Incidence and Risk Factors of Symptomatic Radiation Pneumonitis in Non–Small-Cell Lung Cancer Patients Treated with Concurrent Chemoradiotherapy and Consolidation Durvalumab

Satō, Takashi; Kishi, Noriko; Matsuo, Yukinori; Ogura, Masakazu; Mitsuyoshi, Takamasa; Araki, Norio; Fujii, Kimio; Okumura, Shun; Nakamatsu, Kiyoshi; Kishi, Takahiro; Atsuta, Tomoko; Sakamoto, Takashi; Narabayashi, Masaru; Ishida, Yuichi; Sakamoto, Masato; Fujishiro, S.; Katagiri, Toshimasa; Kim, Young Hak

doi:10.1016/j.cllc.2021.01.017

Cited by 27 publications

(41 citation statements)

References 33 publications

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“…Consistently, our results also indicated that V20 was an independent risk factor for occurrence of symptomatic pneumonitis (OR 3.49 p = 0.007; V20 ≥ 16.7% vs. V20 < 16.7%, 67.44% vs. 36.73%). Notably, the cut‐off value of V20 in our analysis was lower than those established in previous studies with range of 20%–35% 15,16,34‐38 . We speculated that this was possibly due to the predisposition of symptomatic pneumonitis in patients receiving TRT after PD‐(L)1 inhibitor treatment, which alerted radiation oncologists to delineate target plan carefully to control total lung V20 in order to minimize the incidence of pneumonitis when chose this sequential regimen.…”

Section: Discussioncontrasting

confidence: 53%

“…The total lung V20 is a crucial and the most frequently described dosimetric parameter generally used to define a specific threshold dose to predict the occurrence of radiation pneumonitis 15,16,34‐38 . For example, Palma et al performed a meta‐analysis of 836 patients with lung cancer who underwent concurrent chemoradiotherapy and evaluated the association between V20 and symptomatic pneumonitis 15 .…”

Section: Discussionmentioning

confidence: 99%

“…The total lung V20 is a crucial and the most frequently described dosimetric parameter generally used to define a specific threshold dose to predict the occurrence of radiation pneumonitis. 15,16,[34][35][36][37][38] cancer who underwent concurrent chemoradiotherapy and evaluated the association between V20 and symptomatic pneumonitis. 15 The results showed that V20 = 25% was an optimal cut-off value to differentiate patients with high risk for development of symptomatic pneumonitis (OR 1.03, p = 0.008).…”

Section: Discussionmentioning

confidence: 99%

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Safety of thoracic radiotherapy after PD‐(L)1 inhibitor treatment in patients with lung cancer

et al. 2021

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

“…The total lung V20 is a crucial and the most frequently described dosimetric parameter generally used to define a specific threshold dose to predict the occurrence of radiation pneumonitis. 15,16,[34][35][36][37][38] cancer who underwent concurrent chemoradiotherapy and evaluated the association between V20 and symptomatic pneumonitis. 15 The results showed that V20 = 25% was an optimal cut-off value to differentiate patients with high risk for development of symptomatic pneumonitis (OR 1.03, p = 0.008).…”

Section: Discussionmentioning

confidence: 99%

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Safety of thoracic radiotherapy after PD‐(L)1 inhibitor treatment in patients with lung cancer

et al. 2021

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“…In a recent trial with stage III NSCLC patients who qualified for durvalumab consolidation, the incidence of G3+ pneumonitis was 7% (34% for G2+) [ 6 ]. Similarly, Hu et al [ 7 ] reported G3+ RIP in 1% of patients and Shintani et al [ 8 ] 5% for G3+ (35% for G2+). Late RILF is less frequently reported, and for IMRT is around 30% (G1 and single cases of G3+) [ 7 ].…”

Section: Introductionmentioning

confidence: 83%

Normal Lung Tissue CT Density Changes after Volumetric-Arc Radiotherapy (VMAT) for Lung Cancer

