From the Guidelines
Stereotactic body radiation therapy (SBRT) for lung cancer can cause several side effects, including fatigue, skin reactions, radiation pneumonitis, chest wall pain, and esophagitis, with rare but serious complications such as rib fractures, severe pneumonitis, and damage to nearby structures. The most common side effects of SBRT for lung cancer include:
- Fatigue, which typically develops during treatment and may persist for weeks afterward
- Skin reactions at the treatment site, such as redness, irritation, or dryness
- Radiation pneumonitis, an inflammation of lung tissue, occurs in about 10-15% of patients, usually 2-6 months after treatment, causing cough, chest pain, and shortness of breath, as reported in 1
- Chest wall pain can occur, especially when tumors are close to the ribs
- Some patients develop temporary difficulty swallowing (esophagitis) if the radiation field is near the esophagus Rare but serious complications can include:
- Rib fractures, with a risk of approximately 5% when the dose to a volume of 2 mL is limited to three fractions of 9 Gy, as stated in 1
- Severe pneumonitis leading to fibrosis
- Damage to structures near the treatment area such as the heart, major blood vessels, or spinal cord The specific side effects depend on the tumor location, radiation dose, and individual patient factors, with most side effects being temporary and resolving within weeks to months after treatment completion, though some may be permanent, as noted in 1.
From the Research
Side Effects of SBRT for Lung Cancer
The side effects of Stereotactic Body Radiation Therapy (SBRT) for lung cancer include:
- Radiation pneumonitis (RP), which is one of the most common toxicities of SBRT 2
- Symptomatic RP, which can be severe, symptomatic, and potentially fatal 2, 3, 4
- Grade 2 or above radiation pneumonitis (RP2), which was recorded in 10% of patients in one study 3
- Fatal RP, which was identified in 6.9% of all patients in another study 4
Risk Factors for Side Effects
Several risk factors have been identified for the development of side effects after SBRT for lung cancer, including:
- History of respiratory comorbidity 3
- Previous thoracic radiation 3
- Right lung location 3
- Mean lung doses of total or ipsilateral lung 3
- Total lung volume receiving 20 Gy 3
- Presence of interstitial pneumonitis shadow on computed tomography scan and high levels of serum Krebs von den Lungen-6 and surfactant protein D 2
- Pretreatment pulmonary interstitial change (PIC) 4
- Percent vital capacity <70% 4
- Mean percentage normal lung volume receiving more than 20 Gy (>10%) 4
- Performance status of 2-4 4
- Presence of squamous cell carcinoma 4
- Clinical T2 stage 4
- Regular use of steroid before SBRT 4
- Percentage predicting forced expiratory volume in one second (<70%) 4
Management of Side Effects
To minimize the risk of side effects, it is essential to carefully evaluate patients before SBRT and to use dosimetric parameters to limit lung toxicity 3. Additionally, patients with certain risk factors, such as PIC, should be closely monitored for signs of RP 4.