Radiation pneumonitis in lung cancer patients: a retrospective study of risk factors and the long-term prognosis

Inoue, Akira; Kunitoh, Hideo; Sekine, Ikuo; Sumi, Minako; Tokuuye, Koichi; Saijo, Nagahiro

doi:10.1016/s0360-3016(00)00783-5

Cited by 175 publications

(122 citation statements)

References 23 publications

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“…It has been reported that a pre-existing pulmonary disease predisposes the patient to manifestation of RP (Robnett et al, 2000;Inoue et al, 2001). In our patients' sample, 10 patients suffered from COPD.…”

Section: Discussionmentioning

confidence: 99%

Suggestion for a New Grading Scale for Radiation Induced Pneumonitis Based on Radiological Findings of Computerized Tomography: Correlation with Clinical and Radiotherapeutic Parameters in Lung Cancer Patients

Kouloulias

Zygogianni²,

Efstathopoulos³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: The objective of this research is the computed axial tomography (CT) imaging grading of radiation induced pneumonitis (RP) and its correlation with clinical and radiotherapeutic parameters. Materials and Methods: The chest CT films of 20 patients with non-small cell lung cancer who have undergone threedimensional conformal radiation therapy were reviewed. The proposed CT grading of RP is supported on solely radiological diagnosis criteria and distinguishes five grades. The manifestation of RP was also correlated with any positive pre-existing chronic obstructive pulmonary disease (COPD) history, smoking history, the FEV1 value, and the dosimetric variable V20. Results: The CT grading of RP was as follows: 3 patients (15%) presented with ground glass opacity (grade 1), 9 patients (45%) were classified as grade 2, 7 patients (35%) presented with focal consolidation, with or without elements of fibrosis (grade 3), and only one patient (5%) presented with opacity with accompanying atelectasis and loss of pulmonary volume (grade 4). Both univariate and multivariate analysis revealed as prognostic factors for the radiological grading of RP the reduction of FEV1 and the V20 (P=0.026 and P=0.003, respectively). There was also a significant (P<0.001) correlation of radiological grading of RP with FEV1 and V20 (spearman rho 0.92 and 0.93, respectively). Conclusions: The high correlation of the proposed radiological grading with the FEV1 and the V20 is giving a satisfactory clinical validity. Although the proposed grading scale seems relevant to clinical practice, further studies are needed for the confirmation of its validity and reliability.

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Section: Discussionmentioning

confidence: 99%

Suggestion for a New Grading Scale for Radiation Induced Pneumonitis Based on Radiological Findings of Computerized Tomography: Correlation with Clinical and Radiotherapeutic Parameters in Lung Cancer Patients

Kouloulias

Zygogianni²,

Efstathopoulos³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…Several of these clinical factors, such as gender (8,16,23,(36)(37)(38)(39)(40)(41)(42)(43), age (36)(37)(38)(39)(41)(42)(43)(44)(45)(46) and tobacco use (18,22,(36)(37)(38)45,47), may have an impact on RT-induced lung injury, and are not considered in our analysis. For the analysis of responders vs. non-responders, it is not possible to control for all of the clinical variables (such as rates of patients with SCLC, or early stage lesions) since the phenotype of responders and non-responders may be fundamentally different.…”

Section: Study Limitationsmentioning

confidence: 99%

The Impact of Induction Chemotherapy and the Associated Tumor Response on Subsequent Radiation-Related Changes in Lung Function and Tumor Response

