A Clinical Score, Including Biohumoral Parameters, Is a Useful Pretest Index to Discriminate Pulmonary Infections from Radiation Damage in Chemoradiation-Treated Lung Cancer Patients

Abstract

To obtain an easy and prompt differential diagnosis between lower airways infections and acute radiation pneumonitis in chemoradiation lung cancer patients. From 303 patients treated, only patients with severe pulmonary symptoms were hospitalized. Clinical and radiation scores were calculated evaluating clinical, biohumoral, dosimetric parameters. Out of 36 patients hospitalized, infections and acute radiation pneumonitis were reported in 66.7% and 33.3%, respectively. Patients with clinical score ≥ 2 had an Odds Ratio of 3.4 (1.4-8.3; p = .006) to have infectious pneumonia, while radiation score was not predictive.

Early differential diagnosis model for acute radiation pneumonitis based on multiple parameters

“…The multivariate analysis showed that WBC correlated with ARP, and the probability of diagnosing APR seemed to increase with the reduction in WBC, indicating the existence of a relatively high level of WBC in most patients with IP and a lower level of WBC in the patients with ARP. These results were consistent with those reported by Ramella et al [13], in which increased granulocyte count was also included as a factor. Another study found that the WBC count was associated with radiotherapy-induced changes in imaging [15].…”

“…Ultimately, PCT was also integrated into the differential diagnosis model. In another study, attempts were made to construct a scoring system for the diagnosis of ARP, which also included PCT; the results were consistent with those of the present study [13]. CRP is a traditional inflammatory indicator, but it is not specific in distinguishing between infectious and non-infectious diseases [14].…”

“…The inclusion of these predictors can contribute to locking in high-risk patients with ARP; and together with other factors, it can improve the accuracy of differential diagnosis, like the role of cirrhosis, hepatitis, and other risk factors in diagnostic criteria for primary liver cancer. The results of the present study also confirmed that MLD, as an independent predictor, was one of the multiple diagnostic factors, which differed from previous studies that did not report the diagnostic value of radiophysical parameters [13]. This might be because previous studies enrolled only a small number of samples and did not include radiophysical parameters along with the clinical parameters in their multivariate analysis.…”

COVID-19 and radiation induced pneumonitis: Overlapping clinical features of different diseases

“…However, most patients will have a high erythrocyte sedimentation rate (VES) or C-reactive protein and normal procalcitonin. Furthermore, high serum ferritin and D-Dimer are elevated in these patients due to cancer disease [5,6]. In addition, lymphopenia (the most common laboratory finding in patients diagnosed with COVID-19) can be relatively frequent in RP as lymphocytes are known to be more radiosensitive and lymphocyte count reduction has been reported by a median of 67% in NSCLC patients undergoing CCRT [7].…”