Pneumomediastinum as a complication of SABR for lung metastasesReportar como inadecuado

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Radiation Oncology

, 10:25

First Online: 23 January 2015Received: 01 August 2014Accepted: 07 January 2015DOI: 10.1186-s13014-015-0330-y

Cite this article as: Rodríguez-Ruiz, M.E., Arévalo, E., Gil-Bazo, I. et al. Radiat Oncol 2015 10: 25. doi:10.1186-s13014-015-0330-y


BackgroundStereotactic ablative body radiation SABR is a novel and sophisticated radiation modality that involves the irradiation of extracranial tumors through precise and very high doses in patients with oligometastatic lung disease and primary lung tumors.

Case presentationA 52-year-old female with subclinical idiopathic interstitial lung disease ILD and oligometastatic lung disease from squamous urethral cancer who was treated with SABR for a metastatic lesion located in the right lower pulmonary lobe. The patient received a hypo-fractionated course of SABR. A 3D-conformal multifield technique was used with six coplanar and one non-coplanar statics beams. A 48 Gy total dose in three fractions over six days was prescribed to the 95% of the PTV. The presence of idiopathic ILD and other identifiable underlying lung conditions were not taken into account as a constraint to prescribe a different than standard total dose or fractionation schedule. Six months after the SABR treatment, a CT-scan showed the presence of a pneumomediastinum with air outside the bronchial tree and within the subcutaneous tissue without co-existing pneumothorax. To our knowledge, this is the first case of pneumomediastinum appearing 6 months after SABR treatment for a lung metastasis located in the perihiliar-central tumors region as defined by the RTOG protocols as the proximal bronchial tree.

ConclusionRadiation oncologist should be aware of the potential risk of severe lung toxicity caused by SABR in patients with ILD, especially when chemotherapy-induced pulmonary toxicity is administered in a short time interval.

KeywordsOligometastatic lung disease Pneumomediastinum SABR stereotactic ablative body radiation SBRT stereotactic beam radiation therapy  Download fulltext PDF

Autor: María Esperanza Rodríguez-Ruiz - Estefanía Arévalo - Ignacio Gil-Bazo - Alicia Olarte García - German Valtueña - Mart


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