Small soft tissue mass, radition pneumonitis? - 1246560


My dad completed 6 rounds of cisplatin/etoposide, PCI, and 33 radiation treatments to his right lung for limited small cell lung cancer almost 3 months ago.

He was supposed to have his first 3 month CT scan on 08/20/2012 and the medical oncologist followup 08/27/2012 but developed shortness of breath and coughing around 08/01/2012. His radiation oncologist suspected radiation pneumonitis and had a CT scan done the next day.

The radiation oncologist reviewed the CT scan today and said everything had resolved (no evidence of disease) except a small soft tissue mass had appeared in the radiation field.

He said it could be scarring, pneumonitis, or a tumor and has ordered a PET scan for next week.

I was just wondering if scarring or pneumonitis manifests itself as a small soft tissue mass or are we dealing with a recurrence?

We had a CT scan done at the end of 05/2012 and this mass was not present but the original tumor which has now disappeared was.

The signs are all there for pneumonitis but the small tissue mass has everyone scared, any help is appreciated.


Posts: 2753


One problem with radiation is that it can be difficult to interpret what its effects have been until some time has passed. Often more than one scan over time is necessary to be able to judge whether there is new progression or something like scarring. If the small tissue mass doesn't grow over time, it is much less worrisome for cancer, but in the meantime radiation causes tissue damage that makes it impossible to judge what a mass represents. How small a mass is present?

Here's a previous discussion of the difficulty of judging response to radiation:

Forum moderator

Dr West
Posts: 4735

I agree that it's very difficult to interpret changes in the radiation field. Pneumonitis, residual viable cancer, and scarring (with no viable cancer) can all look all but indistinguishable. We sometimes need to either biopsy or follow the scans over time to interpret what's happening.

-Dr. West

Posts: 7

Back in hospital last week, fatigue, cough, spiking temp even after 10 days of antibiotics. Had just completed cycle one of taxol chemo which I tolerated well especially after tarceva caused a bleeding ulcer and small tumors got bigger. CT scan showed "lacy" areas in lungs and, great news, shrinking of tumors. Pulmonologist did bronchoscope , washed lungs and took samples. Suspect radiation pneumonitis, radiation done end of December. Given IV steroids and sent home with tablet steroid, 60 mg a day, taper to 40 over the weekend. Temp and pulmonary function now normal, coughing less but I am so fatigued I can't do much more than walk to the car, chair, etc. Could the taxol have caused the radiation pneumonitis? What can I do to make this extreme fatigue go away?

Dr West
Posts: 4735

It's definitely possible that the chemotherapy contributed to the pneumonitis. That's known to happen sometimes, with various chemo agents. It's not something we necessarily expect, but it's not so rare that it's hard to believe.

As for the fatigue, there are so many things that could be contributing to this that it's not possible for us to nail down a cause or offer a clear answer to how best to treat it. Here's a podcast from Dr. Harman that is specifically about fatigue in the setting of cancer and cancer treatment.

I hope you're feeling better soon.

-Dr. West