Development and Validation of a Random Forest Model for Predicting Radiation Pneumonitis in Lung Cancer Patients Receiving Moderately Hypofractionated Radiotherapy: a Retrospective Cohort Study

Overview

Journal Ann Transl Med

Publisher AME Publishing Company

Date 2023 Jan 9

PMID 36618794

Authors

Yang Zhang

Zongjuan Li

Han Xiao

Zhenjiang Li

Jian He

Shisuo Du

Zhaochong Zeng

Affiliations

Soon will be listed here.

Abstract

Background: Radiation pneumonitis (RP) is a type of toxicity commonly associated with thoracic radiation therapy. We sought to establish a random forest (RF) model and evaluate its ability to predict RP in patients with non-small cell lung cancer (NSCLC) receiving moderately hypofractionated radiotherapy (hypo-RT).

Methods: A total of 106 patients with stage II-IVa NSCLC who received moderately hypofractionated helical tomotherapy (2.3-3.0 Gy/fraction) at Zhongshan Hospital were included. All enrolled patients were divided chronologically into the training (67 patients) and validation (39 patients) groups. Higher than or equal to grade 2 RP was defined as the end point. Logistic regression and RF models were established and compared using the receiver operating characteristic (ROC) and a confusion matrix in the training and validation groups.

Results: The cumulative incidence of the end point was 25.4% and 17.9% in the training and validation groups, respectively. Logistic regression models were constructed by dosage parameters of total lungs, ipsilateral or contralateral lungs, respectively. ROC analysis revealed that the dosimetric factors of total lungs yielded a superior classification performance than did that of the ipsilateral or contralateral lungs [area under the curve (AUC) =0.920, AUC =0.701, and AUC =0.661, respectively]. Furthermore, the RF model yielded a better prediction capacity than did the traditional logistic model based on the dosimetric factors of the total lungs (accuracy: 88.06%; precision: 84.62%; sensitivity: 64.71%; specificity: 96.00%). Moreover, the RF identified mean lung dose [MLD; mean decrease gini (MDG) =5.74], V20 (MDG =4.62), and V35 (MDG =3.08) of total lungs as the most common primary differentiators of RP.

Conclusions: Our RF model established based on the dosimetric parameters of the total lungs could accurately predict the RP risk in patients with NSCLC treated with moderately hypofractionated tomotherapy.

Citing Articles

Dosimetric Predictors of Acute Radiation Pneumonitis and Esophagitis in Hypofractionated Thoracic Irradiation of Non-Small Cell Lung Cancer Patients With Poor Prognostic Factors.

Kenndoff S, Nieto A, Guggenberger J, Taugner J, Mansoorian S, Kasmann L Adv Radiat Oncol. 2025; 10(2):101682.

PMID: 39896724 PMC: 11786736. DOI: 10.1016/j.adro.2024.101682.

Clinical predictors of severe radiation pneumonitis in patients undergoing thoracic radiotherapy for lung cancer.

Yan Y, Zhu Y, Yang S, Qian C, Zhang Y, Yuan X Transl Lung Cancer Res. 2024; 13(5):1069-1083.

PMID: 38854946 PMC: 11157363. DOI: 10.21037/tlcr-24-328.

References

Zhang Y, Li Z, Chen Y, Xiao H, Zhou Y, Du S . Outcomes of Image-Guided Moderately Hypofractionated Radiotherapy for Stage III Non-Small-Cell Lung Cancer. J Oncol. 2021; 2021:2721261. PMC: 8651380. DOI: 10.1155/2021/2721261. View

Mayahara H, Uehara K, Harada A, Kitatani K, Yabuuchi T, Miyazaki S . Predicting factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non-small cell lung cancer. Radiat Oncol. 2022; 17(1):7. PMC: 8760798. DOI: 10.1186/s13014-021-01979-z. View

Kashihara T, Nakayama Y, Ito K, Kubo Y, Okuma K, Shima S . Usefulness of Simple Original Interstitial Lung Abnormality Scores for Predicting Radiation Pneumonitis Requiring Steroidal Treatment After Definitive Radiation Therapy for Patients With Locally Advanced Non-Small Cell Lung Cancer. Adv Radiat Oncol. 2021; 6(1):100606. PMC: 7897760. DOI: 10.1016/j.adro.2020.10.019. View

Parisi G, Mazzola R, Ciammella P, Timon G, Fozza A, Franceschini D . Hypofractionated radiation therapy in the management of locally advanced NSCLC: a narrative review of the literature on behalf of the Italian Association of Radiation Oncology (AIRO)-Lung Working Group. Radiol Med. 2018; 124(2):136-144. DOI: 10.1007/s11547-018-0950-z. View

Kong F, Ao X, Wang L, Lawrence T . The use of blood biomarkers to predict radiation lung toxicity: a potential strategy to individualize thoracic radiation therapy. Cancer Control. 2008; 15(2):140-50. DOI: 10.1177/107327480801500206. View

