Patterns of CT lung injury and toxicity after stereotactic radiotherapy delivered with helical tomotherapy in early stage medically inoperable NSCLC

Arcangeli, Stefano; Agolli, Linda; Portalone, Luigi; Mr, Migliorino; Mg, Lopergolo; Monaco, Angelo; Dognini, J.; Mc, Pressello; Bracci, Stefano; Donato,

doi:10.1259/bjr.20140728

Cited by 12 publications

(12 citation statements)

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“…Indeed, we could not observe specific CT signs at either early or average time points, as in 2/3 of the patients no changes were documented in both settings ( Table 2). These findings replicate those obtained from a smaller series by the use of the same technique 31 and are in agreement with a similar study that investigated radiological changes in 45 patients (52 tumours) treated with non-HT-SABR. 32 Our study, however, has several limitations: as a matter of fact, only half of the patients received a prescription dose which is consistent with recommended guidelines supporting a BED 10 used for SABR treatment of at least 100 Gy.…”

Section: Discussionsupporting

confidence: 91%

“…In contrast to some other series employing HT in either a conventional or a hypofractionated schedule for primary and metastatic lung tumours, where cutoff values for ipsilateral 29 and contralateral percentage of lung volume receiving 5 Gy 11,30 have been proposed, these findings confirm our previous experience with HHT on a limited cohort of patients with early-stage NSCLC. 31 Fourth, we provided a detailed radiological description of lung appearances after HHT and concluded that a specific pattern of lung injury was not associated with this technique. Indeed, we could not observe specific CT signs at either early or average time points, as in 2/3 of the patients no changes were documented in both settings ( Table 2).…”

Section: Discussionmentioning

confidence: 99%

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Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

Arcangeli

Falcinelli²,

Bracci

et al. 2017

The British Journal of Radiology

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Cite this article as: Arcangeli S, Falcinelli L, Bracci S, Greco A, Monaco A, Dognini J, et al. Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours. Objective: To evaluate treatment outcomes and patterns of CT lung injury after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) in a series of inoperable lung lesions. Methods: 68 patients who were medically inoperable (69 lesions) without evidence of viable extrathoracic disease were included. Dose prescription was driven by tumour location (hilar/pericentral vs peripheral) and/or target volume.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

Arcangeli

Falcinelli²,

Bracci

et al. 2017

The British Journal of Radiology

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“…Helical-mode tomotherapy delivers low-dose exposure of almost the entire lung volume at target area level. Several authors reported helical tomotherapy is safe and not associated with a specific pattern of lung injury [ 22 ]. Donato et al assessed the toxicities of hypofractionated radiation course delivered with helical tomotherapy, and they reported acute grade 3 treatment-related pneumonitis was detected in 10 % of patients.…”

Section: Discussionmentioning

confidence: 99%

Risk of radiation-induced pneumonitis after helical and static-port tomotherapy in lung cancer patients and experimental rats

et al. 2015

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BackgroundRadiotherapy (RT) is one of the major non-operative treatment modalities for treating lung cancer. Tomotherapy is an advanced type of intensity-modulated radiotherapy (IMRT) in which radiation may be delivered in a helical fashion. However, unexpected pneumonitis may occur in patients treated with tomotherapy, especially in combination with chemotherapy, as a result of extensive low-dose radiation of large lung volumes. The aim of our study was to investigate the risk of radiation-induced pneumonitis after helical-mode and static-mode tomotherapy in patients with lung cancer and in an animal model.MethodA total of 63 patients with primary lung cancer who were treated with static or helical tomotherapy with or without concurrent chemoradiotherapy (CCRT) were analyzed. Additionally, rats with radiation-induced pulmonary toxicity, which was induced by the application of helical or static tomography with or without CCRT, were evaluated.ResultsHelical-mode tomotherapy resulted in a significantly higher rate of late radiation pneumonitis in lung cancer patients than static-mode tomotherapy when evaluated by the Radiation Therapy Oncology Group (RTOG) and National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) scoring system. In the animal model, helical tomotherapy alone induced significantly higher expression of interleukin (IL)-1α, IL-1β, IL-6, and transforming growth factor (TGF)-β in lung specimens, especially on the untreated side, compared to static tomotherapy alone. Additionally, rats treated with helical tomotherapy and CCRT demonstrated significantly higher expression of inflammatory cytokines compared to those treated with static tomotherapy and CCRT.ConclusionRat models treated with tomotherapy with or without CCRT could present similar patterns of pulmonary toxicity to those shown in lung cancer patients. The models can be used in further investigations of radiation induced pulmonary toxicity.

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“…The primary endpoint was grade ≥2 RP. Early RP usually occurs 1-6 months after radiotherapy, whereas late lung fibrosis usually occurs 6-24 months after radiotherapy (9,20,21). Because we focused on early RP, we used 6 months as the cut-off for diagnosis.…”

Section: Evaluation Of Pulmonary Toxicity and Follow-upmentioning

confidence: 99%

Left Ventricular Systolic Dysfunction Is a Possible Independent Risk Factor of Radiation Pneumonitis in Locally Advanced Lung Cancer Patients

Cai

Liang

et al. 2020

Front. Oncol.

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Objectives: To assess the association between left ventricular (LV) systolic and diastolic dysfunction and grade ≥2 radiation pneumonitis (RP) for locally advanced lung cancer patients receiving definitive radiotherapy. Materials and Methods: A retrospective analysis was carried out for 260 lung cancer patients treated with definitive radiotherapy between 2015 and 2017. RP was evaluated according to Radiation Therapy Oncology Group (RTOG) toxicity criteria. Logistic regression analysis, 10-fold cross validation, and external validation were performed. The prediction model's discriminative performance was evaluated using the area under the receiver operating characteristic curve (AUC), and calibration of the model was assessed by the Hosmer-Lemeshow test and the calibration curve. Results: Within the first 6 months after radiotherapy, 70 patients (26.9%) developed grade ≥2 RP. Reduced left ventricular ejection fraction (LVEF) before radiotherapy was detected in 53 patients (20.4%). The odds ratio (OR) of developing RP for patients with LVEF <50% was 3.42 [p < 0.001, 95% confidence interval (CI), 1.85-6.32]. Multivariate analysis showed that forced expiratory volume in the first second/forced vital capacity (FEV1/FVC), LVEF, Eastern Cooperative Oncology Group (ECOG) performance status, chemotherapy, and mean lung dose (MLD) were significantly associated with grade ≥2 RP. The AUC of a model including the above five variables was 0.835 (95% CI, 0.778-0.891) on 10-fold cross validation and 0.742 (95% CI, 0.633-0.851) on the external validation set. The p-value for the Hosmer-Lemeshow test was 0.656 on 10-fold cross validation and 0.534 on the external validation set. Conclusion: LV systolic dysfunction is a possible independent risk factor for RP in locally advanced lung cancer patients receiving definitive radiotherapy.

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Patterns of CT lung injury and toxicity after stereotactic radiotherapy delivered with helical tomotherapy in early stage medically inoperable NSCLC

Abstract: Our study is among the few showing that HT-SBRT represents a safe and effective option in patients with early stage medically inoperable NSCLC, and that it is not associated with a specific pattern of lung injury.

Cited by 12 publications

References 50 publications

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

Risk of radiation-induced pneumonitis after helical and static-port tomotherapy in lung cancer patients and experimental rats

Left Ventricular Systolic Dysfunction Is a Possible Independent Risk Factor of Radiation Pneumonitis in Locally Advanced Lung Cancer Patients

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