Stereotactic body radiotherapy for lung tumors in patients with subclinical interstitial lung disease: The potential risk of extensive radiation pneumonitis

Yamaguchi, S; Ohguri, Takayuki; Ide, Satoru; Aoki, Takatoshi; Imada, Hajime; Yahara, Katsuya; Narisada, Hiroyuki; Korogi, Yukunori

doi:10.1016/j.lungcan.2013.08.024

Cited by 118 publications

(90 citation statements)

References 24 publications

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“…However, they suggested that the rate of extensive RP beyond the irradiated area was significantly increased for those with subclinical ILD. 36 As for significant ILD, the cumulative incidences of ≥ Gr2 RP and ≥ Gr3 RP were increased significantly versus the others in our cohort. One grade-4 RP was observed in eight patients with significant ILD and their radiological pattern was due to acute exacerbation of interstitial pneumonia.…”

Section: Discussionmentioning

confidence: 48%

“…For patients with subclinical ILD who underwent surgical resection, postoperative acute respiratory distress syndrome showed an increase in those with subclinical idiopathic pulmonary fibrosis. 18 Yamaguchi et al 36 reported that subclinical ILD findings in 16 patients had no significant impact on RP incidence after SBRT. Their subclinical ILD definition was similar to our minimal ILD.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Pretreatment Interstitial Lung Disease on Radiation Pneumonitis and Survival after Stereotactic Body Radiation Therapy for Lung Cancer

Ueki

Matsuo

Togashi

et al. 2015

Journal of Thoracic Oncology

146

105

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Impact of Pretreatment Interstitial Lung Disease on Radiation Pneumonitis and Survival after Stereotactic Body Radiation Therapy for Lung Cancer

Ueki

Matsuo

Togashi

et al. 2015

Journal of Thoracic Oncology

146

105

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“…A single study has raised concerns about the use of stereotactic body radiotherapy in severe ILD because of a high risk of radiation pneumonitis. In subclinical disease, radiotherapy has been shown to be relatively safe with a low risk of radiation pneumonitis extending beyond the irradiated field [128]. Chemotherapy-induced acute exacerbations of lung disease have an incidence of 8.7-21% [129].…”

Section: Lung Cancermentioning

confidence: 99%

Comorbidities in interstitial lung diseases

2017

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Fibrosing lung disorders include a large number of diseases with diverse behaviour. Patients can die because of the progression of their illness, remain stable or even improve after appropriate treatment has been instituted. Comorbidities, such as acute and chronic infection, gastro-oesophageal reflux, pulmonary hypertension, lung cancer, cardiovascular diseases, and obstructive sleep apnoea, can pre-exist or develop at any time during the course of the disease and, if unidentified and untreated, may impair quality of life, impact upon the respiratory status of the patients, and ultimately lead to disease progression and death. Therefore, early identification and accurate treatment of comorbidities is essential.

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“…SBRT dose and fractionation are often considered important, affecting clinical management decisions with respect to lung tolerance and tumor control, particularly in elderly patients and/or those with chronic lung interstitial diseases (12,16). Physical dosimetric measures such as mean lung dose (MLD) and lung V20 (percent or absolute volume receiving over 20 Gy), often used to guide clinical practice, were analyzed in some studies, showing inconsistent relationship with RILT after SBRT (17-19), perhaps due to the limited number of toxicity events from each study.…”

Section: Introductionmentioning

confidence: 99%

Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies

Zhao

Yorke

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

152

108

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Purpose To study the risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiotherapy (SBRT) of the thorax. Methods Published studies on lung toxicity in patients with early stage non-small cell lung cancer (NSCLC) or metastatic lung tumors treated with SBRT were pooled and analyzed. The primary endpoint was RILT including pneumonitis and fibrosis. Data of RILT and risk factors were extracted from each study, and rates of grade 2-5 (G2+) and grade 3-5 (G3+) RILT were computed. Patient, tumor and dosimetric factors were analyzed for their correlation with RILT. Results Eighty-eight studies (7752 patients), that reported RILT incidence, were eligible. The pooled rates of G2+ and G3+ RILT from all 88 studies were 9.1% (95% CI: 7.15-11.4) and 1.8% (95% CI: 1.3-2.5), respectively. The median of median tumor sizes was 2.3 (range 1.4-4.1) cm. Among the factors analyzed, older patient age (P= 0.044) and larger tumor size (the greatest diameter) were significantly correlated with higher rates of G2+ (P= 0.049) and G3+ RILT (P= 0.001). Patients with stage IA vs. stage IB NSCLC had significantly lower risks of G2+ RILT (8.3% vs 17.1%, OR= 0.43, 95% CI: 0.29-0.64, P<0.0001). Among studies that provided detailed dosimetric data, the pooled analysis demonstrated a significantly higher mean lung dose (MLD) (P= 0.027) and V20 (P= 0.019) in patients with G2+ RILT comparing to that of grade 0-1 RILT. Conclusions The overall rate of RILT is relatively low after thoracic SBRT. Older age and larger tumor size are significant adverse risk factors for RILT. Lung dosimetry, specifically lung V20 and MLD also significantly affect RILT risk. Summary Risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiotherapy (SBRT) were analyzed from 88 published studies (7752 patients). The overall rate of RILT is relatively low after thoracic SBRT. Adverse risk factors for RILT after SBRT include older age, larger tumor size and greater lung dose-volume exposure as measured by mean lung dose and volume of lung receiving greater than 20 Gy.

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Stereotactic body radiotherapy for lung tumors in patients with subclinical interstitial lung disease: The potential risk of extensive radiation pneumonitis

Cited by 118 publications

References 24 publications

Impact of Pretreatment Interstitial Lung Disease on Radiation Pneumonitis and Survival after Stereotactic Body Radiation Therapy for Lung Cancer

Impact of Pretreatment Interstitial Lung Disease on Radiation Pneumonitis and Survival after Stereotactic Body Radiation Therapy for Lung Cancer

Comorbidities in interstitial lung diseases

Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies

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