Predicting risk factors for radiation pneumonitis after stereotactic body radiation therapy for primary or metastatic lung tumours

Okubo, Masaaki; Itonaga, Tomohiro; Sato, Tatsuhiko; Shiraishi, S.; Mikami, Ryuji; Nakayama, Hidetsugu; Sakurada, Akira; Sugahara, Shinji; Koizumi, Kiyoshi; Tokuuye, Koichi

doi:10.1259/bjr.20160508

Cited by 33 publications

(17 citation statements)

References 45 publications

(55 reference statements)

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“…It is true that symptomatic RILI is important, and many reports have emphasized the predicting factors of symptomatic RILI. However, the comorbidities of the patient, baseline respiratory function, subclinical interstitial lung disease, performance status or subjectivity of physicians can affect symptomatic complaints [ 10 – 15 ]. Thus, the radiological appearance of RILI is not always accompanied by clinical symptoms [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment and agreement of the CT appearance pattern and its severity grading of radiation-induced lung injury after stereotactic body radiotherapy for lung cancer

et al. 2018

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PurposeRadiographic severity of radiation-induced lung injury (RILI) has not been well-studied. The goal of this study was to assess the CT appearance pattern and severity of RILI without consideration of the clinical presentation.Material and methodsA total of 49 patients, 41 with primary lung cancer and 8 with metastatic lung cancer, were treated by 4-fraction stereotactic body radiotherapy (SBRT). RILI after SBRT was separately assessed by two observers. The early and late CT appearance patterns and CT-based severity grading were explored.ResultsThe median follow-up period was 39.0 months. In the early CT findings of observers 1 and 2, there was diffuse consolidation in 15 and 8, diffuse ground glass opacity (GGO) in 0 and 0, patchy consolidation and GGO in 17 and 20, patchy GGO in 3 and 3, and no changes in 10 and 14, respectively (kappa = 0.61). In late CT findings of observer 1 and 2, there were modified conventional pattern in 28 and 24, mass-like pattern in 8 and 11, scar-like pattern in 12 and 12, and no changes in 1 and 2, respectively (kappa = 0.63). In the results of the CT-based grading by observers 1 and 2, there were grade 0 in 1 and 2, grade 1 in 10 and 14, grade 2 in 31 and 29, grade 3 in 7 and 4, and none of grade 4 or more, respectively (kappa = 0.66). According to multivariate analyses (MVA), the significant predicting factors of grade 2 or more CT-based RILI were age (p = 0.01), oxygen dependence (p = 0.03) and interstitial shadow (p = 0.03).ConclusionsThe agreement of the CT appearance and CT-based grading between two observers was good. These indicators may be able to provide us with more objective information and a better understanding of RILI.

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Section: Introductionmentioning

confidence: 99%

Assessment and agreement of the CT appearance pattern and its severity grading of radiation-induced lung injury after stereotactic body radiotherapy for lung cancer

et al. 2018

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“…Figure 4 shows strong correlation between V 5 , V 13 ,V 20 and MLD for the UCSD cohort with large and significant Spearman’s rank-order correlation coefficients, (Rs ≥ 0.931, p < 0.001). Effect of possible confounders, specifically pulmonary emphysema, tumor location (upper/middle vs lower) and ILD was studied in the original report for the cohort A [ 21 ]. ILD was the only factor significantly associated with RP.…”

Section: Resultsmentioning

confidence: 99%

“…Two patient cohorts from previously reported studies were used, referenced below as cohorts A [ 21 ] and B [ 22 ]. These studies were selected because they provided detailed patient-specific data in a tabulated form.…”

Section: Methodsmentioning

confidence: 99%

Dose-Volume Predictors of Radiation Pneumonitis After Lung Stereotactic Body Radiation Therapy (SBRT): Implications for Practice and Trial Design

