Exceptionally high incidence of symptomatic grade 2–5 radiation pneumonitis after stereotactic radiation therapy for lung tumors

Yamashita, Hideomi; Nakagawa, Keiichi; Nakamura, Naoki; Koyanagi, Hiroki; Tago, Masao; Igaki, Hiroshi; Shiraishi, Kenshiro; Sasano, Nakashi; Ohtomo, Kuni

doi:10.1186/1748-717x-2-21

Cited by 155 publications

(115 citation statements)

References 38 publications

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“…Scoring systems should be considered when interpreting RP results. The reported rates of symptomatic RP after SBRT range from 9% to 28% [8,10,11,[28][29][30][31] . Although most of the RP was Grade 1 or 2 and either asymptomatic or Yamashita H et al .…”

Section: Rp After Sbrtmentioning

confidence: 99%

“…Although most of the RP was Grade 1 or 2 and either asymptomatic or Yamashita H et al . RP after SBRT for lung cancer manageable, a few cases were severe and there was a risk for mortality [8] . It is very important to develop a method to predict the risk of RP after SBRT for lung cancer.…”

Section: Rp After Sbrtmentioning

confidence: 99%

“…Symptomatic lung toxicity with SBRT is typically less than 10% [7] ; however, occurrences up to 25% have been reported [8] , highlighting the necessity of developing SBRT treatment parameters that ensure consistently low toxicity levels.…”

Section: Introductionmentioning

confidence: 99%

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Radiation pneumonitis after stereotactic radiation therapy for lung cancer

Yamashita

Takahashi

Haga

et al. 2014

WJR

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Stereotactic body radiation therapy (SBRT) has a local control rate of 95% at 2 years for non-small cell lung cancer (NSCLC) and should improve the prognosis of inoperable patients, elderly patients, and patients with significant comorbidities who have early-stage NSCLC. The safety of SBRT is being confirmed in international, multi-institutional Phase Ⅱ trials for peripheral lung cancer in both inoperable and operable patients, but reports so far have found that SBRT is a safe and effective treatment for early-stage NSCLC and early metastatic lung cancer. Radiation pneumonitis (RP) is one of the most common toxicities of SBRT. Although most post-treatment RP is Grade 1 or 2 and either asymptomatic or manageable, a few cases are severe, symptomatic, and there is a risk for mortality. The reported rates of symptomatic RP after SBRT range from 9% to 28%. Being able to predict the risk of RP after SBRT is extremely useful in treatment planning. A dose-effect relationship has been demonstrated, but suggested dose-volume factors like mean lung dose, lung V20, and/or lung V2.5 differed among the reports. We found that patients who present with an interstitial pneumonitis shadow on computed tomography scan and high levels of serum Krebs von den Lungen-6 and surfactant protein D have a high rate of severe radiation pneumonitis after SBRT. At our institution, lung cancer patients with these risk factors have not received SBRT since 2006, and our rate of severe RP after SBRT has decreased significantly since then.

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Section: Rp After Sbrtmentioning

confidence: 99%

Section: Rp After Sbrtmentioning

confidence: 99%

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Radiation pneumonitis after stereotactic radiation therapy for lung cancer

Yamashita

Takahashi

Haga

et al. 2014

WJR

Self Cite

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“…Although toxicities from lung SBRT are considered minimal, reported rates of radiation pneumonitis requiring clinical intervention range from 0% to 29% (7,(26)(27)(28). A large Japanese survey (7) of 2390 patients treated with SBRT reported (33).…”

Section: Toxicities and Pulmonary Fibrosismentioning

confidence: 99%

Excellent Cancer Outcomes Following Patient-adapted Robotic Lung SBRT But a Case for Caution in Idiopathic Pulmonary Fibrosis

Bahig

Filion

et al. 2014

Technol Cancer Res Treat

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The aim of this study is to report outcomes and prognostic factors for early stage non-small cell lung cancer treated with patient-adapted Cyberknife stereotactic body radiotherapy. A retrospective analysis of 150 patients with T1-2N0 non-small cell lung cancer treated with stereotactic body radiotherapy was conducted. An algorithm based on tumor and patient's characteristics was used to orient patients towards soft tissue (Xsight Lung), fiducials or adjacent bone (Xsight Spine) tracking. Median biological effective dose without correction for tissue inhomogeneities was 180 Gy 10 for peripheral tumors and 113 Gy 10 for central tumors. Median follow-up was 22 months. Actuarial 2 years local control, overall survival and disease-specific survival were respectively 96%, 87% and 95%. Every 1 cm increase in tumor diameter was associated with a relative risk for regional or distant relapse of 2 (95%CI 5 1.2-3.6, p 5 0.009). With doses 132 Gy 10 and 132 Gy 10 , local control was 98% vs. 82% (p 5 0.07), disease-specific survival 97% vs. 78% (p 5 0.02) and overall survival 93% vs. 76% (p 5 0.01), respectively. Better disease-specific survival and a trend for better overall survival was observed for peripheral vs. central tumors (96% vs. 79%, p 5 0.05 and 92% vs. 74%, p 5 0.08, respectively). A higher Charlson comordibity score (4) predicted lower overall survival (79% vs. 98%, p 5 0.01). Toxicities included 3 patients with idiopathic pulmonary fibrosis who developed grade 5 pneumonitis and 2 patients with grade 3 pneumonitis.We therefore report excellent local control and disease-specific survival following patientadapted Cyberknife lung stereotactic body radiotherapy. Although toxicities were in general minimal, patients with pulmonary fibrosis might be at greater risk of severe complications.Small size, peripheral location, dose  132 Gy 10 and a low Charlson co-morbidity score seem to be associated with better outcomes.

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“…In thoracic radiotherapy, dose escalation is limited by the normal tissue complication probability (NTCP). Using current treatment protocols, the risk of radiation pneumonitis is of most concern as it has considerable impact on patient morbidity and mortality [16,137,[152][153][154][155].…”

Section: Introductionmentioning

confidence: 99%

Effects of genistein following fractionated lung irradiation in mice

Para¹,

Bezjak²,

Yeung³

et al. 2009

Radiotherapy and Oncology

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Radiation therapy for lung cancer and cancers of the upper thorax is limited by side effects to normal tissue of the lung. An understanding of mechanisms leading to radiation induced lung damage is essential to developing protective agents. In this thesis an anti-oxidant and anti-inflammatory agent Genistein was investigated for its potential to affect DNA damage, tissue inflammation, functional deficits and survival. We hypothesized that chronic oxidative stress and the subsequent inflammatory response play a key role in the development of major lung complications, radiation pneumonitis and fibrosis. If side effects of radiation could be reduced, then larger doses could be delivered to the tumor with a better chance of eradicating the disease.ii Acknowledgements

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Exceptionally high incidence of symptomatic grade 2–5 radiation pneumonitis after stereotactic radiation therapy for lung tumors

Abstract: Background: To determine the usefulness of dose volume histogram (DVH) factors for predicting the occurrence of radiation pneumonitis (RP) after application of stereotactic radiation therapy (SRT) for lung tumors, DVH factors were measured before irradiation.

Cited by 155 publications

References 38 publications

Radiation pneumonitis after stereotactic radiation therapy for lung cancer

Radiation pneumonitis after stereotactic radiation therapy for lung cancer

Excellent Cancer Outcomes Following Patient-adapted Robotic Lung SBRT But a Case for Caution in Idiopathic Pulmonary Fibrosis

Effects of genistein following fractionated lung irradiation in mice

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