Rib fracture after stereotactic radiotherapy on follow-up thin-section computed tomography in 177 primary lung cancer patients

Radiation Oncology

Tsutomu Araki³  Eiichi Sawada³  Yoshiyasu Maehata³  Lichto Tominaga³  Ryo Saito³  Masayuki Araya³  Kan Marino²  Takafumi Komiyama¹  Kengo Kuriyama³  Tsuyota Koshiishi³  Shinichi Aoki³  Hiroshi Onishi³  Atsushi Nambu³ 

[1] Department of Radiology, Kofu Municipal Hospital, Kofu City, Japan;Department of Radiology, Yamanashi Prefectural Central Hospital, Kofu City, Japan;Department of Radiology, University of Yamanashi, Chuo City, Japan

关键词: thin-section CT;    rib fracture;    lung cancer;    stereotactic radiotherapy;   

Others  :  1223878
DOI  :  10.1186/1748-717X-6-137

 received in 2011-07-10, accepted in 2011-10-13,  发布年份 2011

【 摘 要 】

Background

Chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer has recently been reported. However, its detailed imaging findings are not clarified. So this study aimed to fully characterize the findings on computed tomography (CT), appearance time and frequency of chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer

Materials and methods

A total of 177 patients who had undergone SRT were prospectively evaluated for periodical follow-up thin-section CT with special attention to chest wall injury. The time at which CT findings of chest wall injury appeared was assessed. Related clinical symptoms were also evaluated.

Results

Rib fracture was identified on follow-up CT in 41 patients (23.2%). Rib fractures appeared at a mean of 21.2 months after the completion of SRT (range, 4 -58 months). Chest wall edema, thinning of the cortex and osteosclerosis were findings frequently associated with, and tending to precede rib fractures. No patients with rib fracture showed tumors > 16 mm from the adjacent chest wall. Chest wall pain was seen in 18 of 177 patients (10.2%), of whom 14 patients developed rib fracture. No patients complained of Grade 3 or more symptoms.

Conclusion

Rib fracture is frequently seen after SRT for lung cancer on CT, and is often associated with chest wall edema, thinning of the cortex and osteosclerosis. However, related chest wall pain is less frequent and is generally mild if present.

