Diabetes mellitus and radiation induced lung injury after thoracic stereotactic body radiotherapy

Highlights: • Diabetes presence increased radiographic changes after thoracic SBRT. • The diabetes effect peaked early after treatment but persisted at 12 months. • Pneumonitis occurred more often in diabetics, independent of radiographic changes. • Smoking, race, tumor site, and other factors correlated with radiographic changes. • Greater caution treating diabetic patients with SBRT may be warranted. Radiographic radiation induced lung injury (RILI) is frequently observed after stereotactic body radiotherapy (SBRT). Models of radiographic change can identify patient risk factors that predict clinical toxicity. We examined the association between radiographic lung changes and lung tissue dose-density response over time with clinical risk factors for RILI, such as diabetes.