Fractional exhaled nitric oxide as a potential biomarker for radiation pneumonitis in patients with non-small cell lung cancer: A pilot study

Szejniuk, Weronika Maria; Nielsen, Martin Skovmos; Brønnum, Dorthe; Takács-Szabó, Zsuzsanna; Weinreich, Ulla Møller; Thomsen, Lars Pilegaard; Bøgsted, Martin; Jensen, I.; McCulloch, Tine; Falkmer, Sture; Carl, Jesper; Røe, Oluf Dimitri

doi:10.1016/j.ctro.2019.09.004

Cited by 6 publications

(9 citation statements)

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Section: Discussionmentioning

confidence: 54%

“…During the past several decades, many researchers carried out a series of studies try to clarify the relationship between NO and lung cancer. These studies were mainly about comparisons of the levels of FeNO and blood NO between lung cancer patients and healthy controls , among lung cancer patients with different stages [7-9, 14, 17-21, 23, 27, 29, 31, 34, 36-39, 42] or types [6, 8, 9, 18-21, 24, 26, 27, 29, 31, 37-39, 42], and variations of these indexes from pretreatment to posttreatment [7,10,14,19,21,29,32,34,36,38,39,43,[46][47][48][49][50][51][52][53][54][55]. However, the results were not consistent among different studies, which might be due to ethnicity, age, pathological type, cancer stage, treatment regimen and follow up period.…”

Section: Introductionmentioning

confidence: 99%

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Nitric Oxide in Occurrence, Progress and Therapy of Lung Cancer: A Systemic Review and Meta-analysis

Zhou

Chen

et al. 2021

Preprint

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Background: Nitric oxide (NO) plays an important role in lung cancer. However, the results of previous studies about NO in the occurrence, progress and therapy were not consistent. Therefore, we conducted a meta-analysis to evaluate the relationship between NO and lung cancer.Method: We carried out comprehensive search in the databases, and collected related studies. The data of fraction of exhaled nitric oxide (FeNO) or blood NO in different populations (lung cancer patients and control subjects) and different time points (before therapy and after therapy) were extracted by two investigators. A random effect model was applied to analyze the differences of FeNO and blood NO in different populations and different time points. To further compare NO level of each subgroup with different pathological types and different stages, a network meta-analysis (NMA) was performed.Results: 50 studies including 2551 cases and 1691 controls were adopted in this meta-analysis. The FeNO (SMD 3.01, 95% CI 1.89-4.13, p < 0.00001) and blood NO (SMD 1.34, 95% CI 0.84-1.85, p < 0.00001) level in lung cancer patients was much higher than that in control subjects. NMA model indicated blood NO level in each cancer type except SCLC was higher than that in control patients. There was no significant difference of blood NO level among four kinds of lung cancer patients. Blood NO level in LCC patients (SUCRA=83.5%) was the highest. Blood NO level in advanced stage but not early stage was higher than that in control subjects. Patients in advanced stage (SUCRA=95.5%) had the highest blood NO level. No significant difference of FeNO (SMD -0.04, 95% CI -0.46-0.38, p > 0.05) and blood NO level (SMD -0.36, 95% CI -1.08-0.36, p > 0.05) was observed between pretreatment and posttreatment in all patients. However, FeNO level elevated (SMD 0.28, 95% CI 0.04-0.51, p = 0.02) and blood NO level decreased in NSCLC patients (SMD -0.95, 95% CI -1.89-0.00, p = 0.05) after therapy. Conclusion: FeNO and blood NO level would contribute to diagnosis of lung cancer and evaluation of therapy effect, especially for NSCLC patients.

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Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Nitric Oxide in Occurrence, Progress and Therapy of Lung Cancer: A Systemic Review and Meta-analysis

Zhou

Chen

et al. 2021

Preprint

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“…So, it was necessary to detect both FeNO and blood NO levels in the same study to prevent the disturbance of therapy regimens. Another point that could not be overlooked was that there was great gap of follow up periods among different studies, from 2 days to more than 2 years [ 7 , 10 , 14 , 46 , 47 , 52 ]. Our results showed that FeNO level increased in long-term follow up subgroup but not in short-term follow up subgroup, while follow up period seemed not affect the pooled results of blood NO.…”

Section: Discussionmentioning

confidence: 99%

Nitric oxide in occurrence, progress and therapy of lung Cancer: a systemic review and meta-analysis

Zhou

Li²,

Chen

et al. 2021

BMC Cancer

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Background Nitric oxide (NO) plays an important role in lung cancer. However, the results of previous studies about NO in the occurrence, progress and therapy were not consistent. Therefore, we conducted a meta-analysis to evaluate the relationship between NO and lung cancer. Method We carried out comprehensive search in the databases, and collected related studies. The data of fraction of exhaled nitric oxide (FeNO) or blood NO in different populations (lung cancer patients and control subjects) and different time points (before therapy and after therapy) were extracted by two investigators. A random effect model was applied to analyze the differences of FeNO and blood NO in different populations and different time points. To further compare NO level of each subgroup with different pathological types and different stages, a network meta-analysis (NMA) was performed. Results Fifty studies including 2551 cases and 1691 controls were adopted in this meta-analysis. The FeNO (SMD 3.01, 95% CI 1.89–4.13, p < 0.00001) and blood NO (SMD 1.34, 95% CI 0.84–1.85, p < 0.00001) level in lung cancer patients was much higher than that in control subjects. NMA model indicated blood NO level in each cancer type except SCLC was higher than that in control patients. There was no significant difference of blood NO level among four kinds of lung cancer patients. Blood NO level in LCC patients (SUCRA = 83.5%) was the highest. Blood NO level in advanced stage but not early stage was higher than that in control subjects. Patients in advanced stage (SUCRA = 95.5%) had the highest blood NO level. No significant difference of FeNO (SMD -0.04, 95% CI -0.46-0.38, p > 0.05) and blood NO level (SMD -0.36, 95% CI -1.08-0.36, p > 0.05) was observed between pretreatment and posttreatment in all patients. However, FeNO level elevated (SMD 0.28, 95% CI 0.04–0.51, p = 0.02) and blood NO level decreased in NSCLC patients (SMD -0.95, 95% CI -1.89-0.00, p = 0.05) after therapy. Conclusion FeNO and blood NO level would contribute to diagnosis of lung cancer and evaluation of therapy effect, especially for NSCLC patients.

