Elevation in Exhaled Nitric Oxide Predicts for Radiation Pneumonitis

Guerrero, Thomas; Martínez, José Luis Zunzunegui; McCurdy, Matthew R.; Wolski, Michael; McAleer, M.F.

doi:10.1016/j.ijrobp.2010.08.041

Cited by 12 publications

(13 citation statements)

References 47 publications

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“…The results were similar to this study. The eNO-changing ratio can be used to predict the occurrence of SRP after thoracic radiotherapy, which is similar to Guerrero et al [29]. Guerrero et al studied 34 patients with esophageal cancer and found that the eNO-changing ratio can be used as a classifier to predict SRP with a smaller average error rate (only 8%).…”

Section: Discussionsupporting

confidence: 54%

Exhaled Nitric Oxide Is Useful in Symptomatic Radioactive Pneumonia: A Retrospective Study

Fei

2017

Mediators of Inflammation

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The aim was to defect the exhaled nitric oxide (eNO) prediction value of symptomatic radioactive pneumonia (SRP). 64 cases of lung cancer or esophagus cancer, who had the primary radiotherapy (intensity-modulated radiation therapy), were included from 2015 June to 2016 January. During the following, the patients were divided: the symptomatic radiation pneumonia group (SRP, with the CTCAE v4.0 score > 2) and the asymptomatic radiation pneumonia group (ASRP, with CTCAE v4.0 score ≤ 1). All the patients were measured eNO before and at the end of thoracic radiotherapy and gain the posttherapy eNO value and the eNO ratio (posttherapy eNO value/pretherapy eNO value), then the predictive values of eNO toward SRP were measured using the receiver-operating characteristic (ROC). 17 cases were included in the SRP group and the other 47 were included in the ASRP group. The posttherapy eNO was 29.35 (19~60) bbp versus 20.646 (11~37) (P < 0 001), and the ratio was 1.669 (0.61~3.5) versus 0.920 (0.35~1.5) (P < 0 01) (symptomatic versus asymptomatic). ROC showed that the cutoff value of SRP was 19.5 bbp (posttherapy eNO, area under concentration-time curve (AUC) = 0.879) and 1.305 (eNO ratio, AUC = 0.774), which meant that posttherapy eNO and eNO ratio were useful in finding SRP.

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Section: Discussionsupporting

confidence: 54%

Exhaled Nitric Oxide Is Useful in Symptomatic Radioactive Pneumonia: A Retrospective Study

Fei

2017

Mediators of Inflammation

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“…A total of 3/5 of these patients developed RP requiring steroid medication (6). McCurdy et al (20) and Guerrero et al (21) examined 28 patients with esophageal cancer and identified that a 1.5-fold increase in eNO exhibited 100% sensitivity and specificity for the prediction of RP (18,20). In another study by the same group, the ratio of eNO (the level at the end of RT/pre-RT level) was calculated for 50 lung or esophageal cancer patients.…”

Section: Discussionmentioning

confidence: 99%

“…In another study by the same group, the ratio of eNO (the level at the end of RT/pre-RT level) was calculated for 50 lung or esophageal cancer patients. A threshold of 1.4 could perfectly distinguish symptomatic and asymptomatic patients (21). In contrast, Enache et al (18) identified that although the specificity of a 10 ppb increase in eNO level was relatively specific (specificity, 83%) for predicting RP symptoms in lung cancer patients, the sensitivity was low (18%).…”

