Acute radiation pneumonitis after conformational radiotherapy for nonsmall cell lung cancer: Clinical, dosimetric, and associated-treatment risk factors

Leprieur, Étienne Giroux; Fernandez, D.; Châtellier, Gilles; Klotz, Susanne; Giraud, P.; Durdux, C.

doi:10.4103/0973-1482.119339

Cited by 26 publications

(27 citation statements)

References 28 publications

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“…Our results did not show an elevated risk of all-cause CAP hospitalization associated with chemotherapy or radiotherapy, although radiotherapy may result in radiation pneumonitis. 35 In our study, influenza vaccine did not have a significant effect on CAP hospitalization. Different virus strains circulating at different years might be one of the reasons.…”

Section: Discussioncontrasting

confidence: 40%

Effect of 23-Valent Pneumococcal Polysaccharide Vaccine Inoculated During Anti-Cancer Treatment Period in Elderly Lung Cancer Patients on Community-Acquired Pneumonia Hospitalization

et al. 2015

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To evaluate effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPSV23) inoculated during defined “vaccination period,” first 6 months post cancer diagnosis (ie, an anti-cancer treatment period), in elderly lung cancer patients on community-acquired pneumonia (CAP) hospitalization incidence.This was a nationwide population-based cohort study of 157 newly diagnosed elderly lung cancer patients receiving PPSV23 during “vaccination period”, and 628 age and sex one-to-one matched controls enrolled in the National Health Insurance Research Database (NHIRD) of Taiwan between 2007 and 2010. All patients were ≥75 years old and still survival post “vaccination period.” Incidence density (ID) of all-cause inpatient CAP and cumulative survival risk were analyzed by multivariate Poisson regression and Kaplan–Meier method, respectively.After a 4-year follow-up, IDs of all-cause inpatient CAP for vaccination and control cohorts were 297 and 444 per 1000 PYs, respectively. Less vaccinated patients had CAP incidence density >1 time per PY (12.7% vs 21.2%) than non-vaccinated patients. After adjusting for potential confounding variables, like influenza vaccination, comorbidities, cancer treatment modalities, and socioeconomic status, adjusted inpatient CAP incidence rate in PPSV23 vaccination cohort was 0.74 times lower than control cohort (incidence rate ratio [IRR] = 0.740, P = 0.0339). Two-year cumulative CAP hospitalization rates and overall survival rates were 37.1% vs. 55.4%, and 46.6% vs. 26.2%, respectively, for lung cancer patients with and without PPSV23 (both P < 0.001). Subgroup analysis showed that for elderly lung cancer patients not ever receiving influenza vaccine, PPSV23 still had trend to reduce all-cause inpatient CAP.For elderly lung cancer patients aged ≥75 years, PPSV23 inoculated during anti-cancer treatment period could reduce CAP hospitalizations and improve survival.

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Section: Discussioncontrasting

confidence: 40%

Effect of 23-Valent Pneumococcal Polysaccharide Vaccine Inoculated During Anti-Cancer Treatment Period in Elderly Lung Cancer Patients on Community-Acquired Pneumonia Hospitalization

et al. 2015

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“…Indeed, some studies [3–7] and a pooled analysis of 13 studies before 2012 [8] showed older age significantly increased the risk of RILT, but others did not find an association between age and the risk of RILT [9–13]. A study including 369 patients found age (≥70 years) was an independent predictor for both grade ≥ 2 (OR = 1.99) and grade ≥ 3 RP (OR = 8.90) [4].…”

Section: Agementioning

confidence: 99%

Nondosimetric Risk Factors for Radiation-Induced Lung Toxicity

Kong

Wang

2015

Seminars in Radiation Oncology

116

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The decision to administer a radical course of radiotherapy is largely influenced by the dose-volume metrics of the treatment plan, but what are the patient related and other factors that may independently increase the risk of radiation lung toxicity? Poor pulmonary function has been regarded as a risk factor and relative contraindication for patients having radical radiotherapy, but recent evidence suggests that patients with poor spirometry may tolerate conventional or high dose radiotherapy as well as, if not better than, patients with normal function. However, caution may need to be exercised in patients with underlying interstitial pulmonary fibrosis. Further there is emerging evidence of molecular markers of increased risk of toxicity. This review will discuss patient related and risk factors other than dosimetry for radiation lung toxicity.

