Table 4. Characteristics of patients with late adverse events ≥ G2.
| Pat. ID | 1 | 3 | 7 | 26 | 51 | 55 |
|---|---|---|---|---|---|---|
| type/grade | Chest wall pain G2 | Dyspnea G3 | Dyspnea G3 | Necrosis G3; stenosis G3 |
Dyspnea G3 | Dyspnea G4 |
| Age (years) | 62 | 73 | 71 | 63 | 77 | 71 |
| Gender | Male | Male | Male | Male | Male | Female |
| Symptoms at baseline | Chest wall pain G1 after lung surgery | Dyspnea G2 by COPD stage III | Dyspnea G2 by CVD and COPD stage II | Dyspnea G3 by COPD stage IV | None | Dyspnea G3 by COPD stage IV |
| Previous treatments | Lung surgery, chemotherapy | Lung surgery | None | None | None | None |
| Post-SABR treatments | None | Chemotherapy | Chemotherapy, lung irradiation | None | None | Endoscopic lung volume reduction |
| Type of cancer | Primary | Primary | Primary | Primary | Primary | Primary |
| Cancer location | Right LL, peripheral | Right UL and LL, peripheral | Right LL, peripheral | Right Hilary, central | Right and left UL, peripheral | Right UL, peripheral |
| PTV volume | 24.3 mL | 31.3 mL, 33 mL | 29.4 mL | 89 mL | 20 mL, 24 mL | 8 mL |
| Treatment schedule | 5×12 Gy | Each 8×7.5 Gy | 5×12 Gy | 8×7.5 Gy | 4×12 Gy | 8×7.5 Gy |
| BED3 | 300 | 210 | 300 | 210 | 240 | 210 |
| Onset in month | 24 | 6 | 6 | 7/9 | 6 | 3 |
| Changes during follow-up | Stabilization, alive | Worsening, died 1 year later | Improvement, died 14 months later | Worsening, died 7 months later | Improvement, alive | Improvement, alive |
| Dosimetric evaluation | Chest wall: Dmean=24 Gy; Dmax=73 Gy; dorsal 8; Rib: Dmean=30 Gy; Dmax=68.9 Gy | V5=32%; V10=24%; V20=12%; MLD=7.7 Gy; 750 mL >10 Gy; 500 mL >15 Gy | V5=25%; V10=17%; V20=6%; MLD =5 Gy; 750 mL >6 Gy; 500 mL >10 Gy | Main and intermediate bronchus: Dmax=74 Gy; Dmean=58 and 65 Gy respectively | Left lung: V5=25%; V10=14%; V20=6%; MLD=4.5 Gy; Right lung:V5=14%; V10=10%; V20=6%; MLD =4 Gy |
Right lung: V5=12%; V10=10%; V20=6%; MLD =3.2 Gy |
| Risk assessment | Rib fracture correlated with Dmax=68.9 Gy was seen on chest CT | No lung consolidation on chest-CT. Decline in PFT (FEV1% decreased by 35% from 41% to 27%). At the onset cancer progression and exacerbation of COPD | Minimal lung consolidation on chest CT. Decline in PFT (FEV1% decreased by 33% from 54% to 36%). COPD exacerbation at the onset | Necrosis correlated with Dmax ; large tumor volume; entire main and intermediate bronchus within PTV; secondary atelectasis in middle lobe | Dyspnea correlated with interstitial consolidation within radiation field in both right and left lung lobe | No sign of lung consolidation within radiation field; COPD exacerbation, decline in DLCO by 28% (from 22% to 15.8%) but no changes in FEV1% |
| Interventions | Occasionally non-opioid pain medication | Hospitalization permanente O2 supplementary, inhaltive drugs | Hospitalization, inhaltive drugs, and O2 supplementary | Hospitalization, endoscopic debridement removing | Hospitalization, inhalative drugs, and cortison treatment | Hospitalization, endoscopic lung volume reduction |
COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; LL, lower lobe; UL, upper lobe; PTV, planning target volume; BED3, biologic effective dose at α/β=3 Gy; Dmean, mean dose; Dmax, maximal dose; Vn, P% the percentage of organ volume that received n Gy; MLD, mean lung dose; CT, computed tomography; PFT, pulmonary function test; FEV1, forced expiration at the first second; DLCO, diffusing capacity of the lung for carbon monoxide; COPD, chronic obstructive pulmonary disease.