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Ackerson BG, Sperduto W, D'Anna R, Niedzwiecki D, Christensen J, Patel P, Mullikin TC, Kelsey CR. Divergent Interpretations of Imaging After Stereotactic Body Radiation Therapy for Lung Cancer. Pract Radiat Oncol 2023; 13:e126-e133. [PMID: 36375770 DOI: 10.1016/j.prro.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Conflicting information from health care providers contributes to anxiety among cancer patients. The purpose of this study was to investigate discordant interpretations of follow-up imaging studies after lung stereotactic body radiation therapy (SBRT) between radiologists and radiation oncologists. METHODS AND MATERIALS Patients treated with SBRT for stage I non-small cell lung cancer from 2007 to 2018 at Duke University Medical Center were included. Radiology interpretations of follow-up computed tomography (CT) chest or positron emission tomography (PET)/CT scans and the corresponding radiation oncology interpretations in follow-up notes from the medical record were assessed. Based on language used, interpretations were scored as concerning for progression (Progression), neutral differential listed (Neutral Differential), or favor stability/postradiation changes (Stable). Neutral Differential required that malignancy was specifically listed as a possibility in the differential. Encounters were categorized as discordant when either radiology or radiation oncology interpreted the surveillance imaging as Progression when the other interpreted the imaging study as Stable or Neutral Differential. The incidence of discordant interpretations was the primary endpoint of the study. RESULTS From 2007 to 2018, 139 patients were treated with SBRT and had available follow-up CT or PET-CT imaging for the analysis. Median follow-up was 61 months and the median number of follow-up encounters per patient was 3. Of 534 encounters evaluated, 25 (4.7%) had overtly discordant interpretations of imaging studies. This most commonly arose when radiology felt the imaging study showed Progression but radiation oncology favored Stable or Neutral Differential (24/25, 96%). No patient or treatment variables were found to be significantly associated with discordant interpretations on univariate analysis including type of scan (CT 22/489, 4.5%; PET-CT 3/45, 7%; P = .46). CONCLUSIONS Surveillance imaging after lung SBRT is often interpreted differently by radiologists and radiation oncologists, but overt discordance was relatively low at our institution. Providers should be aware of differences in interpretation patterns that may contribute to increased patient distress.
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Affiliation(s)
- Bradley G Ackerson
- Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
| | - William Sperduto
- Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Rachel D'Anna
- Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Donna Niedzwiecki
- Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Jared Christensen
- Division of Cardiothoracic Imaging, Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Pranalee Patel
- Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Trey C Mullikin
- Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Chris R Kelsey
- Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
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Szejniuk WM, Nielsen MS, Takács-Szabó Z, Pawlowski J, Al-Saadi SS, Maidas P, Bøgsted M, McCulloch T, Frøkjær JB, Falkmer UG, Røe OD. High-dose thoracic radiation therapy for non-small cell lung cancer: a novel grading scale of radiation-induced lung injury for symptomatic radiation pneumonitis. Radiat Oncol 2021; 16:131. [PMID: 34266462 PMCID: PMC8281688 DOI: 10.1186/s13014-021-01857-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/09/2021] [Indexed: 12/02/2022] Open
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. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01857-8.
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Affiliation(s)
- Weronika Maria Szejniuk
- Department of Oncology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark. .,Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark. .,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
| | | | | | - Jacek Pawlowski
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.,Division of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Panagiotis Maidas
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Martin Bøgsted
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Tine McCulloch
- Department of Oncology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Ursula Gerda Falkmer
- Department of Oncology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.,Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Oluf Dimitri Røe
- Department of Oncology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.,Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway.,Cancer Clinic, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway
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