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“…Although several studies previously reported an association between pre-ILD and radiation pneumonitis [ 4 , 11 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], our current study is different regarding 2 points.…”

Section: Discussionmentioning

confidence: 61%

“…Based on our previous study, the cumulative incidence of lung cancer in patients with idiopathic pulmonary fibrosis is 3.3% after 1 year and 15.4% after 5 years [ 15 ], and it is not rare to find preexisting ILD (pre-ILD) in patients with lung cancer. Several studies previously revealed that the presence of pre-ILD is a significant risk factor for severe radiation pneumonitis [ 4 , 11 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. However, most of these studies defined radiation pneumonitis as a shadow restricted to the irradiated area or did not refer to the extent of radiological findings.…”

Section: Introductionmentioning

confidence: 99%

Impact of Preexisting Interstitial Lung Disease on Acute, Extensive Radiation Pneumonitis: Retrospective Analysis of Patients with Lung Cancer

et al. 2015

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IntroductionThis study investigated the clinical characteristics and predictive factors for developing acute extended radiation pneumonitis with a focus on the presence and radiological characteristics of preexisting interstitial lung disease.MethodsOf 1429 irradiations for lung cancer from May 2006 to August 2013, we reviewed 651 irradiations involving the lung field. The presence, compatibility with usual interstitial pneumonia, and occupying area of preexisting interstitial lung disease were retrospectively evaluated by pretreatment computed tomography. Cases of non-infectious, non-cardiogenic, acute respiratory failure with an extended bilateral shadow developing within 30 days after the last irradiation were defined as acute extended radiation pneumonitis.ResultsNine (1.4%) patients developed acute extended radiation pneumonitis a mean of 6.7 days after the last irradiation. Although preexisting interstitial lung disease was found in 13% of patients (84 patients), 78% of patients (7 patients) with acute extended radiation pneumonitis cases had preexisting interstitial lung disease, which resulted in incidences of acute extended radiation pneumonitis of 0.35 and 8.3% in patients without and with preexisting interstitial lung disease, respectively. Multivariate logistic analysis indicated that the presence of preexisting interstitial lung disease (odds ratio = 22.6; 95% confidence interval = 5.29–155; p < 0.001) and performance status (≥2; odds ratio = 4.22; 95% confidence interval = 1.06–20.8; p = 0.049) were significant predictive factors. Further analysis of the 84 patients with preexisting interstitial lung disease revealed that involvement of more than 10% of the lung field was the only independent predictive factor associated with the risk of acute extended radiation pneumonitis (odds ratio = 6.14; 95% confidence interval = 1.0–37.4); p = 0.038).ConclusionsPretreatment computed tomography evaluations of the presence of and area size occupied by preexisting interstitial lung disease should be assessed for safer irradiation of areas involving the lung field.

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Acute radiation pneumonitis after conformational radiotherapy for nonsmall cell lung cancer: Clinical, dosimetric, and associated-treatment risk factors

Abstract: ARP is a common acute complication, requiring close posttreatment follow-up, particularly for elderly patients. The use of gemcitabine before radiation should be avoided. The benefits and risks of CTR must be carefully analyzed, according to the dosimetric parameters.

Cited by 26 publications

References 28 publications

Effect of 23-Valent Pneumococcal Polysaccharide Vaccine Inoculated During Anti-Cancer Treatment Period in Elderly Lung Cancer Patients on Community-Acquired Pneumonia Hospitalization

Effect of 23-Valent Pneumococcal Polysaccharide Vaccine Inoculated During Anti-Cancer Treatment Period in Elderly Lung Cancer Patients on Community-Acquired Pneumonia Hospitalization

Nondosimetric Risk Factors for Radiation-Induced Lung Toxicity

Impact of Preexisting Interstitial Lung Disease on Acute, Extensive Radiation Pneumonitis: Retrospective Analysis of Patients with Lung Cancer

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