man with multiple rib fractures following a traffic accident was readmitted for chest tube drainage 19 days after trauma, due to delayed haemothorax. Four days later, the patient developed massive haemothorax due to pleural fibrinolysis. Video-assisted thoracic surgery confirmed lacerated diaphragm with protruding, bleeding omentum. INTERPRETATION: This case report describes an atypical presentation of a common complication following thoracic trauma. Identification and control of patients at risk of developing delayed haemothorax is of clinical importance to reduce the risk of long-term complications.


Subject(s)
Rib Fractures , Thoracic Injuries , Wounds, Nonpenetrating , Chest Tubes , Hemothorax/diagnostic imaging , Hemothorax/etiology , Hemothorax/surgery , Humans , Male , Middle Aged , Rib Fractures/complications , Rib Fractures/diagnostic imaging , Thoracic Injuries/complications , Thoracic Injuries/diagnostic imaging , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/diagnostic imaging
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