Pneumotox » Drug » Radiation therapy, stereotactic (SBRT)

Radiation therapy, stereotactic (SBRT)

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A.k.a. conformational or 3D radiation therapy (Reviews of AEs at PMID 12034601, 26083933, 30402100). Separation of radiation lung injury from cancer relapse or progression may be attempted using serial imaging and 18F PET (PMID 23299492, 23473474, 26083933, 27798931). Imaging at PMID 21623237, 21571656.

Last update : 04/01/2020

I.d Organizing pneumonia pattern (an area or areas of consolidation on imaging)

-

I.k Lung nodule or nodules

2

I.s A mass or masses

1

I.y Progression, acceleration or exacerbation of preexisting ILD/fibrosis

1

I.ab Radiation-induced lung injury (RILI)

2

I.ac Acute radiation pneumonitis

1

III.h Major/massive hemoptysis

1

IV.k Bronchiectasis

1

V.f Pneumothorax

2

VII.h Pneumomediastinum

1

VIII.r Tracheal/large airway necrosis, chondronecrosis, perforation

1

VIII.t Vocal cord paresis/paralysis

1

IX.h Dyspnea, unexplained otherwise

1

XI.b Chest pain (acute or subacute), lone or prominent

2

XI.v Rib fracture

2

XI.ag Vertebral compression fracture

1

XI.bf Myositis of chest wall muscle(s) (localized)

1

XVI.k Imaging: An area or areas of consolidation

3

XVI.bl Imaging: An area or areas of avid tracer uptake in the lung/chest on 18F-PET scan

2

XVI.br Imaging: Avid tracer uptake at the chest wall on PET scan

1

Diagnosing DIRD

1

Drug and radiation history

2

Drug singularity - Correct identification of the drug

3

Consistent timing of exposure v. onset of symptoms

4

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

5

Careful exlusion of another cause

6

Remission of symptoms with removal of drug

7

Recurrence with rechallenge (rarely advisable)

8

Causality assessment

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