Analysis of Related Factors Associated with Radiation Pneumonitis in Patients with Locally Advanced Non-small-cell Lung Cancer Treated with Three-dimensional Conformal Radiotherapy

Overview

Journal J Cancer Res Clin Oncol

Specialty Oncology

Date 2010 Feb 5

PMID 20130912

Citations 17

Authors

Jun Dang

Guang Li

Xiaobe Lu

Lei Yao

Shuo Zhang

Zhan Yu

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate the correlation among DVH (lung dose-volume histogram) parameters, clinical factors, and grade > or = 2 radiation pneumonitis (RP) in patients with locally advanced non-small-cell lung cancer (NSCLC) treated with three-dimensional conformal radiotherapy (3D-CRT), and the differences between patients treated with 3D-CRT alone or that combined with chemotherapy on RP.

Patients And Methods: As much as 93 patients of stage III NSCLC were treated with 3D-CRT, among which 36 were treated with chemotherapy after 3D-CRT, 57 received 3D-CRT treatment alone. The radiation dose was 62.5-65 Gy (BED = 68-72.7 Gy).

Results: The morbidity of grade > or = 2 RP was 49.5%, of which grade 2 and grade 3 were 33.3 and 16.1%, respectively. The morbidity of RP in those patients treated with chemotherapy after radiotherapy was evidently higher than that of patients treated with radiotherapy alone (61.1 vs. 42.1%). According to the single factor analysis, V5-V50 and MLD of both the ipsilateral and the whole lung were all related to the occurrence of RP; comparing grade 3 with grade 2 within the same group, except V45, V50, TV20, TV30, and TMLD, other parameters also had their statistical significance (P < 0.01); comparing the non-chemotherapy-treated group with the chemotherapy-treated group, TV30 and TV35 had their statistical significance. According to logistic regression analysis; the occurrence of RP was evidently associated with the comprehensive value of DVH parameters, chemotherapy, and gender. Chemotherapy has increased the risk of RP 7.6 times. The increase of each score in the comprehensive value of DVH parameters would increase the risk of RP 22.7 times.

Conclusion: The comprehensive values of DVH parameters, chemotherapy, and gender have independent effects on the occurrence of RP. Most of DVH parameters were associated with the occurrence of RP. The curve shape composed of multiple points in DVH parameters was more important than any single DVH parameter.

Citing Articles

Symptomatic Radiation Pneumonitis in NSCLC Patients Receiving EGFR-TKIs and Concurrent Once-daily Thoracic Radiotherapy: Predicting the Value of Clinical and Dose-volume Histogram Parameters.

Yang X, Mei T, Yu M, Gong Y Zhongguo Fei Ai Za Zhi. 2022; 25(6):409-419.

PMID: 35747920 PMC: 9244499. DOI: 10.3779/j.issn.1009-3419.2022.102.17.

Dosimetric factors and Lyman normal-tissue complication modelling analysis for predicting radiation-induced lung injury in postoperative breast cancer radiotherapy: a prospective study.

Zhou Z, Han Q, Liang S, He X, Cao N, Zi Y Oncotarget. 2016; 8(20):33855-33863.

PMID: 27806340 PMC: 5464917. DOI: 10.18632/oncotarget.12979.

A survey of changing trends in modelling radiation lung injury in mice: bringing out the good, the bad, and the uncertain.

Dabjan M, Buck C, Jackson I, Vujaskovic Z, Marples B, Down J Lab Invest. 2016; 96(9):936-49.

PMID: 27479087 DOI: 10.1038/labinvest.2016.76.

Inhalative steroids as an individual treatment in symptomatic lung cancer patients with radiation pneumonitis grade II after radiotherapy - a single-centre experience.

Henkenberens C, Janssen S, Lavae-Mokhtari M, Leni K, Meyer A, Christiansen H Radiat Oncol. 2016; 11:12.

PMID: 26830686 PMC: 4736495. DOI: 10.1186/s13014-016-0580-3.

Associated factors of radiation pneumonitis induced by precise radiotherapy in 186 elderly patients with esophageal cancer.

Cui Z, Tian Y, He B, Li H, Li D, Liu J Int J Clin Exp Med. 2015; 8(9):16646-51.

PMID: 26629197 PMC: 4659085.

References

Kim T, Cho K, Pyo H, Lee J, Zo J, Lee D . Dose-volumetric parameters for predicting severe radiation pneumonitis after three-dimensional conformal radiation therapy for lung cancer. Radiology. 2005; 235(1):208-15. DOI: 10.1148/radiol.2351040248. View

Gopal R, Tucker S, Komaki R, Liao Z, Forster K, Stevens C . The relationship between local dose and loss of function for irradiated lung. Int J Radiat Oncol Biol Phys. 2003; 56(1):106-13. DOI: 10.1016/s0360-3016(03)00094-4. View

Wang S, Liao Z, Wei X, Liu H, Tucker S, Hu C . Analysis of clinical and dosimetric factors associated with treatment-related pneumonitis (TRP) in patients with non-small-cell lung cancer (NSCLC) treated with concurrent chemotherapy and three-dimensional conformal radiotherapy (3D-CRT). Int J Radiat Oncol Biol Phys. 2006; 66(5):1399-407. DOI: 10.1016/j.ijrobp.2006.07.1337. View

