Predictors of Pneumonitis in Patients With Locally Advanced Non-Small Cell Lung Cancer Treated With Definitive Chemoradiation Followed by Consolidative Durvalumab

被引:11
作者
Diamond, Brett H. [1 ,2 ]
Belani, Neel [3 ]
Masel, Rebecca [4 ]
DeCarli, Kathryn [5 ,6 ]
DiPetrillo, Thomas [1 ,2 ,5 ]
Hepel, Jaroslaw T. [1 ,5 ]
Azzoli, Christopher G. [5 ,6 ]
Khurshid, Humera [5 ,6 ]
Abbas, Abbas [5 ,7 ]
Koffer, Paul P. [1 ,5 ]
机构
[1] Rhode Isl Hosp, Dept Radiat Oncol, Providence, RI 02903 USA
[2] Tufts Med Ctr, Dept Radiat Oncol, Boston, MA USA
[3] Fox Chase Canc Ctr, Dept Med Oncol, Philadelphia, PA USA
[4] Rhode Isl Hosp, Dept Med, Providence, RI USA
[5] Warren Alpert Sch Med, Providence, RI 02903 USA
[6] Rhode Isl Hosp, Dept Med Oncol, Providence, RI USA
[7] Rhode Isl Hosp, Dept Thorac Surg, Providence, RI USA
关键词
STAGE-III NSCLC; RADIATION PNEUMONITIS; CHEMORADIOTHERAPY; TOXICITY;
D O I
10.1016/j.adro.2022.101130
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: In patients with locally advanced, unresectable non-small cell lung cancer (NSCLC), the standard of care is concurrent chemoradiation (CRT) followed by consolidative immunotherapy with durvalumab. Pneumonitis is a known adverse event of both radiation therapy and immune checkpoint inhibitors such as durvalumab. We sought to characterize pneumonitis rates and dosimetric predictors of pneumonitis in a real-world population of patients with NSCLC treated with definitive CRT followed by consolidative durvalumab. Methods and Materials: Patients with NSCLC from a single institution who were treated with definitive CRT followed by consolidative durvalumab were identified. Outcomes of interest included pneumonitis incidence, type of pneumonitis, progression-free survival, and overall survival. Results: Sixty-two patients were included in our data set treated from 2018 to 2021 with a median follow-up of 17 months. The rate of grade 2+ pneumonitis in our cohort was 32.3%, and the rate of grade 3+ pneumonitis was 9.7%. Lung dosimetry parameters including V20 >30% and mean lung dose (MLD) >18 Gy were found to be correlated with increased rates of grade 2+ and grade 3+ pneumonitis. Patients with a lung V20 >30% had a grade 2+ pneumonitis rate at 1 year of 49.8% compared with 17.8% in patients with a lung V20 <30% (P = .015). Similarly, patients with an MLD >18 Gy had a grade 2+ pneumonitis rate at 1 year of 52.4% compared with 25.8% in patients with an MLD & LE;18 Gy (P = .01). Moreover, heart dosimetry parameters including mean heart dose >10 Gy were found to be correlated with increased rates of grade 2+ pneumonitis. The estimated 1-year overall survival and progression-free survival of our cohort were 86.8% and 64.1%, respectively. Conclusions: The modern management of locally advanced, unresectable NSCLC involves definitive chemoradiation followed by consolidative durvalumab. Pneumonitis rates were higher than expected in this cohort, particularly for patients with a lung V20 >30%, MLD >18 Gy, and mean heart dose >10 Gy, suggesting that more stringent radiation planning dose constraints may be needed. & COPY; 2022 Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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页数:9
相关论文
共 35 条
[21]   Chemoradiotherapy followed by durvalumab in patients with unresectable advanced non-small cell lung cancer: Management of adverse events [J].
Miura, Yu ;
Mouri, Atsuto ;
Kaira, Kyoichi ;
Yamaguchi, Ou ;
Shiono, Ayako ;
Hashimoto, Kosuke ;
Nishihara, Fuyumi ;
Shinomiya, Shun ;
Akagami, Tomoe ;
Murayama, Yoshitake ;
Abe, Takanori ;
Noda, Shin-ei ;
Kato, Shingo ;
Kobayashi, Kunihiko ;
Kagamu, Hiroshi .
THORACIC CANCER, 2020, 11 (05) :1280-1287
[22]  
National Comprehensive Cancer Network, 2021, NCCN GUID NONSM CELL
[23]  
National institute of health, 2017, National cancer institute Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
[24]   ADDING IPSILATERAL V20 AND V30 TO CONVENTIONAL DOSIMETRIC CONSTRAINTS PREDICTS RADIATION PNEUMONITIS IN STAGE IIIA-B NSCLC TREATED WITH COMBINED-MODALITY THERAPY [J].
Ramella, Sara ;
Trodella, Lucio ;
Mineo, Tommaso Claudio ;
Pompeo, Eugenio ;
Stimato, Gerardina ;
Gaudino, Diego ;
Valentini, Vincenzo ;
Cellini, Francesco ;
Ciresa, Marzia ;
Fiore, Michele ;
Piermattei, Angelo ;
Russo, Patrizia ;
Cesario, Alfredo ;
D'Angelillo, Rolando M. .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2010, 76 (01) :110-115
[25]   Prediction of radiation pneumonitis by dose-volume histogram parameters in lung cancer - a systematic review [J].
Rodrigues, G ;
Lock, M ;
D'Souza, D ;
Yu, E ;
Van Dyk, J .
RADIOTHERAPY AND ONCOLOGY, 2004, 71 (02) :127-138
[26]  
Shaverdian N, 2021, JTO CLIN RES REP, V2
[27]   Thoracic Radiation Normal Tissue Injury [J].
Simone, Charles B., II .
SEMINARS IN RADIATION ONCOLOGY, 2017, 27 (04) :370-377
[28]   Five-Year Survival Outcomes From the PACIFIC Trial: Durvalumab After Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer [J].
Spigel, David R. ;
Faivre-Finn, Corinne ;
Gray, Jhanelle E. ;
Vicente, David ;
Planchard, David ;
Paz-Ares, Luis ;
Vansteenkiste, Johan F. ;
Garassino, Marina C. ;
Hui, Rina ;
Quantin, Xavier ;
Rimner, Andreas ;
Wu, Yi-Long ;
Ozguroglu, Mustafa ;
Lee, Ki H. ;
Kato, Terufumi ;
de Wit, Maike ;
Kurata, Takayasu ;
Reck, Martin ;
Cho, Byoung C. ;
Senan, Suresh ;
Naidoo, Jarushka ;
Mann, Helen ;
Newton, Michael ;
Thiyagarajah, Piruntha ;
Antonia, Scott J. .
JOURNAL OF CLINICAL ONCOLOGY, 2022, 40 (12) :1301-+
[29]  
Thomas TS, 2020, J CLIN ONCOL, V38
[30]   Relationship between radiation doses to heart substructures and radiation pneumonitis in patients with thymic epithelial tumors [J].
Tomita, Natsuo ;
Okuda, Katsuhiro ;
Ogawa, Yasutaka ;
Iida, Masato ;
Eguchi, Yuta ;
Kitagawa, Yuto ;
Uchiyama, Kaoru ;
Takaoka, Taiki ;
Nakanishi, Ryoichi ;
Shibamoto, Yuta .
SCIENTIFIC REPORTS, 2020, 10 (01)