Section: Discussionmentioning

confidence: 99%

Measurement of exhaled nitric oxide and serum surfactant protein D levels for monitoring radiation pneumonitis following thoracic radiotherapy

et al. 2017

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The present study aimed to examine the role of exhaled nitric oxide (eNO) and serum surfactant protein D (SP-D) level in the determination of radiation pneumonitis (RP) after thoracic radiotherapy (RT). The study included 34 treatments for 33 patients, including 16 three-dimensional conformal and 18 stereotactic body RT treatments. eNO levels were measured prior to RT, immediately subsequent to RT, every week during the RT course and at 1, 3, 6, 9 and 12 months following the treatment. The therapy reduced the eNO from 24.3±12.8 ppb prior to RT to 19.0±10.4 ppb immediately subsequent to RT (P=0.04). A total of 5 patients (14%) developed symptomatic RP of grade 2 or higher 3–5 months later, and exhibited an eNO elevation of 2.1±0.68-fold the minimum value, whereas the RP- group exhibited 1.4±0.6-fold elevation (P=0.02). The sensitivity of a cut-off of a 1.4-fold increase in the eNO ratio at the onset of RP was 100%; however, the specificity was 52%, and no predictive alterations to eNO levels were observed prior to the onset of RP. RT was associated with an elevated serum SP-D level at 3–6 months after RT. There was a statistically significant difference in the initial serum SP-D level between RP+ and RP- patients. In conclusion, obtaining the eNO ratio was a useful RP monitoring tool but did not predict RP occurrence in the present setting, whereas serum SP-D level may be a potential predictor for the detection of RP risk.

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“…Numerous factors such as percentage of lung irradiated [14-16] and chemotherapy type [3,7,17] have been shown to affect occurrence and degree of RP. Another such factor, interstitial pneumonitis (IP) on pretreatment computed tomography (CT) scans, has been shown to predict an increased risk of symptomatic RP [18-20].…”

Section: Introductionsmentioning

confidence: 99%

Pre-radiotherapy FDG PET predicts radiation pneumonitis in lung cancer

Castillo¹,

Pham

Ansari

et al. 2014

Radiat Oncol

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BackgroundA retrospective analysis is performed to determine if pre-treatment [18 F]-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG PET/CT) image derived parameters can predict radiation pneumonitis (RP) clinical symptoms in lung cancer patients.Methods and MaterialsWe retrospectively studied 100 non-small cell lung cancer (NSCLC) patients who underwent FDG PET/CT imaging before initiation of radiotherapy (RT). Pneumonitis symptoms were evaluated using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv4) from the consensus of 5 clinicians. Using the cumulative distribution of pre-treatment standard uptake values (SUV) within the lungs, the 80th to 95th percentile SUV values (SUV80 to SUV95) were determined. The effect of pre-RT FDG uptake, dose, patient and treatment characteristics on pulmonary toxicity was studied using multiple logistic regression.ResultsThe study subjects were treated with 3D conformal RT (n = 23), intensity modulated RT (n = 64), and proton therapy (n = 13). Multiple logistic regression analysis demonstrated that elevated pre-RT lung FDG uptake on staging FDG PET was related to development of RP symptoms after RT. A patient of average age and V30 with SUV95 = 1.5 was an estimated 6.9 times more likely to develop grade ≥ 2 radiation pneumonitis when compared to a patient with SUV95 = 0.5 of the same age and identical V30. Receiver operating characteristic curve analysis showed the area under the curve was 0.78 (95% CI = 0.69 – 0.87). The CT imaging and dosimetry parameters were found to be poor predictors of RP symptoms.ConclusionsThe pretreatment pulmonary FDG uptake, as quantified by the SUV95, predicted symptoms of RP in this study. Elevation in this pre-treatment biomarker identifies a patient group at high risk for post-treatment symptomatic RP.

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Elevation in Exhaled Nitric Oxide Predicts for Radiation Pneumonitis

Cited by 12 publications

References 47 publications

Exhaled Nitric Oxide Is Useful in Symptomatic Radioactive Pneumonia: A Retrospective Study

Exhaled Nitric Oxide Is Useful in Symptomatic Radioactive Pneumonia: A Retrospective Study

Measurement of exhaled nitric oxide and serum surfactant protein D levels for monitoring radiation pneumonitis following thoracic radiotherapy

Pre-radiotherapy FDG PET predicts radiation pneumonitis in lung cancer

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