Unusual radiologic findings in the thorax after radiation therapy

Our plain-English summary of Unusual radiologic findings in the thorax after radiation therapy, by B. Mesurolle, S.D. Qanadli, M. Merad, et al (Radiographics, 2000).

The study

• Authors: B. Mesurolle, S.D. Qanadli, M. Merad, F. Mignon, P. Baldeyrou, A. Tardivon, P. Lacombe, D. Vanel
• Journal: Radiographics
• Published: 2000;20(1):67-81
• Type of article: Review
• Cited by: 75 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Radiation therapy is used to treat many intrathoracic and chest wall malignancies. A variety of changes may occur after radiation therapy to the thorax. Radiation therapy produces dramatic effects in the lung. Pulmonary necrosis is an uncommon, severe, late complication of adjuvant postoperative radiation therapy. Bronchiolitis obliterans with organizing pneumonia is a distinct clinicopathologic entity characterized by patchy, migratory, peripheral air-space infiltrates. Radiation therapy can also cause spontaneous pneumothorax, mesothelioma, and lung cancer. In the mediastinum, radiation therapy may cause thymic cysts, calcified lymph nodes, and esophageal injuries. Cardiovascular complications of radiation therapy are often delayed and insidious. Premature coronary artery stenosis occurs after radiation therapy to the mediastinum. Radiation therapy may also give rise to calcifications of the ascending aorta, pericardial disease, valvular injuries, and conduction abnormalities. Women who undergo thoracic irradiation before the age of 30 years have a high risk of developing a second breast cancer. Radiation-induced sarcomas are an infrequent but well-recognized complication of radiation therapy. Other chest wall injuries due to radiation therapy are osteochondroma and rib or clavicle fractures. Knowledge of the imaging features of injuries caused by radiation therapy can prevent misinterpretation as recurrent tumor and may facilitate further treatment.

In plain English

This article was a pictorial review, presented as a scientific exhibit, by doctors at the Institut Gustave-Roussy in Villejuif and the Hôpital Ambroise Paré in Boulogne-Billancourt, France. It described unusual changes seen on chest imaging after radiation therapy, illustrated with patient images. The radiation had mainly been given for breast cancer, lung cancer and lymphoma. The review covered the lung, the mediastinum, the heart and blood vessels, and the chest wall. Most rates it gave came from earlier published studies. The authors' own data came from an unpublished study of 1,000 patients with apical lung carcinoma treated with surgery, chemotherapy and radiation. Six of these patients developed benign necrosis, with cavities appearing 1 to 7 years after radiation. The authors noted that other researchers had described mesothelioma caused by radiation. One cited study reported an interval of 5 to 41 years (median 13.5 years) between radiation and mesothelioma. The article does not discuss asbestos. The authors concluded that radiologists need to be aware of these unusual, sometimes very late complications so they are not mistaken for recurrent tumor.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Pictorial review (scientific exhibit) of unusual chest imaging findings after radiation therapy, illustrated with patient cases; it includes one small unpublished series by the authors
• Who was studied: Patients who received radiation therapy to the chest, chiefly for breast carcinoma, bronchogenic carcinoma and lymphoma. Own data came from an unpublished study of 1,000 patients with apical lung carcinoma; illustrative cases came from the authors' institutions in France.
• Exposure: Therapeutic radiation to the thorax (for example 60 Gy or 65 Gy postoperative radiation in the authors' lung cancer series); no asbestos exposure is discussed
• Main results:
  • In the authors' unpublished series of 1,000 patients with apical lung carcinoma (upper lobectomy, chemotherapy and adjuvant radiation), six developed benign apical pleural or chest parenchymal necrosis. Cavities appeared 1 to 7 years after radiation therapy, and tumor recurrence was excluded by surgery (n = 4) or follow-up (n = 2).
  • Citing earlier reports, the review stated that radiation-induced mesothelioma has been described. The interval between radiation therapy and mesothelioma ranged from 5 to 41 years (median 13.5 years), and imaging features were nonspecific (pleural effusion with or without pleura-based masses). These figures come from a cited study, not from the authors' own data.
  • Citing Bhatia et al, the review reported that women treated for childhood Hodgkin disease had a risk of breast cancer 75 times greater than that of the general population. This is a cited finding, not the authors' own.
• The authors' conclusion: The authors concluded that radiologists need to be aware of the range of unusual complications of radiation therapy, some occurring very late, and that knowledge of their imaging features can prevent misinterpretation as recurrent tumor.

Topics

Medical terms in this study, explained in our Lexicon: Thorax, Intrathoracic, Necrosis, Pneumothorax, Mesothelioma, Lung Cancer, Mediastinum, Pericardial.

Related studies

• Patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesothelioma — D.R. Gomez, D.S. Hong, et al. (2013)
• Radiation therapy in the management of patients with mesothelioma — W. Gordon, K.H. Antman, et al. (1982)
• Hemithoracic radiation therapy after extrapleural pneumonectomy for malignant pleural mesothelioma: Toxicity and outcomes at an Australian institution — A. Bece, M.M. Tin, et al. (2015)
• Symptoms, signs and radiologic findings in patients having reoperative surgery for malignant peritoneal mesothelioma — M.D. Llanos, P.H. Sugarbaker (2017)
• The Use of Radiation Therapy for the Treatment of Malignant Pleural Mesothelioma: Expert Opinion from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation — D.R. Gomez, A. Rimner, et al. (2019)
• Magnetic resonance imaging of the thorax in the evaluation of asbestosis — S.I. Bekkelund, U. Aasebø, et al. (1998)

Browse more research in Radiographics, or return to medical research.