Radiological Changes After Stereotactic Radiotherapy for Stage I Lung Cancer Max Dahele, MBChB, MSc, David Palma, MD, Frank Lagerwaard, MD, PhD, Ben Slotman,

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Radiological Changes After Stereotactic Radiotherapy for Stage I Lung Cancer Max Dahele, MBChB, MSc, David Palma, MD, Frank Lagerwaard, MD, PhD, Ben Slotman, MD, PhD, Suresh Senan, FRCR, PhD Journal of Thoracic Oncology Volume 6, Issue 7, Pages 1221-1228 (July 2011) DOI: 10.1097/JTO.0b013e318219aac5 Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Classification of radiological changes after stereotactic body radiotherapy (SBRT). A, Acute radiological pneumonitis within 6 months of treatment. One category (no increasing density) not shown. B, Late radiological fibrosis after more than 6 months from the time of treatment. One category (no increasing density) not shown. GGO, ground glass opacity. Journal of Thoracic Oncology 2011 6, 1221-1228DOI: (10.1097/JTO.0b013e318219aac5) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Cumulative incidence plot of first computed tomography (CT) change after stereotactic body radiation therapy (SBRT). Journal of Thoracic Oncology 2011 6, 1221-1228DOI: (10.1097/JTO.0b013e318219aac5) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Temporal changes in patterns and severity of computed tomography (CT) changes after stereotactic body radiation therapy (SBRT). A, Morphological patterns of CT changes by follow-up time period. B, Severity of CT changes by follow-up time period. GGO, ground glass opacity. Number of lesions scored during each time period is shown at bottom (some lesions may have been scored more than once during each period). Journal of Thoracic Oncology 2011 6, 1221-1228DOI: (10.1097/JTO.0b013e318219aac5) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 These two examples illustrate the dynamic nature of computed tomography (CT) changes after lung stereotactic body radiation therapy (SBRT) 3 × 20 Gy. In the top panel, the treatment CT is on the left. From left to right: “no increase in density” on CT at +6 and +13 months and then a “modified conventional” pattern first appears at +25 months and is still present at +37 months. In the case illustrated in the bottom panel, the treatment CT is again on the left. From left to right: no increase in density at +7 months changing to modified conventional pattern at +13 months, evolving to “mass-like” change on CT at +24 months post-SBRT and then reverting again to modified conventional at +38 months. Journal of Thoracic Oncology 2011 6, 1221-1228DOI: (10.1097/JTO.0b013e318219aac5) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions