Preexisting radiological interstitial lung abnormalities are a risk factor for severe radiation pneumonitis in patients with small-cell lung cancer after thoracic radiation therapy

Li, Fangjuan; Zhou, Ziyang; Wu, Ailu; Cai, Yong; H, Wu; Chen, Ming; Liang, Shi-Xiong

doi:10.1186/s13014-018-1030-1

Cited by 53 publications

(44 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…ILA may be of similar importance as ILD in predicting RRP because a part of ILA was reported to proceed as ILD 16 . Although previous studies reported unfavorable impact of ILA on RP in patients with lung cancer receiving thoracic radiotherapy, their study cohorts were heterogeneous population with tumor stage, total radiation dose, chemotherapy regimen or timing of radiotherapy 17,18 . In contrast in this study, most patients received treatment were etoposide and cisplatin plus concurrent accelerated hyperfractionated thoracic radiotherapy which is standard treatment recommended by The Japanese Lung Cancer Society Guideline 2019 15 .…”

Section: Discussionmentioning

confidence: 99%

Chemoradiotherapy for Limited-Stage Small Cell Lung Cancer and Interstitial Lung Abnormalities

Kobayashi

Wakuda

Naito

et al. 2020

Preprint

View full text Add to dashboard Cite

Purpose: Patients with lung cancer and interstitial lung disease treated with radiotherapy have been reported to be at a risk of developing radiation pneumonitis. However, the association between interstitial lung abnormalities (ILA) and radiation pneumonitis in patients with limited-stage small cell lung cancer (LS-SCLC) remains unclear. Furthermore, the prognosis is unclear for patients with SCLC and ILA treated with chemoradiotherapy. We investigated the impact of ILA on radiation pneumonitis and assessed the prognosis of patients with LS-SCLC and ILA treated chemoradiotherapy. Methods and materials: We retrospectively reviewed the medical records of 149 patients with LS-SCLC who received first-line treatment between January 2009 and December 2016. Results: In a univariate analysis, the patients with ILA showed a higher incidence rate of radiation pneumonitis compared with those without ILA (64% vs. 10%); multivariate analysis confirmed that ILA was significantly associated with the incidence of radiation pneumonitis. In the univariate analysis, patients with ILA showed poorer overall survival than those without ILA (median, 18.9 vs. 67.9 months). Multivariate analysis showed that ILA was a significant independent negative prognostic factor. However, the 2-year and 5-year survival rates for the patients with ILA treated with chemoradiotherapy were 36% and 26%, respectively; for those treated with chemotherapy alone were 8% and 0%, respectively.Conclusions: ILA was a predictive factor for radiation pneumonitis in patients with LS-SCLC treated with chemoradiotherapy. The prognosis of the patients with LS-SCLC and ILA was poor; however, some patients with ILA treated chemoradiotherapy achieved long-term survival.

show abstract

Section: Discussionmentioning

confidence: 99%

Chemoradiotherapy for Limited-Stage Small Cell Lung Cancer and Interstitial Lung Abnormalities

Kobayashi

Wakuda

Naito

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Informed consent will be taken by specially trained physicians registered as investigators for this trial. Risk factors include mean dose to ipsilateral lung > 20 Gy or mean dose > 13 Gy plus at least one other factor (significant cardiovascular disease, history of heavy smoking (≥40 pack years), chemotherapy or immunotherapy) [ 4 , 7 – 13 ].…”

Section: Methods and Designmentioning

confidence: 99%

“…The following parameters will be assessed during the course of the trial: Symptoms of Pneumonitis Quality of life will be assessed at the end of radiotherapy and at the end of the study using the EORTC QLQ-C30 version 3.0 and the EORTC QLQ-LC13 ( https://qol.eortc.org ). Adverse events other than pneumonitis will be assessed on an ongoing basis according to CTCAE v5.0 [ 13 ]. Serious adverse events and unexpected adverse events must be reported within 24 h after their detection/onset by fax to the coordinating investigator.…”

Section: Methods and Designmentioning

confidence: 99%

Pneumonitis after radiotherapy for lung cancer (PARALUC): an interventional study to create a symptom-based scoring system for identification of patients developing radiation pneumonitis

et al. 2020

View full text Add to dashboard Cite

Background Pneumonitis is a possible side effect of radiotherapy for lung cancer. Since it can occur up to several months following treatment, symptoms may not be associated with previous radiotherapy, and pneumonitis can become severe before diagnosed. This study aimed to develop a symptom-based scoring system to contribute to earlier detection of radiation pneumonitis requiring medical intervention (grade ≥ 2). Methods Patients irradiated for lung cancer complete a paper-based questionnaire (symptom-based score) during and up to 24 weeks following radiotherapy. Patients rate symptoms potentially associated with pneumonitis, and scoring points are assigned to severity of these symptoms. Sum scores are used to identify radiation pneumonitis. If radiation pneumonitis is suspected, patients undergo standard diagnostic procedures. If grade ≥ 2 pneumonitis is confirmed, medical intervention is indicated. The discriminative power of the score will be assessed by calculating the area under the receiver operating characteristic curve (AUC). If statistical significance of the AUC is reached, the optimal sum score to predict radiation pneumonitis will be established, which is defined as a cut-off value with sensitivity ≥90% and specificity ≥80%. Assuming a ratio between patients without and with pneumonitis of 3.63, a sample size of 93 patients is required in the full analysis set to yield statistical significance at the level of 5% with a power of 90% if the AUC under the alternative hypothesis is at least 0.9. Considering potential drop-outs, 98 patients should be recruited. If > 20% of patients are not satisfied with the score, modification is required. If the dissatisfaction rate is > 40%, the score is considered not useful. In 10 patients, functionality of a mobile application will be tested in addition to the paper-based questionnaire. Discussion If an optimal cut-off score resulting in sufficiently high sensitivity and specificity can be identified and the development of a symptom-based scoring system is successful, this tool will contribute to better identification of patients experiencing pneumonitis after radiotherapy for lung cancer. Trial registration Clinicaltrials.gov ( NCT04335409 ); registered on 2nd of April, 2020.

show abstract

“…Radiation pneumonitis (RP) is an important dose-limiting complication of thoracic radiotherapy, with clinical symptoms of dyspnea, a non-productive cough, and occasionally low-grade transient fevers (3). Risk factors for RP are various, including lung volume receiving ≥20 Gy, mean lung dose (MLD), chemotherapy, age, former or current smoker, chronic obstructive pulmonary disease, and interstitial lung disease (4)(5)(6)(7)(8)(9).…”

Section: Introductionmentioning

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.

View full text Add to dashboard Cite

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.

show abstract

Preexisting radiological interstitial lung abnormalities are a risk factor for severe radiation pneumonitis in patients with small-cell lung cancer after thoracic radiation therapy

Cited by 53 publications

References 27 publications

Chemoradiotherapy for Limited-Stage Small Cell Lung Cancer and Interstitial Lung Abnormalities

Chemoradiotherapy for Limited-Stage Small Cell Lung Cancer and Interstitial Lung Abnormalities

Pneumonitis after radiotherapy for lung cancer (PARALUC): an interventional study to create a symptom-based scoring system for identification of patients developing radiation pneumonitis

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

Contact Info

Product

Resources

About