The impact of induction chemotherapy and the associated tumor response on subsequent radiation-related changes in lung function and tumor response (original) (raw)
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International Journal of Radiation Oncology*Biology*Physics, 2005
Purpose: Clinical and 3D dosimetric parameters are associated with symptomatic radiation pneumonitis rates in retrospective studies. Such parameters include: mean lung dose (MLD), radiation (RT) dose to perfused lung (via SPECT), and pre-RT lung function. Based on prior publications, we defined pre-RT criteria hypothesized to be predictive for later development of pneumonitis. We herein prospectively test the predictive abilities of these dosimetric/functional parameters on 2 cohorts of patients from Duke and The Netherlands Cancer Institute (NKI).
Turkish Journal of Oncology
The aim of the present study was to evaluate the extent of change in pulmonary function tests (PFTs) in early and late term after concurrent radiochemotherapy (RCT) and whether the baseline PFTs or percentages of changes in PFTs after RCT would predict radiation pneumonitis (RP) after RCT in locally advanced non-small cell lung cancer (NSCLC). METHODS Patients with stage III NSCLC who received RCT between January 2008 and December 2014 were evaluated retrospectively with respect to patients, tumor, and treatment characteristics; PFT parameters before RCT; 1, 6, and 12 months after RCT; response rates; progression-free survival (PFS); and 5-year overall survival (OS). PFT parameters at 1, 6, and 12 months after RCT were compared with the same patients' baseline values. RP was assessed both clinically and radiologically. RESULTS A total of 61 patients were analyzed in the study. Median follow-up was 20 (4-116) months, and PFS was 14 (2-122) months. Five-year OS was 18%. All PFT parameters declined after RCT, but only decreases in forced expiratory volume in 1 second at 6 and 12 months and in diffusion capacity of the lung for carbon monoxide (DLCO) at 6 months were found to be statistically significant. None of the baseline PFT parameters was found to be predictive of RP except the baseline DLCO; patients who had a baseline DLCO value <65% (52%-75%) developed RP in contrast to patients who had baseline DLCO value >75% (71%-95%) (p=0.023). CONCLUSION There has been prominent and persistent decrease in PFT after RCT. However, the clinical outcome of this finding has to be evaluated. Further prospective studies with larger scales are needed to verify the predictive value of baseline DLCO on the development of RP.
International Journal of Radiation Oncology*Biology*Physics, 2001
To relate lung dose-volume histogram-based factors to symptomatic radiation pneumonitis (RP) in patients with lung cancer undergoing 3-dimensional (3D) radiotherapy planning. Between 1991 and 1999, 318 patients with lung cancer received external beam radiotherapy (RT) with 3D planning tools at Duke University Medical Center. One hundred seventeen patients were not evaluated for RP because of &amp;lt;6 months of follow-up, development of progressive intrathoracic disease making scoring of pulmonary symptoms difficult, or unretrievable 3D dosimetry data. Thus, 201 patients were analyzed for RP. Univariate and multivariate analyses were performed to test the association between RP and dosimetric factors (i.e., mean lung dose, volume of lung receiving &amp;gt;or=30 Gy, and normal tissue complication probability derived from the Lyman and Kutcher models) and clinical factors, including tobacco use, age, sex, chemotherapy exposure, tumor site, pre-RT forced expiratory volume in 1 s, weight loss, and performance status. Thirty-nine patients (19%) developed RP. In the univariate analysis, all dosimetric factors (i.e., mean lung dose, volume of lung receiving &amp;gt;or=30 Gy, and normal tissue complication probability) were associated with RP (p range 0.006-0.003). Of the clinical factors, ongoing tobacco use at the time of referral for RT was associated with fewer cases of RP (p = 0.05). These factors were also independently associated with RP according to the multivariate analysis (p = 0.001). Models predictive for RP based on dosimetric factors only, or on a combination with the influence of tobacco use, had a concordance of 64% and 68%, respectively. Dosimetric factors were the best predictors of symptomatic RP after external beam RT for lung cancer. Multivariate models that also include clinical variables were slightly more predictive.
