Factors predicting severe radiation pneumonitis in patients receiving definitive chemoradiation for lung cancer

Robnett, Theodore J.; Machtay, Mitchell; Vinés, Eugenio; McKenna, Michael G.; Algazy, Kenneth M.; McKenna, W. Gillies

doi:10.1016/s0360-3016(00)00648-9

Cited by 272 publications

(177 citation statements)

References 22 publications

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“…It has been reported that a pre-existing pulmonary disease predisposes the patient to manifestation of RP (Robnett et al, 2000;Inoue et al, 2001). In our patients' sample, 10 patients suffered from COPD.…”

Section: Discussionmentioning

confidence: 99%

Suggestion for a New Grading Scale for Radiation Induced Pneumonitis Based on Radiological Findings of Computerized Tomography: Correlation with Clinical and Radiotherapeutic Parameters in Lung Cancer Patients

Kouloulias

Zygogianni²,

Efstathopoulos³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: The objective of this research is the computed axial tomography (CT) imaging grading of radiation induced pneumonitis (RP) and its correlation with clinical and radiotherapeutic parameters. Materials and Methods: The chest CT films of 20 patients with non-small cell lung cancer who have undergone threedimensional conformal radiation therapy were reviewed. The proposed CT grading of RP is supported on solely radiological diagnosis criteria and distinguishes five grades. The manifestation of RP was also correlated with any positive pre-existing chronic obstructive pulmonary disease (COPD) history, smoking history, the FEV1 value, and the dosimetric variable V20. Results: The CT grading of RP was as follows: 3 patients (15%) presented with ground glass opacity (grade 1), 9 patients (45%) were classified as grade 2, 7 patients (35%) presented with focal consolidation, with or without elements of fibrosis (grade 3), and only one patient (5%) presented with opacity with accompanying atelectasis and loss of pulmonary volume (grade 4). Both univariate and multivariate analysis revealed as prognostic factors for the radiological grading of RP the reduction of FEV1 and the V20 (P=0.026 and P=0.003, respectively). There was also a significant (P<0.001) correlation of radiological grading of RP with FEV1 and V20 (spearman rho 0.92 and 0.93, respectively). Conclusions: The high correlation of the proposed radiological grading with the FEV1 and the V20 is giving a satisfactory clinical validity. Although the proposed grading scale seems relevant to clinical practice, further studies are needed for the confirmation of its validity and reliability.

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Section: Discussionmentioning

confidence: 99%

Suggestion for a New Grading Scale for Radiation Induced Pneumonitis Based on Radiological Findings of Computerized Tomography: Correlation with Clinical and Radiotherapeutic Parameters in Lung Cancer Patients

Kouloulias

Zygogianni²,

Efstathopoulos³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…In particular, dosimetric parameters, such as the mean lung dose, have been most consistently linked with the risk of pneumonitis in many studies [2][3][4][5][6]8]. Furthermore, several studies suggest that patients with relatively poor pre-RT lung function are more likely to experience toxicity than are patients with better lung function [7,9,23,24].…”

Section: Discussionmentioning

confidence: 99%

“…We are uncertain why we achieve different results in this regard, and this is a topic of ongoing study. A number of other research groups also did not find different rates of pneumonitis based on tumor location [7,30,31]. The model tested in this study was DVHbased, which discards all spatial information.…”

Section: Discussionmentioning

confidence: 99%

“…Radiation (RT)-induced shortness of breath occurs in approximately 5-30% of patients receiving thoracic RT for lung cancer [1][2][3][4][5][6][7][8]. Despite the large number of patients receiving thoracic RT, there are currently no validated and standardized means of predicting an individual patient's the risk of developing pulmonary toxicity.…”

Section: Introductionmentioning

confidence: 99%

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Prospective assessment of dosimetric/physiologic-based models for predicting radiation pneumonitis