【 授权许可】

   
2011 Nambu et al; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Uematsu M, Shioda A, Suda A, Fukui T, Ozeki Y, Hama Y, Wong JR, Kusano S: Computed tomography-guided frameless stereotactic radiotherapy for stage I non-small cell lung cancer: a 5-year experience. Int J Radiat Oncol Biol Phys 2001, 51:666-670.
• [2]Onishi H, Araki T, Shirato H, Nagata Y, Hiraoka M, Gomi K, Yamashita T, Niibe Y, Karasawa K, Hayakawa K, Takai Y, Kimura T, Hirokawa Y, Takeda A, Ouchi A, Hareyama M, Kokubo M, Hara R, Itami J, Yamada K: Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study. Cancer 2004, 10:1623-1631.
• [3]Nagata Y, Takayama K, Matsuo Y, Norihisa Y, Mizowaki T, Sakamoto T, Sakamoto M, Mitsumori M, Shibuya K, Araki N, Yano S, Hiraoka M: Clinical outcomes of a phase I/II study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame. Int J Radiat Oncol Biol Phys 2005, 63:1427-1431.
• [4]Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, Niibe Y, Karasawa K, Hayakawa K, Takai Y, Kimura T, Takeda A, Ouchi A, Hareyama M, Kokubo M, Hara R, Itami J, Yamada K, Araki T: Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol 2007, 2(7 Suppl 3):94-100.
• [5]Nyman J, Johansson KA, Hultén U: Stereotactic hypofractionated radiotherapy for stage I non-small cell lung cancer--mature results for medically inoperable patients. Lung Cancer 2006, 51:97-103.
• [6]Zimmermann FB, Geinitz H, Schill S, Thamm R, Nieder C, Schratzenstaller U, Molls M: Stereotactic hypofractionated radiotherapy in stage I (T1-2 N0 M0) non-small-cell lung cancer (NSCLC). Acta Oncol 2006, 45:796-801.
• [7]Fritz P, Kraus HJ, Blaschke T, Mühlnickel W, Strauch K, Engel-Riedel W, Chemaissani A, Stoelben E: Stereotactic, high single-dose irradiation of stage I non-small cell lung cancer (NSCLC) using four-dimensional CT scans for treatment planning. Lung Cancer 2008, 60:193-199.
• [8]Haasbeek CJ, Lagerwaard FJ, de Jaeger K, Slotman BJ, Senan S: Outcomes of stereotactic radiotherapy for a new clinical stage I lung cancer arising postpneumonectomy. Cancer 2009, 115:587-594.
• [9]Inoue T, Shimizu S, Onimaru R, Takeda A, Onishi H, Nagata Y, Kimura T, Karasawa K, Arimoto T, Hareyama M, Kikuchi E, Shirato H: Clinical outcomes of stereotactic body radiotherapy for small lung lesions clinically diagnosed as primary lung cancer on radiologic examination. Int J Radiat Oncol Biol Phys 2009, 75:683-687.
• [10]Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, Karasawa K, Hayakawa K, Niibe Y, Takai Y, Kimura T, Takeda A, Ouchi A, Hareyama M, Kokubo M, Kozuka T, Arimoto T, Hara R, Itami J, Araki T: Stereotactic Body Radiotherapy (SBRT) for Operable Stage I Non-Small-Cell Lung Cancer: Can SBRT Be Comparable to Surgery? Int J Radiat Oncol Biol Phys 2010, in press.
• [11]Barriger RB, Forquer JA, Brabham JG, Andolino DL, Shapiro RH, Henderson MA, Johnstone PA, Fakiris AJ: A Dose-Volume Analysis of Radiation Pneumonitis in Non-Small Cell Lung Cancer Patients Treated with Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2010, in press.
• [12]Takeda A, Ohashi T, Kunieda E, Enomoto T, Sanuki N, Takeda T, Shigematsu N: Early graphical appearance of radiation pneumonitis correlates with the severity of radiation pneumonitis after stereotactic body radiotherapy (SBRT) in patients with lung tumors. Int J Radiat Oncol Biol Phys 2010, 77:685-690.
• [13]Dunlap NE, Cai J, Biedermann GB, Yang W, Benedict SH, Sheng K, Schefter TE, Kavanagh BD, Larner JM: Chest wall volume receiving > 30 Gy predicts risk of severe pain and/or rib fracture after lung stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 2010, 76:796-801.
• [14]Pettersson N, Nyman J, Johansson KA: Radiation-induced rib fractures after hypofractionated stereotactic body radiation therapy of non-small cell lung cancer: a dose- and volume-response analysis. Radiother Oncol 2009, 91:360-368.
• [15]Voroney JP, Hope A, Dahele MR, Purdie TG, Franks KN, Pearson S, Cho JB, Sun A, Payne DG, Bissonnette JP, Bezjak A, Brade AM: Chest wall pain and rib fracture after stereotactic radiotherapy for peripheral non-small cell lung cancer. J Thorac Oncol 2009, 4:1035-1037.
• [16]Milano MichaelT, Constine LouisS, Okunieff Paul: Normal tissue toxicity after small field hypofractionated stereotactic body radiation. Radiation Oncology 2008, 3:36. BioMed Central Full Text
• [17]Pierce SM, Recht A, Lingos TI, Abner A, Vicini F, Silver B, Herzog A, Harris JR: Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer. Int J Radiat Oncol Biol Phys 1992, 23:915-923.
• [18]Meric F, Buchholz TA, Mirza NQ, Vlastos G, Ames FC, Ross MI, Pollock RE, Singletary SE, Feig BW, Kuerer HM, Newman LA, Perkins GH, Strom EA, McNeese MD, Hortobagyi GN, Hunt KK: Long-term complications associated with breast-conservation surgery and radiotherapy. Ann Surg Oncol 2002, 9:543-549.
• [19]Bluemke DA, Fishman EK, Scott WW Jr: Skeletal complications of radiation therapy. Radiographics 1994, 14:111-121.
• [20]Kwon JW, Huh SJ, Yoon YC, Choi SH, Jung JY, Oh D, Choe BK: Pelvic bone complications after radiation therapy of uterine cervical cancer: evaluation with MRI. AJR Am J Roentgenol 2008, 191:987-994.
• [21]Bragg DG, Shidnia H, Chu FC, Higinbotham NL: The clinical and radiographic aspects of radiation osteitis. Radiology 1970, 97:103-111.
• [22]Hoff AO, Toth B, Hu M, Hortobagyi GN, Gagel RF: Epidemiology and risk factors for osteonecrosis of the jaw in cancer patients. Ann N Y Acad Sci 2010, in press.