journal of Cancer Therapeutics and Research, 2012
Purpose: We sought to identify factors predictive of development of radiation pneumonitis and pulmonary fibrosis following split course concurrent chemoirradiation for locally advanced non-small cell lung cancer (LA-NSCLC). Methods and Materials: We reviewed records of 108 patients treated with regimen of split course radiotherapy (median 60 Gy in 30 fractions) and concurrent chemotherapy for stage IIIa/IIIb NSCLC. Fisher's Exact Test and Paired Student T Test were performed to identify factors predictive of development of any pulmonary toxicity (pneumonitis or fibrosis of any grade) and severe pulmonary toxicity (grade 3 or higher pneumonitis, grade 2 or higher fibrosis). Results: 56 patients (51.2%%) developed any toxicity; 22 patients (20.4%) developed severe toxicity. The following predictive factors were identified for any and severe pulmonary toxicity, respectively: reactive airway disease (RAD), age, RV % expected (EXP), PEF %EXP, FEV1/FVC ratio, smoking status; and RAD, FEV1 %EXP, FVC %EXP, FEV1/FVC %EXP, RV %EXP, FEF25/75 %EXP, PEF %EXP, S-GAW %, FEV1, FVC, and FEV1/FVC. Conclusions: Our overall rates of any and severe pulmonary toxicity are acceptable. History of RAD and active smoking are protective, whereas patients with severe COPD have increased risk. A trend was seen toward improved outcomes with the use of prophylactic steroid control medication. These results should be confirmed in the context of a prospective study.
Journal of Medical Imaging and Radiation Oncology, 2020
Introduction There is some evidence to suggest that patients with underlying pulmonary fibrosis (PF) have increased risk of adverse respiratory and survival outcomes, when treated with conventional, long-course radiotherapy (RT) for non-small-cell lung cancer (NSCLC). We performed a retrospective analysis to determine the size of these risks. Methods Data from 21 patients with PF (cases) were retrospectively analysed for respiratory toxicity and mortality outcomes, and compared with patients without PF (non-cases). Age and mean lung dose were included as covariates in regression analyses. The additional predictive value of other patient, disease and treatment characteristics on radiation pneumonitis (RP) risk and severity was explored. Results There was a numerical (though not statistically significant) increase in grade ≥2 RP among PF cases (OR 2.74, p=0.074). Cases were significantly more likely to discontinue radical treatment early (OR 6.10, p=0.015). There was a significant association between increased RP severity and underlying PF (p=0.039), with RP strongly implicated in the death in 3 of 21 cases (14.3%) compared to 1 non-case (1.2%). Cases experienced increased grade ≥2 respiratory toxicity otherwise (OR 4.35, p=0.020), and poorer median overall survival (0.6 versus 1.7 years, p<0.001). Two cases, and no non-cases, died during the proposed RT period. None of the analysed patient, disease or treatment factors, was a significant additional predictor of RP risk/ severity.
Respiratory Research, 2018
Background: Radiation pneumonitis (RP) is a frequent complication of concurrent chemoradiotherapy (CCRT) and is associated with severe symptoms that decrease quality of life and might result in pulmonary fibrosis or death. The aim of this study is to identify whether pulmonary function test (PFT) abnormalities may predict RP in nonsmall cell lung cancer (NSCLC) patients. Methods: A prospective multi-institutional study was conducted with locally advanced and oligometastatic NSCLC patients. All participants were evaluated at baseline, end of CCRT, week 6, 12, 24, and 48 post-CCRT. They completed forced spirometry with a bronchodilator, body plethysmography, impulse oscillometry, carbon monoxide diffusing capacity (DLCO), molar mass of CO 2 , six-minute walk test and exhaled fraction of nitric oxide (FeNO). Radiation pneumonitis was assessed with RTOG and CTCAE. The protocol was registered in www. clinicaltrials.gov (NCT01580579), registered April 19, 2012. Results: Fifty-two patients were enrolled; 37 completed one-year follow-up. RP ≥ Grade 2 was present in 11/37 (29%) for RTOG and 15/37 (40%) for CTCAE. Factors associated with RP were age over 60 years and hypofractionated dose. PFT abnormalities at baseline that correlated with the development of RP included lower forced expiratory volume in one second after bronchodilator (p = 0.02), DLCO (p = 0.02) and FeNO (p = 0.04). All PFT results decreased after CCRT and did not return to basal values at follow-up. Conclusions: FEV 1 , DLCO and FeNO prior to CCRT predict the development of RP in NSCLC. This study suggests that all patients under CCRT should be assessed by PFT to identify high-risk patients for close follow-up and early treatment.