CTICasesLocal Tumor Recurrence within a Radiation Field
Imaging findings
A patient treated with IMRT for non-small cell lung cancer has a post-radiation treatment field showing traction bronchiectasis with patent air bronchograms, volume loss, and straight or curvilinear margins. A follow-up scan about six months later shows loss of the air bronchograms, a convex bulging margin, and a discrete enlarging mass; FDG-PET showed a necrotic mass with active tumor at the edges, and transbronchial biopsy confirmed recurrence.
Key takeaways
Loss of previously visible air bronchograms within a radiation fibrosis field is a red flag for local tumor recurrence, since radiation typically distorts but preserves the airways. Other clues include new outward or convex bulging growth at the field edge and an enlarging discrete mass; FDG-PET helps confirm recurrence and guide biopsy toward the metabolically active tumor margins. Larger tumors and those near the hilum carry higher recurrence risk.
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