Predictors of Radiation Pneumonitis in Patients with Lung Cancer after Chemoradiotherapy
ABSTRACT
The reported incidence of radiation pneumonitis (RP) has varied widely in clinical studies ranging from 0% to 54%. This wide range is probably the result of differences in its precipitating factors. This study aimed to find out the predictive factors of RP in patients with NSCLC who were treated with concurrent chemotherapy and radiotherapy (CCRT). We prospectively studied 76 lung cancer patients who were treated with CCRT consecutively between January 2011 and May 2013 in the Department of Radiation Oncology at Cancer Institute, Assiut University. Radiographic images, pulmonary function tests and symptom assessment were used for the diagnosis of RP. Of the studied 76 patients, 25 patients developed RP (33%), 15 of them developed grade 2 RP, 8 patients developed grade 3 RP, 1 patient developed grade 4 toxicity, and 1 patient developed grade 5 toxicity. In multivariate analysis, FEV1 value (p = 0.000) and chronic obstructive pulmonary disease (COPD) (p = 0.012) were the most significant factors associated with RP. Pretreatment FEV1 value and COPD are useful indicators for predicting RP in NSCLC patients treated with CCRT. Pretreatment of pulmonary function and base-line pulmonary disease is critical for patients’ well being after chemoradiotherapy.
Cite this paper
Hassan, W. and Abd-Elwaness, M. (2014) Predictors of Radiation Pneumonitis in Patients with Lung Cancer after Chemoradiotherapy. Open Journal of Respiratory Diseases, 4, 27-33. doi: 10.4236/ojrd.2014.42005.
Hassan, W. and Abd-Elwaness, M. (2014) Predictors of Radiation Pneumonitis in Patients with Lung Cancer after Chemoradiotherapy. Open Journal of Respiratory Diseases, 4, 27-33. doi: 10.4236/ojrd.2014.42005.
References
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http://dx.doi.org/10.1016/j.ijrobp.2005.11.046 [16] Seppenwoolde, Y., Lebesque, J.V., De Jaeger, K., et al. (2003) Comparing Different NTCP Models That Predict the Incidence of Radiation Pneumonitis. International Journal of Radiation Oncology * Biology * Physics, 55, 724-735. http://dx.doi.org/10.1016/S0360-3016(02)03986-X [17] Lee, J.S., Scott, C., Komaki, R., et al. (1996) Concurrent Chemoradiation Therapy with Oral Etoposide and Cisplatin for Locally Advanced Inoperable Non-Small-Cell Lung Cancer: Radiation Therapy Oncology Group Protocol 91-06. Journal of Clinical Oncology, 14, 1055-1064. [18] Rodrigues, G., Lock, M., D’Souza, D., et al. (2004) Prediction of Radiation Pneumonitis by Dose-Volume Histogram Parameters in Lung Cancer: A Systematic Review. Radiotherapy & Oncology, 71, 127-138. http://dx.doi.org/10.1016/j.radonc.2004.02.015 [19] Wang, S., Liao, Z., Wei, X., et al. (2006) Analysis of Clinical and Dosimetric Factors Associated with Treatment-Related Pneumonitis (TRP) in Patients with Non-Small-Cell Lung Cancer (NSCLC) Treated with Concurrent Chemotherapy and Three-Dimensional Conformal Radiotherapy (3-DCRT). International Journal of Radiation Oncology * Biology * Physics, 66, 1399-1407.
http://dx.doi.org/10.1016/j.ijrobp.2006.07.1337 [20] Byhardt, R.W., Scott, C., Sause, W.T., et al. (1998) Response, Toxicity, Failure Patterns, and Survival in Five Radiation Therapy Oncology Group (RTOG) Trials of Sequential and/or Concurrent Chemotherapy and Radiotherapy for Locally Advanced Non-Small-Cell Carcinoma of the Lung. International Journal of Radiation Oncology * Biology * Physics, 42, 469-478.
http://dx.doi.org/10.1016/S0360-3016(98)00251-X [21] Zhao, Y.H., Li, Z.P., Chen, X.M., et al. (2008) Correlation Study of Physical and Biologic Parameters to Acute Radiation Pneumonitis. Journal of Sichuan University: Medical Science Edition, 39, 796-800. [22] Roach III, M., Gandara, D.R., You, H.S., et al. (1995) Radiation Pneumonitis Following Combined Modality Therapy for Lung Cancer: Analysis of Prognostic Factors. Journal of Clinical Oncology, 13, 2606-2612. [23] Das, S.K., Chen, S., Deasy, J.O., et al. (2008) Combining Multiple Models to Generate Consensus: Application to Radiation-Induced Pneumonitis Prediction. Medical Physics, 35, 5098-5109.
