Severe radiation pneumonitis after lung stereotactic ablative radiation therapy in patients with interstitial lung disease

ESTRO ACROP consensus guideline on implementation and practice of stereotactic body radiotherapy for peripherally located early stage non-small cell lung cancer

“…Clinical situations, which are potentially associated with an increased risk for toxicity, do not preclude use of SBRT, for example following a contralateral pneumonectomy [38][39][40], treatment of two simultaneous primaries [41,42] and treatment of centrally located NSCLC [43,44]. Recently, idiopathic pulmonary fibrosis (IPF) has been identified as a risk factor for severe radiation induced pneumonitis but was not a relative contraindication for SBRT in the majority of the institutions [45][46][47]. However, all institutions agree that more extensive SBRT experience is required in these situations and institutions starting their SBRT program should refer such patients to more experienced colleagues.…”

Clarithromycin mitigates radiation pneumonitis in patients with lung cancer treated with stereotactic body radiotherapy

“…Radiation pneumonitis is one of the most critical pulmonary toxicities following SBRT for lung tumors. Many previous radiation pneumonitis studies have investigated risk factors (12,(28)(29)(30)(31), dose-volumetric analyses (32,33), and prophylactic drugs (34,35).…”

“…Since January 2014, we have administered oral CAM for patients who had following high risk factors for radiation pneumonitis, using 200 mg/day once daily for 3 months from the start of SBRT. Pretreatment predictable highrisk factors included at least one of the following: IIPs or secondary interstitial pneumonia (12,28); elevated Krebs von den Lungen-6 (KL-6) (>500 U/mL) and/or surfactant protein D (SP-D) (>110 ng/mL) (29,30). CAM was also administered to patients with other risk factors at the physicians' discretion; risk factors included severely decreased pulmonary function, a history of thoracic irradiation, and severe steroid-dependent asthma.…”

“…In this study, we considered IIPs, pre-treatment elevation of KL-6 and/or SP-D, and early onset of radiation pneumonitis as risk factors for severe radiation pneumonitis (8,9,12,(28)(29)(30), and administered CAM to patients with those risks. Dose-volumetric factors related to the lung were not included as high-risk factors in the current study, although they are well known to be risk factors for radiation pneumonitis (32,33).…”

Stereotaktische Strahlentherapie bei Lungenkrebs im Stadium I – gibt es eine Evidenz?

“…Die Mehrzahl der mit SBRT behandelten Patienten leidet an einer begleitenden Lungengrunderkrankung, meist einer Raucherassoziierten chronisch obstruktiven Lungenerkrankung (COPD) als Ursache für die Inoperabilität: Auch bei schwerer COPD ist die SBRT eine sichere und kurative Therapieoption [44]. In aktuellen Arbeiten wurde allerdings eine interstitielle Lungenerkrankung als Risikofaktor für vermehrt schwere und auch tödliche Komplikationen nach SBRT beschrieben [45][46][47]. Interstitielle Lungenerkrankung ist aber bekanntlich ein Überbegriff für verschiedenste Erkrankungen mit sehr unterschiedlicher Prognose und jeweils differenzierten Erkrankungsstadien.…”