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“…The clinical manifestations of RILI range from mild pulmonary symptoms to severe radiation pneumonitis (RP) [1]. Clinical RP of all grades is seen in 8-57% of cases, usually occurring 4-12 weeks after RT, and typically requires steroid treatment for several weeks [1,2,6,7]. Severe RP is observed in 6-8% of cases [2,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…Currently, there is insufficient information to enable the prediction of RP development and no radiological scales that assess the risk of RP based on grading of RILI are available [1,2,6,7,[13][14][15]. There are several tools to grade lung toxicity based on clinical and radiological data, such as the Radiation Therapy Oncology Group / European Organization for Research and Treatment of Cancer (RTOG/EORTC) [16], the Common Terminology Criteria for Adverse Events (CTCAE) [17], or the Southwest Oncology Group (SWOG) scoring system [18].…”

Section: Introductionmentioning

confidence: 99%

High-dose thoracic radiation therapy for non-small cell lung cancer: a novel grading scale of radiation-induced lung injury for symptomatic radiation pneumonitis

et al. 2021

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Background Symptomatic radiation pneumonitis (RP) may be a serious complication after thoracic radiation therapy (RT) for non-small cell lung cancer (NSCLC). This prospective observational study sought to evaluate the utility of a novel radiation-induced lung injury (RILI) grading scale (RGS) for the prediction of RP. Materials and methods Data of 41 patients with NSCLC treated with thoracic RT of 60–66 Gy were analysed. CT scans were scheduled before RT, one month post-RT, and every three months thereafter for one year. Symptomatic RP was defined as Common Terminology Criteria for Adverse Events grade ≥ 2. RGS grading ranged from 0 to 3. The inter-observer variability of the RGS was assessed by four senior radiologists. CT scans performed 28 ± 10 days after RT were used to analyse the predictive value of the RGS. The change in the RGS severity was correlated to dosimetric parameters. Results The CT obtained one month post-RT showed RILI in 36 (88%) of patients (RGS grade 0 [5 patients], 1 [25 patients], 2 [6 patients], and 3 [5 patients]). The inter-observer agreement of the RGS grading was high (Kendall’s W coefficient of concordance = 0.80, p < 0.01). Patients with RGS grades 2–3 had a significantly higher risk for development of RP (relative risk (RR): 2.4, 95% CI 1.6–3.7, p < 0.01) and RP symptoms within 8 weeks after RT (RR: 4.8, 95% CI 1.3–17.6, p < 0.01) compared to RGS grades 0–1. The specificity and sensitivity of the RGS grades 2–3 in predicting symptomatic RP was 100% (95% CI 80.5–100%) and 45.4% (95% CI 24.4–67.8%), respectively. Increase in RGS severity correlated to mean lung dose and the percentage of the total lung volume receiving 5 Gy. Conclusions The RGS is a simple radiologic tool associated with symptomatic RP. A validation study is warranted.

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Fractional exhaled nitric oxide as a potential biomarker for radiation pneumonitis in patients with non-small cell lung cancer: A pilot study

Abstract: HighlightsWeekly FeNO during radiotherapy can be useful in predicting radiation pneumonitis.6 months of clinical follow-up is necessary to detect delayed radiation pneumonitis.Pulmonary function tests are not predictable for radiation pneumonitis.

Cited by 6 publications

References 40 publications

Nitric Oxide in Occurrence, Progress and Therapy of Lung Cancer: A Systemic Review and Meta-analysis

Nitric Oxide in Occurrence, Progress and Therapy of Lung Cancer: A Systemic Review and Meta-analysis

Nitric oxide in occurrence, progress and therapy of lung Cancer: a systemic review and meta-analysis

High-dose thoracic radiation therapy for non-small cell lung cancer: a novel grading scale of radiation-induced lung injury for symptomatic radiation pneumonitis

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Fractional exhaled nitric oxide as a potential biomarker for radiation pneumonitis in patients with non-small cell lung cancer: A pilot study

Abstract: HighlightsWeekly FeNO during radiotherapy can be useful in predicting radiation pneumonitis.6 months of clinical follow-up is necessary to detect delayed radiation pneumonitis.Pulmonary function tests are not predictable for radiation pneumonitis.

Cited by 6 publications

References 40 publications

Nitric Oxide in Occurrence, Progress and Therapy of Lung Cancer: A Systemic Review and Meta-analysis

Nitric Oxide in Occurrence, Progress and Therapy of Lung Cancer: A Systemic Review and Meta-analysis

Nitric oxide in occurrence, progress and therapy of lung Cancer: a systemic review and meta-analysis

High-dose thoracic radiation therapy for non-small cell lung cancer: a novel grading scale of radiation-induced lung injury for symptomatic radiation pneumonitis

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Product

Resources

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Abstract: HighlightsWeekly FeNO during radiotherapy can be useful in predicting radiation pneumonitis.6 months of clinical follow-up is necessary to detect delayed radiation pneumonitis.Pulmonary function tests are not predictable for radiation pneumonitis.