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

Abstract

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.

Systemic Sclerosis Associated Interstitial Lung Disease: A Comprehensive Overview

“…164 Both chemotherapy and thoracic surgery can cause an acute exacerbation in ILD patients 167,168 and radiotherapy is associated with the risk of radiation pneumonitis. 164,169 The infectious complications of chemotherapy can also be challenging in patients who have required immunosuppression for their lung disease. Individualized diagnostic and management pathways are necessary for SSc-ILD patients who develop suspected/proven malignancy, with a patient-centered approach.…”

Stereotactic body radiotherapy for second primary lung cancer and intra-parenchymal lung metastasis in patients previously treated with surgery: evaluation of indications and predictors of decreased respiratory function

“…The two patients with grade 5 PF were diagnosed with mild IP on diagnostic imaging. Ozawa et al investigated the clinical characteristics and predictive factors for developing acute extended RP with a focus on the presence and radiological characteristics of preexisting IP, and concluded that the presence of preexisting IP on the CT scan before radiotherapy was a significant predictive factor (odds ratio ¼ 22.6; 95% confidence interval: 5.29-155; p < .001) [24]. Lee et al reported that the interstitial changes in the pre-RT chest CT scan (p ¼ .009), mean lung dose (p < .001), and the percentage of lung volume receiving over 30 Gy (V30) (p < .001) significantly predicted RP on multivariate analysis.…”

Radiotherapy of Lung Tumours in Idiopathic Pulmonary Fibrosis

“…V různých studiích byl výskyt PP všech stupňů popsán až u 73 % ozářených nemocných s mediánem odstupu od SBRT 1,9 měsíce. Výskyt PP stupně 3 byl v 5, 3 % a byl častější, pokud se PP objevila do 1 měsíce od SBRT [8,9]. V jiné studii měl výskyt symptomatické PP medián 5 měsíců [10].…”

“…SBRT u IPF je i nadále považovaná za kontroverzní a v japonské prospektivní studii JCOG 0403 byla prokázaná IPF považovaná za relativní kontraindikaci SBRT [15]. Jsou popsány také případy vzniku závažné exacerbace subklinické IPF po SBRT při minimálních známkách předchozího intersticiálního postižení [9]. PP stupně 2 byla popsána až v 50 % případů u nemocných po SBRT, pokud byly před radioterapií prokázány jakékoli intersticiální změny na CT plic [16].…”