Konkol

Bryl

Fechner³

et al. 2022

JPM

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Radiation-induced lung injury remains a significant toxicity in thoracic radiotherapy. Because a precise diagnosis is difficult and commonly used assessment scales are unclear and subjective, there is a need to establish quantitative and sensitive grading methods. The lung tissue density change expressed in Hounsfield units (HUs) derived from CT scans seems a useful numeric surrogate. The study aimed to confirm a dose-response effect on HU value changes (ΔHU), their evolution in time, and the impact of selected clinical and demographic factors. We used dedicated, self-developed software to register and analyze 120 pairs of initial and follow-up CT scans of 47 lung cancer patients treated with dynamic arc radiotherapy. The differences in HU values between CT scans were calculated within discretized dose-bins limited by isodose lines. We have proved the dose-effect relationship, which is well described with a sigmoid model. We found the time evolution of HU changes to suit a typical clinical presentation of radiation-induced toxicity. Some clinical factors were found to correlate with ΔHU degree: planning target volume (PTV), V35 in the lung, patient’s age and a history of arterial hypertension, and initial lung ventilation intensity. Lung density change assessment turned out to be a sensitive and valuable method of grading post-RT lung toxicity.

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“…At the same time, if the patient has diabetes, smoking, COPD, concurrent chemotherapy, and radiotherapy, the total dose should be optimized and preventive measures should be taken to reduce the occurrence of RILI [41]. Previous studies [42,43] have shown that complications such as chronic obstructive pulmonary disease and ventilatory dysfunction caused by smoking can increase the risk of lung injury. It is recommended that the lung diffusion function be tested before radiotherapy to evaluate the status of lung function.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for radiation-induced lung injury in patients with advanced non-small cell lung cancer: implication for treatment strategies

et al. 2021

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Background The radiation-induced lung injury (RILI) in patients with advanced non-small cell lung cancer (NSCLS) is very common in clinical settings; we aimed to evaluate the risk factors of RILI in NSCLS patients, to provide insights into the treatment of NSCLS. Methods NSCLC patients undergoing three-dimensional conformal radiotherapy (3D-CRT) in our hospital from June 1, 2018, to June 30, 2020, were included. The characteristics and treatments of RILI and non-RILI patients were analyzed. Logistic regression analyses were conducted to assess the risk factors of RILI in patients with NSCLC. Results A total of 126 NSCLC patients were included; the incidence of RILI in NSCLC patients was 35.71%. There were significant differences in diabetes, smoke, chronic obstructive pulmonary disease (COPD), concurrent chemotherapy, radiotherapy dose, and planning target volume (PTV) between the RILI group and the non-RILI group (all P < 0.05). Logistic regression analyses indicated that diabetes (OR 3.076, 95%CI 1.442~5.304), smoke (OR 2.745, 95%CI 1.288~4.613), COPD (OR 3.949, 95%CI 1.067~5.733), concurrent chemotherapy (OR 2.072, 95%CI 1.121~3.498), radiotherapy dose ≥ 60 Gy (OR 3.841, 95%CI 1.932~5.362), and PTV ≥ 396 (OR 1.247, 95%CI 1.107~1.746) were the independent risk factors of RILI in patients with NSCLC (all P < 0.05). Conclusions RILI is commonly seen in NSCLS patients; early targeted measures are warranted for patients with those risk factors; future studies with larger sample sizes and different areas are needed to further elucidate the influencing factors of RILI in the treatment of NSCLS.

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Incidence and Risk Factors of Symptomatic Radiation Pneumonitis in Non–Small-Cell Lung Cancer Patients Treated with Concurrent Chemoradiotherapy and Consolidation Durvalumab

Cited by 27 publications

References 33 publications

Safety of thoracic radiotherapy after PD‐(L)1 inhibitor treatment in patients with lung cancer

Safety of thoracic radiotherapy after PD‐(L)1 inhibitor treatment in patients with lung cancer

Normal Lung Tissue CT Density Changes after Volumetric-Arc Radiotherapy (VMAT) for Lung Cancer

Risk factors for radiation-induced lung injury in patients with advanced non-small cell lung cancer: implication for treatment strategies

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