A Prognostic Tool to Estimate the Risk of Pneumonitis in Patients Irradiated for Lung Cancer

Glatzel, Esther; Werner, Elisa; Bohnet, Sabine; Rades, Dirk

doi:10.21873/anticanres.15683

Cited by 3 publications

(4 citation statements)

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“…The MLD was previously identified as risk factor of symptomatic pneumonitis in patients of any age (3,11,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). In contrast to our study, these studies did not report the prevalence of grade ≥2 pneumonitis in elderly patients receiving higher mean doses to the ipsilateral lung.…”

Section: Discussioncontrasting

confidence: 99%

“…The prevalence of grade ≥2 pneumonitis in our present study was in the range of 7.2-49.5% found in previous studies for patients of any age (9-11, 13, 15-23). Three larger studies including 82, 156 and 267 elderly lung cancer patients, respectively, reported the prevalence of grade ≥2 pneumonitis for this age group (12,13,19). In these studies, the prevalence ranged between 16.1% and 28.0%.…”

Section: Discussionmentioning

confidence: 99%

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Associations Between Mean Lung Dose and Prevalence of Radiation Pneumonitis in Elderly Lung Cancer Patients

RADES,

CREMERS,

JANSSEN

et al. 2024

Anticancer Res

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Background/Aim: Pneumonitis is a serious radiotherapy complication. This study, which is a prerequisite for a prospective trial, aimed to identify the prevalence of pneumonitis and risk factors in elderly patients with lung cancer. Patients and Methods: Ninety-eight lung cancer patients aged ≥65 years were included. Seventeen factors were investigated regarding grade ≥2 pneumonitis at 24 weeks following radiotherapy. Results: The prevalence of grade ≥2 pneumonitis at 24 weeks was 27.3%. On univariate analysis, a significant association was observed for mean (ipsilateral) lung dose (MLD; 0% vs. 24.9% vs. 48.7%). Results were significant also for ≤13.0 vs. >13.0 Gy (0% vs. 37.1%) or ≤20.0 vs. >20.0 Gy (13.4% vs. 48.7%). MLD achieved significance on multivariate analysis. Conclusion: Elderly patients receiving MLDs >13.0 Gy, particularly >20.0 Gy, have a high risk of grade ≥2 pneumonitis. These results are important for designing a prospective trial.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Associations Between Mean Lung Dose and Prevalence of Radiation Pneumonitis in Elderly Lung Cancer Patients

RADES,

CREMERS,

JANSSEN

et al. 2024

Anticancer Res

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“…Of these factors, the mean radiation dose to ipsilateral lung >20 Gy and history of autoimmune disease were significant. Both characteristics were previously reported as risk factors for radiation pneumonitis [5,9,19,20]. Particularly, dose-volume parameters regarding the radiation dose to the lung such as the mean lung dose and the lung volume receiving ≥20 Gy were identified to be associated with pneumonitis [5,9,19,20].…”

Section: Discussionmentioning

confidence: 81%

“…Particularly, dose-volume parameters regarding the radiation dose to the lung such as the mean lung dose and the lung volume receiving ≥20 Gy were identified to be associated with pneumonitis [5,9,19,20]. Moreover, in a retrospective study of 169 patients irradiated for lung cancer, a history of chronic inflammatory disease (bronchial asthma, neurodermatitis, rheumatoid arthritis, or psoriasis arthritis) was significantly associated with a greater risk of radiation pneumonitis [20]. The fact that our findings agree with the results of previous studies demonstrates the consistency of our data.…”

Section: Discussionmentioning

confidence: 99%

Early Identification of Pneumonitis in Patients Irradiated for Lung Cancer—Final Results of the PARALUC Trial