http://dx.doi.org/10.1118/1.2996012 [24] Inoue, A., Kunitoh, H., Sekine, I., et al. (2001) Radiation Pneumonitis in Lung Cancer Patients: A Study of Risk Factors and the Long-Term Prognosis. International Journal of Radiation Oncology * Biology * Physics, 49, 649-655.
http://dx.doi.org/10.1016/S0360-3016(00)00783-5
[1] Hernando, M.L., Marks, L.B., Bentel, G.C., et al. (2001) Radiation-Induced Pulmonary Toxicity: A Dose-Volume Histogram Analysis in 201 Patients with Lung Cancer. International Journal of Radiation Oncology * Biology * Physics, 51, 650-659.
http://dx.doi.org/10.1016/S0360-3016(01)01685-6 [2] Yorke, E.D., Jackson, A., Rosenzweig, K.E., et al. (2002) Dose-Volume Factors Contributing to the Incidence of Radiation Pneumonitis in Non-Small-Cell Lung Cancer Patients Treated with Three-Dimensional Conformal Radiation Therapy. International Journal of Radiation Oncology * Biology * Physics, 54, 329-339.
http://dx.doi.org/10.1016/S0360-3016(02)02929-2 [3] Kwa, S.L., Theuws, J.C., Wagenaar, A., et al. (1998) Evaluation of Two Dose-Volume Histogram Reduction Models for the Prediction of Radiation Pneumonitis. Radiotherapy & Oncology, 48, 61-69.
http://dx.doi.org/10.1016/S0167-8140(98)00020-6 [4] Graham, M.V., Purdy, J.A., Emami, B., et al. (1999) Clinical Dose-Volume Histogram Analysis for Pneumonitis after 3D Treatment for Non-Small Cell Lung Cancer (NSCLC). International Journal of Radiation Oncology * Biology * Physics, 45, 323-329.
http://dx.doi.org/10.1016/S0360-3016(99)00183-2 [5] Tsujino, K., Hirota, S., Endo, M., et al. (2003) Predictive Value of Dose-Volume Histogram Parameters for Predicting Radiation Pneumonitis after Concurrent Chemoradiation for Lung Cancer. International Journal of Radiation Oncology * Biology * Physics, 55, 110-115.
http://dx.doi.org/10.1016/S0360-3016(02)03807-5 [6] Rancati, T., Ceresoli, G.L., Gagliardi, G., Schipani, S. and Cattaneo, G.M. (2003) Factors Predicting Radiation Pneumonitis in Lung Cancer Patients: A Retrospective Study. Radiotherapy & Oncology, 67, 275-283.
http://dx.doi.org/10.1016/S0167-8140(03)00119-1 [7] Claude, L., Perol, D., Ginestet, C., et al. (2004) A Prospective Study on Radiation Pneumonitis Following Conformal Radiation Therapy in Non-Small-Cell Lung Cancer: Clinical and Dosimetric Factors Analysis. Radiotherapy & Oncology, 71, 175-181.
http://dx.doi.org/10.1016/j.radonc.2004.02.005 [8] Shi, A., Zhu, G., Wu, H., Yu, R., Li, F. and Xu, B. (2010) Analysis of Clinical and Dosimetric Factors Associated with Severe Acute Radiation Pneumonitis in Patients with Locally Advanced Non-Small Cell Lung Cancer Treated with Concurrent Chemotherapy and Intensity-Modulated Radiotherapy. Radiotherapy & Oncology, 5, 35.
http://dx.doi.org/10.1186/1748-717X-5-35 [9] Robnett, T.J., Machtay, M., Vines, E.F., McKenna, M.G., Algazy, K.M. and McKenna, W.G. (2000) Factors Predicting Severe Radiation Pneumonitis in Patients Receiving Definitive Chemoradiation for Lung Cancer. International Journal of Radiation Oncology * Biology * Physics, 48, 89-94. http://dx.doi.org/10.1016/S0360-3016(00)00648-9 [10] Kim, T.H., Cho, K.H., Pyo, H.R., et al. (2005) Dose-Volumetric Parameters for Predicting Severe Radiation Pneumonitis after Three-Dimensional Conformal Radiation Therapy for Lung Cancer. Radiology, 235, 208-215.
http://dx.doi.org/10.1148/radiol.2351040248 [11] Yom, S.S., Liao, Z., Liu, H.H., et al. (2007) Initial Evaluation of Treatment-Related Pneumonitis in Advanced-Stage Non-Small-Cell Lung Cancer Patients Treated with Concurrent Chemotherapy and Intensity-Modulated Radiotherapy. International Journal of Radiation Oncology * Biology * Physics, 68, 94-102.
