Prescreening based on the presence of CT-scan abnormalities and biomarkers (KL-6 and SP-D) may reduce severe radiation pneumonitis after stereotactic radiotherapy

Radiat Oncol. 2010 May 9:5:32. doi: 10.1186/1748-717X-5-32.


Purpose: To determine the risk factors of severe radiation pneumonitis (RP) after stereotactic body radiation therapy (SBRT) for primary or secondary lung tumors.

Materials and methods: From January 2003 to March 2009, SBRT was performed on 117 patients (32 patients before 2005 and 85 patients after 2006) with lung tumors (primary = 74 patients and metastatic/recurrent = 43 patients) in our institution. In the current study, the results on cases with severe RP (grades 4-5) were evaluated. Serum Krebs von den Lungen-6 (KL-6) and serum Surfactant protein-D (SP-D) were used to predict the incidence of RP. A shadow of interstitial pneumonitis (IP) on the CT image before performing SBRT was also used as an indicator for RP. Since 2006, patients have been prescreened for biological markers (KL-6 & SP-D) as well as checking for an IP-shadow in CT.

Results: Grades 4-5 RP was observed in nine patients (7.7%) after SBRT and seven of these cases (6.0%) were grade 5 in our institution. A correlation was found between the incidence of RP and higher serum KL-6 & SP-D levels. IP-shadow in patient's CT was also found to correlate well with the severe RP. Severe RP was reduced from 18.8% before 2005 to 3.5% after 2006 (p = 0.042). There was no correlation between the dose volume histogram parameters and these severe RP patients.

Conclusion: Patients presenting with an IP shadow in the CT and a high value of the serum KL-6 & SP-D before SBRT treatment developed severe radiation pneumonitis at a high rate. The reduction of RP incidence in patients treated after 2006 may have been attributed to prescreening of the patients. Therefore, pre-screening before SBRT for an IP shadow in CT and serum KL-6 & SP-D is recommended in the management and treatment of patients with primary or secondary lung tumors.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor / metabolism
  • Female
  • Humans
  • Lung Diseases, Interstitial / diagnostic imaging
  • Lung Neoplasms / diagnostic imaging
  • Lung Neoplasms / metabolism
  • Lung Neoplasms / surgery*
  • Male
  • Middle Aged
  • Mucin-1 / metabolism*
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasm Recurrence, Local / metabolism
  • Neoplasm Recurrence, Local / surgery
  • Pulmonary Surfactant-Associated Protein D / metabolism*
  • Radiation Pneumonitis / etiology
  • Radiation Pneumonitis / prevention & control*
  • Radiosurgery / adverse effects*
  • Retrospective Studies
  • Tomography, X-Ray Computed*
  • Treatment Outcome


  • Biomarkers, Tumor
  • MUC1 protein, human
  • Mucin-1
  • Pulmonary Surfactant-Associated Protein D