PMC2892714_01
CT images before SBRT showing a solitary lung tumor in the right upper lobe.
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A 72-year-old woman was diagnosed as having primary lung cancer (cT1N0M0 stageIA) of the right upper lobe (Figure 1).
Dose distribution of treatment plan. The dashed line indicates the 50% isodose curve.
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SBRT is shown in Figure 2.
Serial CT images after SBRT. (a), (b), (c) CT images at 2, 6, and 9 months after SBRT show irregularly shaped patchy consolidation in the irradiated area. (d) CT images at 12 months after SBRT showing the appearance of mass-like consolidation in the irradiated area.
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On CT images 2 months after treatment, irregularly shaped patchy consolidation, which was considered radiation pneumonitis, appeared in the irradiated field (Figure 3(a)). After 6 and 9 months, the patchy consolidation was retracted, which was considered to be typical radiation fibrosis (Figures 3(b), 3(c)), and serum CEA gradually decreased. However, after 12 months, mass-like consolidation appeared around the irradiated area (Figure 3(d)), and after 13 months, it had increased in size.
FDG-PET at 13 months after SBRT. High FDG uptake (SUVmax  = 5.61) was observed for the consolidation.
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FDG-PET revealed high uptake (SUVmax  = 5.61) for the consolidation (Figure 4).
Serial CT images. (a) CT images at 15 months after SBRT show the mass-like consolidation enlarged at its dorsal side. (b), (c) CT images at 18 and 27 months after SBRT show that the mass-like consolidation gradually retracted.
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CT images (Figure 5). CEA, KL-6, and SP-D decreased by degrees (Figure 6), although transient re-elevation was observed after 31 months, accompanied by the development of pneumonia in the left lower lung.
Serial changes of serum CEA, KL-6, and SP-D. (1) At 12 months after SBRT, mass-like consolidation appeared in the irradiated area. (2) At 15 months, the mass-like consolidation enlarged at the dorsal side and serum CEA increased accompanied by KL-6 and SP-D. (3) At 16 months, serum CEA was slightly decreased. (4) At 31 months, minimal lung opacities suggesting pneumonia in the left lower lobe were observed on CT images, but no significant change was seen in the irradiated area.
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CT images (Figure 5). CEA, KL-6, and SP-D decreased by degrees (Figure 6), although transient re-elevation was observed after 31 months, accompanied by the development of pneumonia in the left lower lung.