Severe COPD Is Correlated With Mild Radiation Pneumonitis Following Stereotactic Body Radiotherapy

Takeda, Atsuya; Kunieda, Etsuo; Ohashi, Toshio; Aoki, Yousuke; Oku, Yohei; Enomoto, Tatsuji; Nomura, Koichiro; Sugiura, Madoka

doi:10.1378/chest.11-1193

Cited by 79 publications

(53 citation statements)

References 33 publications

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“…In two studies, RILT rates were relatively high after moderate-dose SBRT to larger or centrally located lesions (27,28). For patients with severe COPD, the RP rate after a total dose of 40-50 Gy/5fx was relatively limited in Takeda's study (23.4% and 4.9% for G2+ and G3+ RP); however, the authors pointed out that this does not assure that SBRT is tolerable for all patients, and that pulmonary function, tumor location, interstitial lung diseases and other factors should be carefully considered before prescribing SBRT (29), consistent with recommendations from Yamashita et al (30,31). …”

Section: Discussionmentioning

confidence: 99%

Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies

Zhao

Yorke

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

144

108

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Purpose To study the risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiotherapy (SBRT) of the thorax. Methods Published studies on lung toxicity in patients with early stage non-small cell lung cancer (NSCLC) or metastatic lung tumors treated with SBRT were pooled and analyzed. The primary endpoint was RILT including pneumonitis and fibrosis. Data of RILT and risk factors were extracted from each study, and rates of grade 2-5 (G2+) and grade 3-5 (G3+) RILT were computed. Patient, tumor and dosimetric factors were analyzed for their correlation with RILT. Results Eighty-eight studies (7752 patients), that reported RILT incidence, were eligible. The pooled rates of G2+ and G3+ RILT from all 88 studies were 9.1% (95% CI: 7.15-11.4) and 1.8% (95% CI: 1.3-2.5), respectively. The median of median tumor sizes was 2.3 (range 1.4-4.1) cm. Among the factors analyzed, older patient age (P= 0.044) and larger tumor size (the greatest diameter) were significantly correlated with higher rates of G2+ (P= 0.049) and G3+ RILT (P= 0.001). Patients with stage IA vs. stage IB NSCLC had significantly lower risks of G2+ RILT (8.3% vs 17.1%, OR= 0.43, 95% CI: 0.29-0.64, P<0.0001). Among studies that provided detailed dosimetric data, the pooled analysis demonstrated a significantly higher mean lung dose (MLD) (P= 0.027) and V20 (P= 0.019) in patients with G2+ RILT comparing to that of grade 0-1 RILT. Conclusions The overall rate of RILT is relatively low after thoracic SBRT. Older age and larger tumor size are significant adverse risk factors for RILT. Lung dosimetry, specifically lung V20 and MLD also significantly affect RILT risk. Summary Risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiotherapy (SBRT) were analyzed from 88 published studies (7752 patients). The overall rate of RILT is relatively low after thoracic SBRT. Adverse risk factors for RILT after SBRT include older age, larger tumor size and greater lung dose-volume exposure as measured by mean lung dose and volume of lung receiving greater than 20 Gy.

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Section: Discussionmentioning

confidence: 99%

Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies

Zhao

Yorke

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

144

108

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“…A recent study by Pamla and colleagues reported a 3-year actual local control rate of 89% in stage I non-small cell lung cancer (NSCLC) patients with concomitant COPD (GOLD class III/IV) after SBRT [103], and a subsequent systematic review demonstrated comparable outcomes between SBRT and surgery in this patient population [103]. The toxicity following SBRT was tolerable, and even milder in patients with COPD than those with normal lung function [104]. Data on the effectiveness of chemotherapy in COPD-associated lung cancer remain limited, although COPD has been reported to increase the risk of chemotherapy-induced febrile neutropenia [105].…”

Section: Treatment For Lung Cancer With Copdmentioning

confidence: 99%

Lung cancer and chronic obstructive pulmonary disease: From a clinical perspective

et al. 2017

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Chronic obstructive pulmonary disease (COPD) and lung cancer are devastating pulmonary diseases that commonly coexist and present a number of clinical challenges. COPD confers a higher risk for lung cancer development, but available chemopreventive measures remain rudimentary. Current studies have shown a marked benefit of cancer screening in the COPD population, although challenges remain, including the common underdiagnosis of COPD. COPD-associated lung cancer presents distinct clinical features. Treatment for lung cancer coexisting with COPD is challenging as COPD may increase postoperative morbidities and decrease survival. In this review, we outline current progress in the understanding of the clinical association between COPD and lung cancer, and suggest possible cancer prevention strategies in this patient population.

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“…In a retrospective study of 265 patients treated with SABR, the risk of RP ≥ Grade 1 was lower in patients with severe COPD, defined as a Global Initiative for Chronic Obstructive Lung Disease (GOLD) score of III or IV (odds ratio [OR] of RP 0.37 for GOLD III, compared with patients with GOLD 0, p < 0.01). 20 Treatment-related mortality is also low: a systematic review of the literature comparing surgery to SABR in 176 patients with severe COPD (defined as GOLD score III or IV or a predicted postoperative forced expiratory volume in 1 second (FEV 1 ) of ≤ 40%), showed a 30-day mortality of 10% versus 0% respectively, favoring SABR. Local and locoregional control rates were excellent in all identified studies with either surgery or SABR (≥ 89%).…”

Section: Radiation Pneumonitis After Sabrmentioning

confidence: 99%

Follow-Up of Patients after Stereotactic Radiation for Lung Cancer: A Primer for the Nonradiation Oncologist

Huang

Palma

2015

Journal of Thoracic Oncology

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Severe COPD Is Correlated With Mild Radiation Pneumonitis Following Stereotactic Body Radiotherapy

Cited by 79 publications

References 33 publications

Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies

Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies

Lung cancer and chronic obstructive pulmonary disease: From a clinical perspective

Follow-Up of Patients after Stereotactic Radiation for Lung Cancer: A Primer for the Nonradiation Oncologist

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