Pulmonary Interstitial Changes Is a Predictive Factor for Radiation Pneumonitis After Stereotactic Body Radiation Therapy for Lung Cancer Patients

Abstract

retrospectively. They were treated with thoracic radiation therapy with median dose of 54 Gy (range, 45-64 Gy) in combination with chemotherapy regimen of etoposide/carboplatin (nZ15) or etoposide/cisplatin (nZ33). We proposed early treatment volume reduction rate (ETVRR) as a parameter for early treatment response that appeared percentage changes in gross tumor volume (GTV) between diagnostic chest CT or FDG-PET/ CT at pretreatment and adaptive CT performed at median dose of 36 Gy (range, 30-43 Gy) during CRT. Adaptive CT was performed in 30 patients (62.5%). Results: With median follow-up time of 27.4 months (range, 6.2-66.4 months), 2 year loco-regional progression free survival (LRPFS), and overall survival (OS) rates were 72.5% and 58.2%, respectively. Median initial GTV, median adaptive GTV, median ETVRR were 88.8 cc (range, 5.9-447 cc), 26 cc (range, 2.5-391 cc), and 71.4% (range, 31-97.6%). The ETVRR was correlated significantly with LRPFS (p Z 0.008) and OS (p < 0.001). The median LRPFS and OS were 47.8 and 31.8 months for patients with more than 45% of ETVRR, compared with 6.8 and 8.2 months for those with below 45%. Other factors such as age, sex, ECOG performance status, TNM stage, initial GTV, and overall treatment response did not show statistically difference in LRPFS and OS (All p > 0.05). Conclusion: The ETVRR as a parameter for early treatment response may be useful in prognostic factor of treatment outcomes in LS-SCLC patients treated with CRT.

European Organization for Research and Treatment of Cancer (EORTC) recommendations for planning and delivery of high-dose, high precision radiotherapy for lung cancer

“…Patient features such as lung function, age and gender fail to identify patients at high risk of radiation pneumonitis. However, interstitial lung disease and more particularly idiopathic pulmonary fibrosis, should be highlighted as risk factors for severe pneumonitis [98][99][100][101][102][103][104][105]. Such patients should be assessed by an expert pulmonary physician, and patients counselled and informed about high risk of radiation-related side-effects.…”

Proton Beam Therapy for Histologically or Clinically Diagnosed Stage I Non-Small Cell Lung Cancer (NSCLC): The First Nationwide Retrospective Study in Japan

“…The rates of grade !3 pneumonitis after SBRT in patients with interstitial changes on CT images or ILD have been reported to range from 10% to 38%. [32][33][34] In a recent multi-institutional study in Japan, the incidence of fatal RP was 6.9% after SBRT in patients with pulmonary interstitial change. 35 Further evaluation is planned to define which patients are the best candidates for PBT.…”

Radiotherapy of Lung Tumours in Idiopathic Pulmonary Fibrosis

“…Léčba závisí na závažnosti postižení, je ovlivněna především celkovým stavem pa cienta, stupněm dušnosti, jinými kli-nost intersticiálních změn je rizikem fatální PP [21,26]. Tento závěr podporuje i fakt, že v tuto chvíli neexistují jednoznačné limity dávek pro ozařování plicních karcinomů u IPF, a to ať již v případě využití radioterapie s konvenční frakcionací, či SBRT.…”

“…Jako prediktivní faktory vzniku PP u různých forem radioterapie vč. SBRT byly zkoumány věk, kouření, výkonnostní stav, pohlaví, plicní funkce, CRP, LDH, rozsah intersticiálního postižení, emfyzém, velikost ozařované léze (> 3 cm), typ dříve podané chemoterapie [15,[19][20][21][22][23]. V ně kte rých studiích byla PP častější u vysokého CRP a LDH, u PS 2 a u rozsahu intersticiálních změn > 10 % [6,11,17,24].…”