Moiseenko¹,

Grimm²,

Yorke³

et al. 2020

Cureus

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Background and purpose Recently published HyTEC report summarized lung toxicity data and proposed guidelines of mean lung dose (MLD) <8 Gy and normal lung receiving at least 20 Gy, V 20Gy <10-15% to avoid lung toxicity. Support for preferred use of a particular dosimetric parameter has been limited. We performed a detailed dose-volume analysis of data on radiation pneumonitis (RP) following lung stereotactic body radiation therapy (SBRT) to search for parameters showing the strongest correlation with RP. Materials and methods Two patient cohorts (primary and metastatic lung tumor patients) from previously reported studies were analyzed. Total number of patients was 96, and incidence of grade ≥2 RP was 13.5% (13/96). Fitting to the logistic function was performed to investigate correlation between incidence of RP and reported dosimetric and volumetric parameters. Another independent cohort was used to explore correlation between dosimetric parameters. Results Among normal lung parameters (MLD and reported V x ), only MLD consistently showed significant correlation with incidence of RP. Gross tumor volume (GTV), internal target volume, planning target volume (PTV), and minimum dose covering 95% of GTV or PTV did not show statistical significance. A significant correlation between reported V x and MLD was observed in all cohorts. Conclusions In considering tumor- and target-specific (e.g., GTV, PTV) and normal lung-specific (e.g., MLD, V x ) metrics, MLD was the only parameter that consistently correlated with incidence of RP across both cohorts. Because SBRT planning constraints allow small normal lung volumes to receive high doses, utility of MLD is not obvious. The parallel structure of lung is one possible explanation, but correlation between dosimetric parameters obscures elucidation of the preferred or mechanistically based parameter to guide radiotherapy planning.

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“…Zhao et al (78) analyzed pooled data and showed that older age, larger tumor size, the mean lung dose, and the volume of lung receiving a dose of more than 20 Gy are all associated with an increased risk of developing radiation pneumonitis. In the findings from a retrospective analysis, Okubo et al (79) showed that the presence of preexisting CT changes of interstitial pneumonitis was an independent predictor for development of post-SBRT radiation pneumonitis. The depiction of honeycombing on CT images had a high potential for fatality related to severe radiation pneumonitis (79).…”

Section: Radiation Pneumonitismentioning

confidence: 99%

“…In the findings from a retrospective analysis, Okubo et al (79) showed that the presence of preexisting CT changes of interstitial pneumonitis was an independent predictor for development of post-SBRT radiation pneumonitis. The depiction of honeycombing on CT images had a high potential for fatality related to severe radiation pneumonitis (79).…”

Section: Radiation Pneumonitismentioning

confidence: 99%

Stereotactic Body Radiation Therapy for Early-Stage Non–Small Cell Lung Cancer: A Primer for Radiologists

2018

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The past 2 decades have seen a rapid growth in use of stereotactic body radiation therapy (SBRT) for the management of non-small cell lung cancer (NSCLC). Not only is SBRT the reference standard for treatment of early-stage node-negative NSCLC in medically inoperable patients, it is also currently challenging the role of surgery for early-stage operable disease. SBRT is also used to treat recurrent disease and has a role in the management of multiple synchronous lung cancers. Imaging changes after SBRT differ from the changes after conventional radiation therapy in many ways, the knowledge of which is pertinent for accurate image interpretation. Posttreatment response assessment and detection of recurrent disease are heavily reliant on radiologic assessment, and often the decision to treat recurrent disease is based on the imaging findings themselves. This article provides a comprehensive review of the concepts of SBRT and the current indications for its use in the treatment of early-stage NSCLC, as well as a discussion of the CT findings seen after SBRT compared with the changes after conventional radiation therapy. Radiologic findings that are suggestive of recurrent disease and the imaging pitfalls are also highlighted. Finally, the rare complications after SBRT are described. SBRT is a major component of the changing treatment paradigms for early- and late-stage NSCLC. The imaging findings after SBRT often determine the next steps in a patient's clinical management. Therefore, radiologists must be familiar with the uses of this therapy and its radiologic appearance to be able to effectively contribute to the care of patients with NSCLC. RSNA, 2018.

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Predicting risk factors for radiation pneumonitis after stereotactic body radiation therapy for primary or metastatic lung tumours

Cited by 33 publications

References 45 publications

Assessment and agreement of the CT appearance pattern and its severity grading of radiation-induced lung injury after stereotactic body radiotherapy for lung cancer

Assessment and agreement of the CT appearance pattern and its severity grading of radiation-induced lung injury after stereotactic body radiotherapy for lung cancer

Dose-Volume Predictors of Radiation Pneumonitis After Lung Stereotactic Body Radiation Therapy (SBRT): Implications for Practice and Trial Design

Stereotactic Body Radiation Therapy for Early-Stage Non–Small Cell Lung Cancer: A Primer for Radiologists

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