Koçak

Borst

Zeng

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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Purpose-Clinical and 3D dosimetric parameters are associated with symptomatic radiation pneumonitis rates in retrospective studies. Such parameters include: mean lung dose (MLD), radiation (RT) dose to perfused lung (via SPECT), and pre-RT lung function. Based on prior publications, we defined pre-RT criteria hypothesized to be predictive for later development of pneumonitis. We herein prospectively test the predictive abilities of these dosimetric/functional parameters on two cohorts of patients from Duke and the Netherlands Cancer Institute (NKI).Methods and Materials-For the Duke cohort, 55 eligible patients treated between 1999-2005 on a prospective IRB-approved study to monitor RT-induced lung injury were analyzed. A similar group of patients treated at the NKI between 1996-2002 were identified. Patients believed to be at high and low risk for pneumonitis were defined based on: a) MLD; b) OpRP (sum of predicted perfusion reduction based on regional dose response curve); and c) pre-RT DLCO. All doses reflected tissue density heterogeneity. The rates of grade ≥2 pneumonitis in the "presumed" high and low risk groups were compared using Fisher's exact test.Results-In the Duke group, pneumonitis rates in patients prospectively deemed to be at "high" vs. "low" risk are 7/20 and 9/35, respectively; p=0.33 one tailed Fisher's. Similarly, comparable rates for the NKI group are 4/21 and 6/44, respectively, p=0.41 one-tailed Fisher's. Conclusion-The prospective model is unable to accurately segregate patients into high vs. low risk groups. However, considered retrospectively, these data are consistent with prior studies suggesting that dosimetric (e.g. MLD) and functional (e.g. PFTs or SPECT) parameters are predictive Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errorsmaybe discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. for RT-induced pneumonitis. Additional work is needed to better identify, and prospectively assess, predictors of RT-induced lung injury. NIH Public Access

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“…Several of these clinical factors, such as gender (8,16,23,(36)(37)(38)(39)(40)(41)(42)(43), age (36)(37)(38)(39)(41)(42)(43)(44)(45)(46) and tobacco use (18,22,(36)(37)(38)45,47), may have an impact on RT-induced lung injury, and are not considered in our analysis. For the analysis of responders vs. non-responders, it is not possible to control for all of the clinical variables (such as rates of patients with SCLC, or early stage lesions) since the phenotype of responders and non-responders may be fundamentally different.…”

Section: Study Limitationsmentioning

confidence: 99%

The Impact of Induction Chemotherapy and the Associated Tumor Response on Subsequent Radiation-Related Changes in Lung Function and Tumor Response

Mao

Koçak

Zhou

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To assess the impact of induction chemotherapy, and associated tumor shrinkage, on the subsequent radiation-related changes in pulmonary function and tumor response.Methods and Materials-As part of a prospective IRB-approved study, 91 evaluable patients treated definitively with thoracic RT for unresectable lung cancer were analyzed. The rates of RTassociated pulmonary toxicity and tumor response were compared in the patients with and without pre-RT chemotherapy. In the patients receiving induction chemotherapy, the rates of RT-associated pulmonary toxicity and tumor response were compared in the patients with and without a response (modified RECIST criteria) to the pre-RT chemotherapy. Comparisons of the rates of improvements in PFTs post-RT, dyspnea requiring steroids, and percent declines in PFTs post-RT were compared in patient subgroups using Fisher's exact test, analysis of variance, and linear or logistic regression.Results and conclusion-The use of pre-RT chemotherapy appears to increase the rate of radiation-induced pneumonitis (p=0.07-0.01), but has no consistent impact on changes in PFTs. The degree of induction-chemotherapy-associated tumor shrinkage is not associated with the rate of subsequent-RT-associated pulmonary toxicity. The degree of tumor response to chemotherapy is not related to the degree of tumor response to RT. Additional study is needed to better clarify this issue.

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Factors predicting severe radiation pneumonitis in patients receiving definitive chemoradiation for lung cancer

Cited by 272 publications

References 22 publications

Suggestion for a New Grading Scale for Radiation Induced Pneumonitis Based on Radiological Findings of Computerized Tomography: Correlation with Clinical and Radiotherapeutic Parameters in Lung Cancer Patients

Suggestion for a New Grading Scale for Radiation Induced Pneumonitis Based on Radiological Findings of Computerized Tomography: Correlation with Clinical and Radiotherapeutic Parameters in Lung Cancer Patients

Prospective assessment of dosimetric/physiologic-based models for predicting radiation pneumonitis

The Impact of Induction Chemotherapy and the Associated Tumor Response on Subsequent Radiation-Related Changes in Lung Function and Tumor Response

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