Rades

Werner

Glatzel

et al. 2023

Cancers

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Radiotherapy of lung cancer may cause pneumonitis that generally occurs weeks or months following therapy and can be missed. This prospective trial aimed to pave the way for a mobile application (app) allowing early diagnosis of pneumonitis. The primary goal was the identification of the optimal cut-off of a score to detect pneumonitis of grade ≥2 after radiotherapy for lung cancer. Based on the severity of symptoms (cough, dyspnea, fever), scoring points were 0–9. Receiver operating characteristic (ROC)-curves were used to describe the sensitivity and specificity. The area under the ROC-curve (AUC) was calculated to judge the accuracy of the score, Youden-index was employed to define the optimal cut-off. Until trial termination, 57 of 98 patients were included. Eight of 42 patients evaluable for the primary endpoint (presence or absence of radiation pneumonitis) experienced pneumonitis. AUC was 0.987 (0.961–1.000). The highest sensitivity was achieved with 0–4 points (100%), followed by 5 points (87.5%), highest specificity with 5–6 points (100%). The highest Youden-index was found for 5 points (87.5%). The rate of patient satisfaction with the symptom-based scoring system was 93.5%. A cut-off of 5 points was identified as optimal to differentiate between pneumonitis and no pneumonitis. Moreover, pneumonitis was significantly associated with an increase of ≥3 points from baseline (p < 0.0001). The scoring system provided excellent accuracy and high patient satisfaction. Important foundations for the development of a mobile application were laid.

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Pneumonitis in older lung cancer patients after radiotherapy (POLCAR): A prospective study to develop a scoring instrument that helps identify radiation pneumonitis in elderly patients with lung cancer

Rades,

Zwaan,

Ohlen

et al. 2024

Preprint

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Background: Pneumonitis caused by radiotherapy for lung cancer may be missed, since it often occurs only several months later. In a previous trial including patients of any age, a symptom-based scoring system was tested to facilitate the correct diagnosis of radiation pneumonitis. Since elderly lung cancer patients have a greater risk of developing this complication, a separate scoring system particularly for this age group appears reasonable. This trial investigates such a specific tool for elderly patients irradiated for lung cancer. Methods: Patients with lung cancer patients aged ≥65 years will be included in this prospective multi-center trial and complete paper-based questionnaires (symptom-based scoring system). Patients indicate and rate symptoms potentially caused by pneumonitis, namely cough, dyspnea, and fever, once a week during and up to 24 weeks following their radiotherapy course. If symptomatic (grade ≥2) pneumonitis is confirmed by corresponding diagnostic procedures, patients receive prednisolone whenever possible. The total score of the symptom-based scoring system, which ranges between 0 and 9 points, is correlated to pneumonitis (yes or no). The discriminative power of the scoring system is evaluated by calculating the area under the receiver operating characteristic curve (AUC). Optimality is defined as a cut-off score with sensitivity ≥90% and specificity ≥80%. In addition, the Youden index (sensitivity + specificity – 1) will be applied. Fifty-nine patients (18 with and 41 without pneumonitis) are required in the full analysis set. Assuming that 5% of the patients will not qualify for this set, 62 patients should be enrolled. In addition, patient satisfaction with the scoring system is evaluated. If the dissatisfaction rate is >20%, the score needs modifications; if the dissatisfaction rate is >40%, the scoring system is considered not useful. Discussion: If the optimal cut-off score facilitates the diagnosis of radiation pneumonitis and its discrimination from other lung diseases in elderly patients with lung cancer, it will contribute to the development of a mobile application for identification of radiation pneumonitis, which can be used by the patients at home. Trial registration: clinicaltrials.gov (NCT06480734; URL: https://clinicaltrials.gov/show/NCT06480734); protocol version 1.2, registered on 27th of June, 2024.

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A Prognostic Tool to Estimate the Risk of Pneumonitis in Patients Irradiated for Lung Cancer

Cited by 3 publications

References 0 publications

Associations Between Mean Lung Dose and Prevalence of Radiation Pneumonitis in Elderly Lung Cancer Patients

Associations Between Mean Lung Dose and Prevalence of Radiation Pneumonitis in Elderly Lung Cancer Patients

Early Identification of Pneumonitis in Patients Irradiated for Lung Cancer—Final Results of the PARALUC Trial

Pneumonitis in older lung cancer patients after radiotherapy (POLCAR): A prospective study to develop a scoring instrument that helps identify radiation pneumonitis in elderly patients with lung cancer

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