Mao

Koçak

Zhou

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To assess the impact of induction chemotherapy, and associated tumor shrinkage, on the subsequent radiation-related changes in pulmonary function and tumor response.Methods and Materials-As part of a prospective IRB-approved study, 91 evaluable patients treated definitively with thoracic RT for unresectable lung cancer were analyzed. The rates of RTassociated pulmonary toxicity and tumor response were compared in the patients with and without pre-RT chemotherapy. In the patients receiving induction chemotherapy, the rates of RT-associated pulmonary toxicity and tumor response were compared in the patients with and without a response (modified RECIST criteria) to the pre-RT chemotherapy. Comparisons of the rates of improvements in PFTs post-RT, dyspnea requiring steroids, and percent declines in PFTs post-RT were compared in patient subgroups using Fisher's exact test, analysis of variance, and linear or logistic regression.Results and conclusion-The use of pre-RT chemotherapy appears to increase the rate of radiation-induced pneumonitis (p=0.07-0.01), but has no consistent impact on changes in PFTs. The degree of induction-chemotherapy-associated tumor shrinkage is not associated with the rate of subsequent-RT-associated pulmonary toxicity. The degree of tumor response to chemotherapy is not related to the degree of tumor response to RT. Additional study is needed to better clarify this issue.

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“…Several efforts have been made to identify patient-, tumor-and dose-related factors that may influence the risk of RP (9)(10)(11). However, the proposed predictive models have limited clinical utility, predominantly due to the lack of validation of the models in an independent dataset (9,10), and the omission of important clinical and treatment-related confounding factors (11).…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of all-grade RP following CCRT ranges between 13 and 37%, whereas the incidence of severe RP (grades III-IV) has been reported in ≤20% of cases (6)(7)(8). Considering the substantial negative impact of RP on quality of life and prognosis (9), it is essential to stratify patients according to their risk of developing RP prior to the initiation of CCRT, in order to individualize the treatment strategy.…”

Section: Introductionmentioning

confidence: 99%

“…However, the proposed predictive models have limited clinical utility, predominantly due to the lack of validation of the models in an independent dataset (9,10), and the omission of important clinical and treatment-related confounding factors (11). Recently, an individual patient meta-analysis presented a predictive model for RP (STRIPE project) that divided the patients into three different risk groups based on the type of chemotherapy used, the age of the patient and two dosimetric parameters [the mean lung dose (MLD) and V20] (12).…”

Section: Introductionmentioning

confidence: 99%

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Validation and optimization of a predictive model for radiation pneumonitis in patients with lung cancer

et al. 2016

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Abstract. The aim of the current retrospective study was to validate a predictive model for radiation pneumonitis (STRIPE) in an independent dataset and to investigate whether the addition of other potential risk factors could strengthen the accuracy of the model. Consecutive patients with non-small cell lung carcinoma (NSCLC; n=71) treated with definitive concurrent chemotherapy and radiotherapy were retrospectively assessed for radiation pneumonitis (RP). The results identified that 16 (23%) patients developed grade ≥2 RP. Furthermore, STRIPE score (intermediate vs. low risk) was independently associated with the development of RP [odds ratio (OR), 3.72; 95% confidence interval (CI), 1.00-13.89], whereas current smoking status was found to be protective against RP (OR, 0.09; 95% CI, 0.01-0.78). Similar discriminatory power of the STRIPE score was observed as in the original study. The addition of smoking status strengthened the model's discriminatory ability to predict RP. Thus, the addition of smoking status as a risk factor may strengthen the accuracy of the model for predicting RP in patients with NSCLC.

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Radiation pneumonitis in lung cancer patients: a retrospective study of risk factors and the long-term prognosis

Cited by 175 publications

References 23 publications

Suggestion for a New Grading Scale for Radiation Induced Pneumonitis Based on Radiological Findings of Computerized Tomography: Correlation with Clinical and Radiotherapeutic Parameters in Lung Cancer Patients

Suggestion for a New Grading Scale for Radiation Induced Pneumonitis Based on Radiological Findings of Computerized Tomography: Correlation with Clinical and Radiotherapeutic Parameters in Lung Cancer Patients

The Impact of Induction Chemotherapy and the Associated Tumor Response on Subsequent Radiation-Related Changes in Lung Function and Tumor Response

Validation and optimization of a predictive model for radiation pneumonitis in patients with lung cancer

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