5. Complications of Lung Irradiation

What normal anatomy is involved in a typical lung field? (i.e. normal tissue that also gets irradiated)

1. normal lung tissue

2. esophagus

3. heart

4. spinal cord

5. skin

Part 1: Effects on Normal Lung

Lung density is (less/more) than other tissues

Less, cuz it has a lot of air

Because lung density is less than other tissues, then we need to irradiate the lungs with (lower/ higher) dose, and by how much (less/more)?

15-20% higher dose

(less dense tissue. absorbs less so higher dose needed)

What are the 4 side effects to normal lung tissue

1. Radiation Pneumonitis

2. Lung Fibrosis

3. Chronic, dry, non-productive cough

4. Dyspnea 

What is the major complication of lung irradiation:

Radiation pneumonitis

What is the second leading major complication of lung irradiation? 

Lung Fibrosis

What is the most serious side effect of lung irradiation?

(Radiation) Transverse Myelitis

1. Radiation pneumonitis, typically happens ____ after tx is done

2. Lung fibrosis, typically happens ___ after tx is done

1. 1-3 months

2. 2-4 months

(so 1-3 months for lungs to get irritated & 2-4 months for lungs to get scars)

term. Dyspnea

SOB, difficulty breathing 

Tolerance Doses for lung:

1. Whole Lung

2. Partial Lung

1. Whole Lung: 1750

2. Partial Lung: 4500

Part 2: Effects on Esophagus

What are the 2 side effects to the esophagus & at what doses do they begin

1. esophagitis; begins ~ 25 Gy

2. dysphagia; begins ~ 30 Gy

Part 3: Effects on the spinal cord

What is the effects to the spinal cord

RTM

What does RTM stand for

Radiation Transverse Myelitis

(inflammation of spinal cord)

RTM can result in

Paralysis 

Tolerance Doses for spinal cord:

1. Whole cord

2. Partial cord

1. Whole cord: 5000 cGy

2. Partial cord: 4700 cGy

Part 4: Cardiac Effects

What are the 2 cardiac effects? (term and def)

1. Pericarditis: inflammation of the pericardium

2. Pancarditis: inflammation of the entire heart

When does pericarditis happen?

When 60% or more of the heart is tx to 45 Gy or above

Part 5: Skin effects 

What skin area should be monitored when radiating lung tissue?

Back of trapezius area (upper back + neck)

When treating lung, how often should skin be assessed and by who?

Daily by RTT