http://dx.doi.org/10.1016/j.ijrobp.2006.12.031 [12] Seung, S.K. and Ross, H.J. (2009) Phase II Trial of Combined Modality Therapy with Concurrent Topotecan plus Radiotherapy Followed by Consolidation Chemotherapy for Unresectable Stage III and Selected Stage IV Non-Small-Lung Cancer. International Journal of Radiation Oncology * Biology * Physics, 73, 802-809.
http://dx.doi.org/10.1016/j.ijrobp.2008.04.074 [13] Rodrigues, G., Lock, M., D’Souza, D., et al. (2004) Prediction of Radiation Pneumonitis by Dose-Volume Histogram Parameters in Lung Cancer: A Systematic Review. Radiotherapy & Oncology, 71, 127-138.
http://dx.doi.org/10.1016/j.radonc.2004.02.015 [14] Curran, W., Scott, C.B., Langer, C.J., et al. (2003) Long-Term Benefit Is Observed in a Phase III Comparison of Sequential vs. Concurrent Chemo-Radiation for Patients with Unresectable Stage III NSCLC: RTOG 9410. Proceedings of American Society of Clinical Oncology, 22, 621. (Abstr) [15] Hope, A.J., Lindsay, P.E., El Naqa, I., et al. (2006) Modeling Radiation Pneumonitis Risk with Clinical, Dosimetric, and Spatial Parameters. International Journal of Radiation Oncology * Biology * Physics, 65, 112-124.
http://dx.doi.org/10.1016/j.ijrobp.2005.11.046 [16] Seppenwoolde, Y., Lebesque, J.V., De Jaeger, K., et al. (2003) Comparing Different NTCP Models That Predict the Incidence of Radiation Pneumonitis. International Journal of Radiation Oncology * Biology * Physics, 55, 724-735. http://dx.doi.org/10.1016/S0360-3016(02)03986-X [17] Lee, J.S., Scott, C., Komaki, R., et al. (1996) Concurrent Chemoradiation Therapy with Oral Etoposide and Cisplatin for Locally Advanced Inoperable Non-Small-Cell Lung Cancer: Radiation Therapy Oncology Group Protocol 91-06. Journal of Clinical Oncology, 14, 1055-1064. [18] Rodrigues, G., Lock, M., D’Souza, D., et al. (2004) Prediction of Radiation Pneumonitis by Dose-Volume Histogram Parameters in Lung Cancer: A Systematic Review. Radiotherapy & Oncology, 71, 127-138. http://dx.doi.org/10.1016/j.radonc.2004.02.015 [19] Wang, S., Liao, Z., Wei, X., et al. (2006) Analysis of Clinical and Dosimetric Factors Associated with Treatment-Related Pneumonitis (TRP) in Patients with Non-Small-Cell Lung Cancer (NSCLC) Treated with Concurrent Chemotherapy and Three-Dimensional Conformal Radiotherapy (3-DCRT). International Journal of Radiation Oncology * Biology * Physics, 66, 1399-1407.
http://dx.doi.org/10.1016/j.ijrobp.2006.07.1337 [20] Byhardt, R.W., Scott, C., Sause, W.T., et al. (1998) Response, Toxicity, Failure Patterns, and Survival in Five Radiation Therapy Oncology Group (RTOG) Trials of Sequential and/or Concurrent Chemotherapy and Radiotherapy for Locally Advanced Non-Small-Cell Carcinoma of the Lung. International Journal of Radiation Oncology * Biology * Physics, 42, 469-478.
http://dx.doi.org/10.1016/S0360-3016(98)00251-X [21] Zhao, Y.H., Li, Z.P., Chen, X.M., et al. (2008) Correlation Study of Physical and Biologic Parameters to Acute Radiation Pneumonitis. Journal of Sichuan University: Medical Science Edition, 39, 796-800. [22] Roach III, M., Gandara, D.R., You, H.S., et al. (1995) Radiation Pneumonitis Following Combined Modality Therapy for Lung Cancer: Analysis of Prognostic Factors. Journal of Clinical Oncology, 13, 2606-2612. [23] Das, S.K., Chen, S., Deasy, J.O., et al. (2008) Combining Multiple Models to Generate Consensus: Application to Radiation-Induced Pneumonitis Prediction. Medical Physics, 35, 5098-5109.
http://dx.doi.org/10.1118/1.2996012 [24] Inoue, A., Kunitoh, H., Sekine, I., et al. (2001) Radiation Pneumonitis in Lung Cancer Patients: A Study of Risk Factors and the Long-Term Prognosis. International Journal of Radiation Oncology * Biology * Physics, 49, 649-655.
http://dx.doi.org/10.1016/S0360-3016(00)00783-5