CT-DIAGNOSTICS OF POST-RADIATION CHANGES IN THE LUNGS (LITERATURE REVIEW AND OWN DATA)

Abstract

Introduction. Local effect on the lung tissue during radiation therapy according to about various diseases — post-radiation pneumonitis — is well studied and described in various works, but poorly diagnosed in practice medicine, because develops over a long period of time exposure and has nonspecific clinical manifestations. Radiation knowledge pictures of the acute stage and fibrotic postradiation changes affect tactics patient management and improve prognosis. The purpose of the study. To evaluate the radiation patterns of post-radiation changes of the chest organs. Materials and methods. From 2006 to 2022, 78 patients who underwent different types of radiation therapy for various diseases (breast cancer — 52 patients, lung cancer — 10 patients, lymphoproliferative processes — 16 patients) were observed at the Pavlov State Medical University, the prescription period for radiation therapy ranged from 3 months to 20 years. All patients complained of shortness of breath (up to shortness of breath at rest), dry cough (of varying severity). The average age of the patients was 46.3±19.1 years (w/m — 66/12). All patients underwent traditional X-ray examinations (radiography in two projections), VRKT, if possible, a comprehensive functional study of external respiration (CPIVD) and echocardiography. Results. The picture of acute post-radiation pneumonitis was detected in 42 patients (53.84%) and was characterized by the following radiation symptoms: extra-segmental (repeating the shape of the irradiation field) infiltration of interstitial lung tissue (CT picture of “frosted glass”, reticulation) — 24 patients (57.14%), alveolar (consolidation of linear, focal and irregular shape) — 8 patients (19.04%), and of a mixed nature — 10 patients (23.8%). With timely administration of HCST, there was a complete regression of changes in 12 patients (28.5%) and the preservation of pneumofibrosis of varying severity in 30 patients (71.42%). The changes were accompanied by persistent induration of the adjacent cellular spaces. The formation of post–radiation pneumofibrosis at the initial examination was determined in 35 patients (44.87%) and was characterized by the presence of local (12 patients — 34.28%) and widespread (23 patients — 65.71%). CT patterns of pulmonary tissue fibrosis included: linear (12 patients — 34.28%), severe (10 patients — 28.57%), focal (7 patients — 20.00%) type, carnification of varying degrees of extent (20 patients — 57.14%), repeated the shape of the irradiation field, accompanied by signs of a decrease in the volume of lung tissue (elevation of the diaphragm, displacement of the mediastinum) and fibrosis of the adjacent cellular spaces and skin. Conclusions. The accumulation of experience in clinical and radiation examination of patients with post-radiation changes in the lungs will allow timely anti-inflammatory and antifibrotic therapy, which is important for the prognosis of the course of the disease. The STATISTIСA 16.0 program/statistical package was used for statistical data processing.