Exhaled nitric oxide predicts radiation pneumonitis in esophageal and lung cancer patients receiving thoracic radiation

McCurdy, Matthew R.; Wazni, Mohamad W.; Martínez, José Luis Zunzunegui; McAleer, Mary Frances; Guerrero, Thomas

doi:10.1016/j.radonc.2011.08.035

Cited by 19 publications

(19 citation statements)

References 52 publications

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“…Our previous study demonstrated that irradiation itself does not increase the iNOS mRNA levels in vitro ; however, it enhances the expression of iNOS in the presence of cytokines [tumor necrosis factor α and interleukin (IL)-6] (16,19). Additionally, the progression of RP can be reduced by treatment with an iNOS inhibitor (16,20). …”

Section: Discussionmentioning

confidence: 99%

“…A total of 3/5 of these patients developed RP requiring steroid medication (6). McCurdy et al (20) and Guerrero et al (21) examined 28 patients with esophageal cancer and identified that a 1.5-fold increase in eNO exhibited 100% sensitivity and specificity for the prediction of RP (18,20). In another study by the same group, the ratio of eNO (the level at the end of RT/pre-RT level) was calculated for 50 lung or esophageal cancer patients.…”

Section: Discussionmentioning

confidence: 99%

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Measurement of exhaled nitric oxide and serum surfactant protein D levels for monitoring radiation pneumonitis following thoracic radiotherapy

et al. 2017

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The present study aimed to examine the role of exhaled nitric oxide (eNO) and serum surfactant protein D (SP-D) level in the determination of radiation pneumonitis (RP) after thoracic radiotherapy (RT). The study included 34 treatments for 33 patients, including 16 three-dimensional conformal and 18 stereotactic body RT treatments. eNO levels were measured prior to RT, immediately subsequent to RT, every week during the RT course and at 1, 3, 6, 9 and 12 months following the treatment. The therapy reduced the eNO from 24.3±12.8 ppb prior to RT to 19.0±10.4 ppb immediately subsequent to RT (P=0.04). A total of 5 patients (14%) developed symptomatic RP of grade 2 or higher 3–5 months later, and exhibited an eNO elevation of 2.1±0.68-fold the minimum value, whereas the RP- group exhibited 1.4±0.6-fold elevation (P=0.02). The sensitivity of a cut-off of a 1.4-fold increase in the eNO ratio at the onset of RP was 100%; however, the specificity was 52%, and no predictive alterations to eNO levels were observed prior to the onset of RP. RT was associated with an elevated serum SP-D level at 3–6 months after RT. There was a statistically significant difference in the initial serum SP-D level between RP+ and RP- patients. In conclusion, obtaining the eNO ratio was a useful RP monitoring tool but did not predict RP occurrence in the present setting, whereas serum SP-D level may be a potential predictor for the detection of RP risk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Measurement of exhaled nitric oxide and serum surfactant protein D levels for monitoring radiation pneumonitis following thoracic radiotherapy

et al. 2017

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“…McCurdy et al [28] studied the ability of eNO to predict SRP in 60 patients with esophageal cancer or lung cancer. The results were similar to this study.…”

Section: Discussionmentioning

confidence: 99%

Exhaled Nitric Oxide Is Useful in Symptomatic Radioactive Pneumonia: A Retrospective Study

