Radiation pneumonitis in patients with lung and mediastinal tumours: a retrospective study of risk factors focused on pulmonary emphysema

Abstract

Objectives: To evaluate the impact of pulmonary emphysema (PE) on the incidence and severity of radiation pneumonitis (RP) in patients with lung and mediastinal tumours. Methods: 92 patients were enrolled. Involved-field radiation therapy (non-small cell carcinoma or mediastinal tumours in 69 patients; median 70 Gy) and accelerated hyperfractionation (limited disease small cell carcinoma in 23 patients; median 45 Gy) were performed. Common Terminology Criteria for Adverse Events v.3.0 was used to evaluate RP and the relationship with the percentage of pulmonary volume irradiated to .20 Gy (V20) and PE. PE was diagnosed by the presence of low-attenuation areas (LAAs) on CT scans and was classified into Grades 0-4 according to the extent of the LAAs. Results: The median follow-up time was 16 months. The 6-month cumulative incidence of RP at Grade 3 or greater was 7.7% and 34.1% in patients with a V20 of ,25% and >25%, respectively (p50.017). In patients with PE Grades 0, 1, 2 and 3 or greater, the incidence of RP was 16.5%, 9.1%, 8.6% and 54.0%, respectively. As the PE Grade increased, the incidence of RP also increased significantly. Conclusion: The incidence and severity of RP are significantly higher in patients with a high V20 value as well as in those with severe PE.

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

“…At the same time, it was shown that there is a high correlation of the decrease in the percentage of FEV1 and V20, (r=0.49, P=0.032). Our observations confirm V20 as a significant factor of predisposition for the manifestation of RP in accordance with relevant publications (Claude et al, 2005;Piotrowski et al, 2005;Kong et al, 2006;Uno et al, 2006;Schallenkamp et al, 2007;Ramella et al, 2010;Kimura et al, 2012;Kumar et al, 2012).…”

Dosimetric comparison for volumetric modulated arc therapy and intensitymodulated radiotherapy on the left-sided chest wall and internal mammary nodes irradiation in treating post-mastectomy breast cancer

“…It has been shown that the V 20 and mean dose to the lung are good predictors for radiation induced lung toxicity 26. Also, an analysis of non-small-cell lung cancer has shown that the V 5 is a significant cut off point for the subsequent development of pneumonitis 27.…”

Combined Ventilation and Perfusion Imaging Correlates With the Dosimetric Parameters of Radiation Pneumonitis in Radiation Therapy Planning for Lung Cancer

“…Chronic obstructive pulmonary disease (COPD) has been recognized as an important risk factor for radiation pneumonitis (RP) (1,2). Pulmonary emphysema (PE) is a subtype of COPD characterized by airspace enlargement distal to and accompanied by destructive changes in the alveolar walls (3).…”

“…In patients with COPD, low attenuation areas (LAAs) that characteristically appear on computed tomography (CT) scans have been established as diagnostic imaging findings of COPD, including PE (4). Following a previously reported correlation between the incidence of RP and the extent of LAAs in whole-lung fields (2), we demonstrated the potential effectiveness of LAA-based functional image-guided radiotherapy planning for respiratory-guided intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) as a possible means of functional lung preservation in lung cancer patients with COPD (5). In addition, several other authors have reported functional image-guided radiotherapy planning studies intended to reduce the dose to the normal lung, including the functional lung, in M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 6 patients with COPD (5)(6)(7)(8)(9)(10)(11)(12).…”