Bradley J, Hope A, El Naqa I, Apte A, Lindsay P, Bosch W . A nomogram to predict radiation pneumonitis, derived from a combined analysis of RTOG 9311 and institutional data. Int J Radiat Oncol Biol Phys. 2007; 69(4):985-92. PMC: 2196217. DOI: 10.1016/j.ijrobp.2007.04.077. View

Zelefsky M, Kollmeier M, Cox B, Fidaleo A, Sperling D, Pei X . Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 2012; 84(1):125-9. DOI: 10.1016/j.ijrobp.2011.11.047. View

Patel H, Vock D, Marai G, Fuller C, Mohamed A, Canahuate G . Oropharyngeal cancer patient stratification using random forest based-learning over high-dimensional radiomic features. Sci Rep. 2021; 11(1):14057. PMC: 8263609. DOI: 10.1038/s41598-021-92072-8. View

Liu Y, Wang W, Shiue K, Yao H, Cerra-Franco A, Shapiro R . Risk factors for symptomatic radiation pneumonitis after stereotactic body radiation therapy (SBRT) in patients with non-small cell lung cancer. Radiother Oncol. 2020; 156:231-238. DOI: 10.1016/j.radonc.2020.10.015. View

10.

Yorke E, Jackson A, Rosenzweig K, Braban L, Leibel S, Ling C . Correlation of dosimetric factors and radiation pneumonitis for non-small-cell lung cancer patients in a recently completed dose escalation study. Int J Radiat Oncol Biol Phys. 2005; 63(3):672-82. DOI: 10.1016/j.ijrobp.2005.03.026. View

11.

Thompson M, Dumane V, Lazarev S, Zia Y, Rosenzweig K . Dosimetric Correlates of Pulmonary Toxicity in Patients with Malignant Pleural Mesothelioma Receiving Radiation Therapy to the Intact Lungs. Pract Radiat Oncol. 2019; 9(3):e331-e337. PMC: 6500743. DOI: 10.1016/j.prro.2018.12.008. View

12.

Scrimger R, Tome W, Olivera G, Reckwerdt P, Mehta M, Fowler J . Reduction in radiation dose to lung and other normal tissues using helical tomotherapy to treat lung cancer, in comparison to conventional field arrangements. Am J Clin Oncol. 2003; 26(1):70-8. DOI: 10.1097/00000421-200302000-00014. View

13.

He J, Huang Y, Chen Y, Shi S, Ye L, Hu Y . Feasibility and efficacy of helical intensity-modulated radiotherapy for stage III non-small cell lung cancer in comparison with conventionally fractionated 3D-CRT. J Thorac Dis. 2016; 8(5):862-71. PMC: 4842790. DOI: 10.21037/jtd.2016.03.46. View

14.

Robinson S, Tahir B, Absalom K, Lankathilake A, Das T, Lee C . Radical accelerated radiotherapy for non-small cell lung cancer (NSCLC): A 5-year retrospective review of two dose fractionation schedules. Radiother Oncol. 2019; 143:37-43. DOI: 10.1016/j.radonc.2019.08.025. View

15.

Marks L, Bentzen S, Deasy J, Kong F, Bradley J, Vogelius I . Radiation dose-volume effects in the lung. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl):S70-6. PMC: 3576042. DOI: 10.1016/j.ijrobp.2009.06.091. View

16.

Bentzen S . High-tech in radiation oncology: should there be a ceiling?. Int J Radiat Oncol Biol Phys. 2004; 58(2):320-30. DOI: 10.1016/j.ijrobp.2003.09.057. View

17.

Wang C, Rimner A, Gelblum D, Dick-Godfrey R, McKnight D, Torres D . Analysis of pneumonitis and esophageal injury after stereotactic body radiation therapy for ultra-central lung tumors. Lung Cancer. 2020; 147:45-48. PMC: 7484437. DOI: 10.1016/j.lungcan.2020.07.009. View

18.

Hope A, Lindsay P, El Naqa I, Alaly J, Vicic M, Bradley J . Modeling radiation pneumonitis risk with clinical, dosimetric, and spatial parameters. Int J Radiat Oncol Biol Phys. 2006; 65(1):112-24. DOI: 10.1016/j.ijrobp.2005.11.046. View

19.

Jung H, Noh J, Sun J, Lee S, Ahn J, Ahn M . Real world data of durvalumab consolidation after chemoradiotherapy in stage III non-small-cell lung cancer. Lung Cancer. 2020; 146:23-29. DOI: 10.1016/j.lungcan.2020.05.035. View

20.

Beli I, Koukourakis G, Platoni K, Tolia M, Kelekis N, Kouvaris J . Hypofractionated radiotherapy in non small cell lung cancer: a review of the current literature. Rev Recent Clin Trials. 2010; 5(2):103-11. DOI: 10.2174/157488710791233608. View