Robnett T, Machtay M, Vines E, McKenna M, Algazy K, McKenna W . Factors predicting severe radiation pneumonitis in patients receiving definitive chemoradiation for lung cancer. Int J Radiat Oncol Biol Phys. 2000; 48(1):89-94. DOI: 10.1016/s0360-3016(00)00648-9. View

Zhao L, West B, Hayman J, Lyons S, Cease K, Kong F . High radiation dose may reduce the negative effect of large gross tumor volume in patients with medically inoperable early-stage non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2007; 68(1):103-10. DOI: 10.1016/j.ijrobp.2006.11.051. View

Hernando M, Marks L, Bentel G, Zhou S, Hollis D, Das S . Radiation-induced pulmonary toxicity: a dose-volume histogram analysis in 201 patients with lung cancer. Int J Radiat Oncol Biol Phys. 2001; 51(3):650-9. DOI: 10.1016/s0360-3016(01)01685-6. View

Madani I, De Ruyck K, Goeminne H, De Neve W, Thierens H, Meerbeeck J . Predicting risk of radiation-induced lung injury. J Thorac Oncol. 2007; 2(9):864-74. DOI: 10.1097/JTO.0b013e318145b2c6. View

Onishi H, Kuriyama K, Yamaguchi M, Komiyama T, Tanaka S, Araki T . Concurrent two-dimensional radiotherapy and weekly docetaxel in the treatment of stage III non-small cell lung cancer: a good local response but no good survival due to radiation pneumonitis. Lung Cancer. 2003; 40(1):79-84. DOI: 10.1016/s0169-5002(02)00532-9. View

Gopal R . Pulmonary toxicity associated with the treatment of non-small cell lung cancer and the effects of cytoprotective strategies. Semin Oncol. 2005; 32(2 Suppl 3):S55-9. DOI: 10.1053/j.seminoncol.2005.03.010. View

10.

Oetzel D, Schraube P, Hensley F, Sroka-Perez G, Menke M, Flentje M . Estimation of pneumonitis risk in three-dimensional treatment planning using dose-volume histogram analysis. Int J Radiat Oncol Biol Phys. 1995; 33(2):455-60. DOI: 10.1016/0360-3016(95)00009-N. View

11.

Blom-Goldman U, Svane G, Wennberg B, Lidestahl A, Lind P . Quantitative assessment of lung density changes after 3-D radiotherapy for breast cancer. Acta Oncol. 2007; 46(2):187-93. DOI: 10.1080/02841860600949586. View

12.

Schallenkamp J, Miller R, Brinkmann D, Foote T, Garces Y . Incidence of radiation pneumonitis after thoracic irradiation: Dose-volume correlates. Int J Radiat Oncol Biol Phys. 2007; 67(2):410-6. DOI: 10.1016/j.ijrobp.2006.09.030. View

13.

GRAHAM M . Predicting radiation response. Int J Radiat Oncol Biol Phys. 1997; 39(3):561-2. DOI: 10.1016/s0360-3016(97)00353-2. View

14.

Tsujino K, Hirota S, Kotani Y, Kado T, Yoden E, Fujii O . Radiation pneumonitis following concurrent accelerated hyperfractionated radiotherapy and chemotherapy for limited-stage small-cell lung cancer: Dose-volume histogram analysis and comparison with conventional chemoradiation. Int J Radiat Oncol Biol Phys. 2005; 64(4):1100-5. DOI: 10.1016/j.ijrobp.2005.09.025. View

15.

Seppenwoolde Y, Lebesque J, De Jaeger K, Belderbos J, Boersma L, Schilstra C . Comparing different NTCP models that predict the incidence of radiation pneumonitis. Normal tissue complication probability. Int J Radiat Oncol Biol Phys. 2003; 55(3):724-35. DOI: 10.1016/s0360-3016(02)03986-x. View

16.

Willner J, Jost A, Baier K, Flentje M . A little to a lot or a lot to a little? An analysis of pneumonitis risk from dose-volume histogram parameters of the lung in patients with lung cancer treated with 3-D conformal radiotherapy. Strahlenther Onkol. 2003; 179(8):548-56. DOI: 10.1007/s00066-003-1078-0. View

17.

Marks L, Munley M, Bentel G, Zhou S, Hollis D, Scarfone C . Physical and biological predictors of changes in whole-lung function following thoracic irradiation. Int J Radiat Oncol Biol Phys. 1997; 39(3):563-70. DOI: 10.1016/s0360-3016(97)00343-x. View

18.

Rengan R, Rosenzweig K, Venkatraman E, Koutcher L, Fox J, Nayak R . Improved local control with higher doses of radiation in large-volume stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2004; 60(3):741-7. DOI: 10.1016/j.ijrobp.2004.04.013. View

19.

Choi Y, Munden R, Erasmus J, Park K, Chung W, Jeon S . Effects of radiation therapy on the lung: radiologic appearances and differential diagnosis. Radiographics. 2004; 24(4):985-97. DOI: 10.1148/rg.244035160. View

20.

Piotrowski T, Matecka-Nowak M, Milecki P . Prediction of radiation pneumonitis: dose-volume histogram analysis in 62 patients with non-small cell lung cancer after three-dimensional conformal radiotherapy. Neoplasma. 2005; 52(1):56-62. View