Analysis of related factors associated with radiation pneumonitis in patients with locally advanced non-small-cell lung cancer treated with three-dimensional conformal radiotherapy

Dang, Jun; Li, Guang; Lu, X.; Yao, Lei; Zhang, Shuo; Yu, Zhan

doi:10.1007/s00432-010-0764-4

Cited by 26 publications

(19 citation statements)

References 24 publications

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“…It is worth mentioning that this study has confirmed previous reports that MLD is a significant predictor for RP, regardless of the calculation method (6, 13, 14), although some lung DVH studies neglected to mention the method of DVH computation (11, 15–18). In the studies that clearly specified lung volume definition, more researchers used the BL-GTV method recently; however, methods vary from study to study (5, 6, 19, 20).…”

Section: Discussionsupporting

confidence: 87%

Effect of Normal Lung Definition on Lung Dosimetry and Lung Toxicity Prediction in Radiation Therapy Treatment Planning

Wang

Schipper

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

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Purpose This study aimed to compare lung dose–volume histogram (DVH) parameters such as mean lung dose (MLD) and the lung volume receiving ≥20 Gy (V20) of commonly used definitions of normal lung in terms of tumor/target subtraction and to determine to what extent they differ in predicting radiation pneumonitis (RP). Methods and Materials One hundred lung cancer patients treated with definitive radiation therapy were assessed. The gross tumor volume (GTV) and clinical planning target volume (PTVc) were defined by the treating physician and dosimetrist. For this study, the clinical target volume (CTV) was defined as GTV with 8-mm uniform expansion, and the PTV was defined as CTV with an 8-mm uniform expansion. Lung DVHs were generated with exclusion of targets: (1) GTV (DVHG); (2) CTV (DVHC); (3) PTV (DVHP); and (4) PTVc (DVHPc). The lung DVHs, V20s, and MLDs from each of the 4 methods were compared, as was their significance in predicting radiation pneumonitis of grade 2 or greater (RP2). Results There are significant differences in dosimetric parameters among the various definition methods (all Ps<.05). The mean and maximum differences in V20 are 4.4% and 12.6% (95% confidence interval 3.6%–5.1%), respectively. The mean and maximum differences in MLD are 3.3 Gy and 7.5 Gy (95% confidence interval, 1.7–4.8 Gy), respectively. MLDs of all methods are highly correlated with each other and significantly correlated with clinical RP2, although V20s are not. For RP2 prediction, on the receiver operating characteristic curve, MLD from DVHG (MLDG has a greater area under curve of than MLD from DVHC (MLDC) or DVHP (MLDP). Limiting RP2 to 30%, the threshold is 22.4, 20.6, and 18.8 Gy, for MLDG, MLDC, and MLDP, respectively. Conclusions The differences in MLD and V20 from various lung definitions are significant. MLD from the GTV exclusion method may be more accurate in predicting clinical significant radiation pneumonitis.

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Section: Discussionsupporting

confidence: 87%

Effect of Normal Lung Definition on Lung Dosimetry and Lung Toxicity Prediction in Radiation Therapy Treatment Planning

Wang

Schipper

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

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“…Combination of chemotherapy and RT has been well reported increasing the risk of pulmonary injury, either sequential [16] or concurrent [12,13]. Weekly docetaxel with concurrent conventional radiotherapy resulted in 47% grade ≥3 RP [13]; Carboplatin plus taxanes with concurrent 3D-CRT resulted in 32% grade ≥3 RP [12].…”

Section: Discussionmentioning

confidence: 99%

Risk and predictors for early radiation pneumonitis in patients with stage III non-small cell lung cancer treated with concurrent or sequential chemoradiotherapy

Dang

Zang

et al. 2014

Radiat Oncol

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BackgroundThe rate of radiation pneumonitis (RP) for patients receiving chemoradiotherapy has been various across studies. Whether it is related to different chemotherapy schedules used in combination with radiation therapy were evaluated in this study. New factors associated with RP were also investigated.Methods and materialsA total of 369 consecutive patients with Stage III non small cell lung cancer treated with chemoradiotherapy were followed after radiotherapy (RT). Among them 262 patients received concurrent chemoradiotherapy followed by consolidation chemotherapy and 107 patients received only sequential chemotherapy after RT. RP was graded according to Common Terminology Criteria for Adverse Events version 4.0.ResultsThe rate of grade ≥ 2 were 39.7%, 31% and 33.6% in the concurrent DP (docetaxel/cisplatin), concurrent NP (vinorelbine/cisplatin) and sequential group, and grade ≥ 3 RP were 18.4%, 9.5%, and 11.2% respectively. The rate of grade ≥ 3 RP was significantly higher in concurrent DP group than that in concurrent NP group (p = 0.04). RP occurred earlier in concurrent DP group than that in the other two groups. There were no significant differences in response rate among the three groups. In the multivariate analysis, age (OR = 1.99, p = 0.038 and OR = 8.90, p < 0.001), chemotherapy schedule (OR = 1.45, p = 0.041 and OR = 1.98, p = 0.013), mean lung dose(OR = 1.42, p < 0.001 and OR = 1.64, p < 0.001), and planning target volume(OR = 1.004, p = 0.001 and OR = 1.005, p = 0.021) were predictors for both grade ≥ 2 and grade ≥ 3 RP. Response to treatment was a new predictor for grade ≥ 3 RP only (OR = 4.39, p = 0.034).ConclusionsResponse to treatment was found to be a new predictor for grade ≥ 3 RP. Compared to concurrent NP schedule, concurrent DP schedule achieved similar response to treatment but resulted in a higher risk of grade ≥ 3 RP.

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“…Combination of chemotherapy and RT has been well reported increasing the risk of pulmonary injury, either sequential [8] or concurrent [9]. The targets of drugs with direct toxicity to human cells were consistent with the radioactive rays.…”

Section: Discussionmentioning

confidence: 90%

Radiation Pneumonitis after Radiotherapy of Neck Lymphoma

Wei

Cai

Tong

et al. 2014

Case Reports in Pulmonology

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Radiotherapy is still one of the effective means for treatment of malignant tumors up to now. Particularly, it is an indispensable effective measure for treatment of some lymphoma patients. In routine work, radiation pneumonitis (RP) is the most significant complication of acute treatment-related toxicities in lung cancer; however, serious radioactive pneumonia is rare for the radiotherapy of neck lymphoma because the volume of the lungs affected by radiation dose was very small. We report a lymphoma case, where the patient had undergone radiotherapy for the bilateral neck and bilateral supraclavicular/infraclavicular area. Following completion of radiotherapy, the patient developed severe radiation pneumonitis.

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Analysis of related factors associated with radiation pneumonitis in patients with locally advanced non-small-cell lung cancer treated with three-dimensional conformal radiotherapy

Cited by 26 publications

References 24 publications

Effect of Normal Lung Definition on Lung Dosimetry and Lung Toxicity Prediction in Radiation Therapy Treatment Planning

Effect of Normal Lung Definition on Lung Dosimetry and Lung Toxicity Prediction in Radiation Therapy Treatment Planning

Risk and predictors for early radiation pneumonitis in patients with stage III non-small cell lung cancer treated with concurrent or sequential chemoradiotherapy

Radiation Pneumonitis after Radiotherapy of Neck Lymphoma

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