Fei

2017

Mediators of Inflammation

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The aim was to defect the exhaled nitric oxide (eNO) prediction value of symptomatic radioactive pneumonia (SRP). 64 cases of lung cancer or esophagus cancer, who had the primary radiotherapy (intensity-modulated radiation therapy), were included from 2015 June to 2016 January. During the following, the patients were divided: the symptomatic radiation pneumonia group (SRP, with the CTCAE v4.0 score > 2) and the asymptomatic radiation pneumonia group (ASRP, with CTCAE v4.0 score ≤ 1). All the patients were measured eNO before and at the end of thoracic radiotherapy and gain the posttherapy eNO value and the eNO ratio (posttherapy eNO value/pretherapy eNO value), then the predictive values of eNO toward SRP were measured using the receiver-operating characteristic (ROC). 17 cases were included in the SRP group and the other 47 were included in the ASRP group. The posttherapy eNO was 29.35 (19~60) bbp versus 20.646 (11~37) (P < 0 001), and the ratio was 1.669 (0.61~3.5) versus 0.920 (0.35~1.5) (P < 0 01) (symptomatic versus asymptomatic). ROC showed that the cutoff value of SRP was 19.5 bbp (posttherapy eNO, area under concentration-time curve (AUC) = 0.879) and 1.305 (eNO ratio, AUC = 0.774), which meant that posttherapy eNO and eNO ratio were useful in finding SRP.

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“…In lungs, ALC pretreatment decrease oxidative stress early after irradiation [33], which, according to our results, seems to improve clinical prognosis 7 weeks after irradiation and seems to reduce the intensity of post-radiation changes during an initial phase of radiation pneumonitis on a microscopic level (Fig 3, 4). In humans, radiation pneumonitis has been associated with increased exhalation of NO [7]. Moreover, the elevation of eNO on the last day of radiotherapy predicts subsequent symptomatic radiation pneumonitis weeks to months after treatment [7].…”

Section: Discussionmentioning

confidence: 99%

“…In humans, radiation pneumonitis has been associated with increased exhalation of NO [7]. Moreover, the elevation of eNO on the last day of radiotherapy predicts subsequent symptomatic radiation pneumonitis weeks to months after treatment [7]. The SPF Wistar rat model appears to be different.…”

Section: Discussionmentioning

confidence: 99%

Effect of Acetyl-L-Carnitine Pretreatment on Radiation Pneumonitis and L-Arginine-No Metabolic Pathway

Babicová¹,

Pejchal²,

Havlínová³

et al. 2012

Mil. Med. Sci. Lett.

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SummaryPurpose: The purpose of our study is to examine the effect of acetyl-L-carnitine (ALC) pretreatment on radiation pneumonitis and L-arginine-nitric oxide (NO) metabolic pathway after local chest irradiation. Materials and methods: Female Wistar rats were pretreated with either phosphate buffer saline or ALC and locally irradiated by a dose of 15 Gy onto the chest. Samples were collected 7 weeks after irradiation. Exhaled NO was monitored using chemiluminiscence method. In plasma and bronchoalveolar lavage (BAL) fluid, nitrite/nitrate (NO x ) and malondialdehyde were measured by high-performance liquid chromatography. Total protein concentration was assayed colorimetrically. In lungs, inducible and endothelial nitric oxide synthase (iNOS, eNOS), arginase (Arg) I and II, cationic amino acid transporter (CAT) 1, 2 and 3 relative mRNA expression were measured by RT-PCR. Expression of Arg I and II was also evaluated by Western blot. Histochemical analysis was used to measure air/tissue ratio and neutrophil infiltration. Results: ALC pretreatment increased survival rate of irradiated rats. It also decreased NO x concentration in BAL, while in lungs, we observed increased air/tissue ratio, reduced neutrophil infiltration, decreased CAT 1 and CAT 3 mRNA expression, and reduced Arg I and Arg II expression. Conclusions: ALC pretreatment improves clinical prognosis and seems to reduce intensity of post-radiation changes on a molecular and microscopic level.

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Exhaled nitric oxide predicts radiation pneumonitis in esophageal and lung cancer patients receiving thoracic radiation

Cited by 19 publications

References 52 publications

Measurement of exhaled nitric oxide and serum surfactant protein D levels for monitoring radiation pneumonitis following thoracic radiotherapy

Measurement of exhaled nitric oxide and serum surfactant protein D levels for monitoring radiation pneumonitis following thoracic radiotherapy

Exhaled Nitric Oxide Is Useful in Symptomatic Radioactive Pneumonia: A Retrospective Study

Effect of Acetyl-L-Carnitine Pretreatment on Radiation Pneumonitis and L-Arginine-No Metabolic Pathway

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