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

Kalman, Noah S.; Hugo, Geoffrey D.; Mahon, R.N.; Deng, Xiaoyan; Mukhopadhyay, Nitai D.; Weiss, Elisabeth

doi:10.1016/j.radonc.2018.08.024

Cited by 21 publications

(17 citation statements)

References 27 publications

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“…However, few studies in the literature show the association between the risk of developing RP and DM. In recently published three studies have been reported that DM increased the risk of RP by 2‐fold in lung cancer patients treated with both conventional and stereotacticRT 22‐24 . In the latest study, the relationship between DM, HbA1c and fasting glucose level and RP was shown for the first time and the incidence of grade ≥3 RP was reported to be 2‐fold higher in diabetic patients than in nondiabetic patients 25 .…”

Section: Discussionmentioning

confidence: 97%

Risk factors of radiation pneumonitis in patients with NSCLC treated with concomitant chemoradiotherapy––Are we underestimating diabetes?––Turkish oncology group (TOG)/Lung cancer study group

Ergen

Dinçbaş

Yücel

et al. 2020

Clinical Respiratory J

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Introduction To evaluate the clinical and dosimetric parameters that increase the risk of radiation pneumonitis (RP) in locally advanced non‐small cell lung cancer (NSCLC) patients treated with concomitant chemoradiotherapy of nationwide multicentric data analysis. Methods All data of 268 patients who underwent definitive chemoradiotherapy were retrospectively collected from eight institutes participating in this study. Patient, tumor and treatment‐related factors and dosimetric parameters were analyzed for grade ≥2 RP. The toxicity scoring system of The Radiation Therapy Oncology Group used for grading the severity of pneumonitis. A relationship with the risk of RP with potential predictive factors were evaluated by univariate and multivariate analyses. A recursive partition analysis (RPA) was applied to stratify patients according to the risk of developing RP. Results There were 90 (33.6%) patients who had grade ≥2 RP. The median time to pneumonitis after treatment was 4 months (range:1‐6 months). In univariate analysis, diabetes mellitus (DM), use of cisplatin/etoposide, total and daily radiotherapy (RT) fraction dose, the planning target volume (PTV) size, mean lung dose, V5, V10 and RT technique were associated with the development of pneumonitis. In multivariate analysis, only DM (P = 0.008) was found to be independent risk factors for RP. According to RPA, the risk of developing RP was highest in patients with DM. Conclusions In our study, besides the known dosimetric factors, DM was found to be the most important risk factor causing RP development in multivariate analysis and RPA. The risk is tripled compared to patients without DM.

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Section: Discussionmentioning

confidence: 97%

Risk factors of radiation pneumonitis in patients with NSCLC treated with concomitant chemoradiotherapy––Are we underestimating diabetes?––Turkish oncology group (TOG)/Lung cancer study group

Ergen

Dinçbaş

Yücel

et al. 2020

Clinical Respiratory J

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“…Texture features extracted from kV-CT images can be used to predict distant metastases in oropharyngeal carcinoma (31), assess radiation-induced lung injury after stereotactic body radiotherapy (32), and act as imaging correlates for tumor hypoxia and angiogenesis for NSCLC (8). In this study, we found some texture features were reproducible in MVCT images.…”

Section: Discussionmentioning

confidence: 99%

The Feasibility Study of Megavoltage Computed Tomographic (MVCT) Image for Texture Feature Analysis

Zhu

Qiu

et al. 2018

Front. Oncol.

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Purpose: To determine whether radiomics texture features can be reproducibly obtained from megavoltage computed tomographic (MVCT) images acquired by Helical TomoTherapy (HT) with different imaging conditions.Methods: For each of the 195 textures enrolled, the mean intrapatient difference, which is considered to be the benchmark for reproducibility, was calculated from the MVCT images of 22 patients with early-stage non-small-cell lung cancer. Test–retest MVCT images of an in-house designed phantom were acquired to determine the concordance correlation coefficient (CCC) for these 195 texture features. Features with high reproducibility (CCC > 0.9) in the phantom test–retest set were investigated for sensitivities to different imaging protocols, scatter levels, and motion frequencies using a wood phantom and in-vitro animal tissues.Results: Of the 195 features, 165 (85%) features had CCC > 0.9. For the wood phantom, 124 features were reproducible in two kinds of scatter materials, and further investigations were performed on these features. For animal tissues, 108 features passed the criteria for reproducibility when one layer of scatter was covered, while 106 and 108 features of in-vitro liver and bone passed with two layers of scatter, respectively. Considering the effect of differing acquisition pitch (AcP), 97 features extracted from wood passed, while 103 and 59 features extracted from in-vitro liver and bone passed, respectively. Different reconstruction intervals (RI) had a small effect on the stability of the feature value. When AcP and RI were held consistent without motion, all 124 features calculated from wood passed, and a majority (122 of 124) of the features passed when imaging with a “fine” AcP with different RIs. However, only 55 and 40 features passed with motion frequencies of 20 and 25 beats per minute, respectively.Conclusion: Motion frequency has a significant impact on MVCT texture features, and features from MVCT were more reproducibility in different scatter conditions than those from CBCT. Considering the effects of AcP and RI, the scanning protocols should be kept consistent when MVCT images are used for feature analysis. Some radiomics features from HT MVCT images are reproducible and could be used for creating clinical prediction models in the future.

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“…Besides, several clinical studies indicate that radiation pneumonitis is more common in patients with diabetes and lung cancer (Kornum et al, 2007;Barnett et al, 2009;Busaidy et al, 2012;Tornovsky-Babeay et al, 2014). Similarly, skin necrosis and fibrosis are also more frequent in diabetic patients undergoing radiation therapy against cancer (Peairs et al, 2011;Busaidy et al, 2012;Jha et al, 2016;Kalman et al, 2018). Enhanced sensitivity of the microvasculature to radiation has also been demonstrated in patients with diabetes (Clark et al, 2002;Simo et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

CompromisedDNArepair is responsible for diabetes‐associated fibrosis

et al. 2020

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Diabetes-associated organ fibrosis, marked by elevated cellular senescence, is a growing health concern. Intriguingly, the mechanism underlying this association remained unknown. Moreover, insulin alone can neither reverse organ fibrosis nor the associated secretory phenotype, favoring the exciting notion that thus far unknown mechanisms must be operative. Here, we show that experimental type 1 and type 2 diabetes impairs DNA repair, leading to senescence, inflammatory phenotypes, and ultimately fibrosis. Carbohydrates were found to trigger this cascade by decreasing the NAD + /NADH ratio and NHEJ-repair in vitro and in diabetes mouse models. Restoring DNA repair by nuclear overexpression of phosphomimetic RAGE reduces DNA damage, inflammation, and fibrosis, thereby restoring organ function. Our study provides a novel conceptual framework for understanding diabetic fibrosis on the basis of persistent DNA damage signaling and points to unprecedented approaches to restore DNA repair capacity for resolution of fibrosis in patients with diabetes.

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

Cited by 21 publications

References 27 publications

Risk factors of radiation pneumonitis in patients with NSCLC treated with concomitant chemoradiotherapy––Are we underestimating diabetes?––Turkish oncology group (TOG)/Lung cancer study group

Risk factors of radiation pneumonitis in patients with NSCLC treated with concomitant chemoradiotherapy––Are we underestimating diabetes?––Turkish oncology group (TOG)/Lung cancer study group

The Feasibility Study of Megavoltage Computed Tomographic (MVCT) Image for Texture Feature Analysis

CompromisedDNArepair is responsible for diabetes‐associated fibrosis

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