Interstitial Lung Change in Pre-radiation Therapy Computed Tomography Is a Risk Factor for Severe Radiation Pneumonitis

被引:47
作者
Lee, Yun Hee [1 ]
Kim, Yeon Sil [1 ]
Lee, Sang Nam [1 ]
Lee, Hyo Chun [1 ]
Oh, Se Jin [1 ]
Kim, Seoung Joon [2 ]
Kim, Young Kyoon [2 ]
Han, Dae Hee [3 ]
Yoo, Ie Ryung [4 ]
Kang, Jin Hyung [5 ]
Hong, Suk Hee [5 ]
机构
[1] Catholic Univ Korea, Dept Radiat Oncol, Seoul St Marys Hosp, Coll Med, Seoul 06591, South Korea
[2] Catholic Univ Korea, Dept Internal Med, Seoul St Marys Hosp, Coll Med, Seoul 06591, South Korea
[3] Catholic Univ Korea, Dept Radiol, Seoul St Marys Hosp, Coll Med, Seoul 06591, South Korea
[4] Catholic Univ Korea, Dept Nucl Med, Seoul St Marys Hosp, Coll Med, Seoul 06591, South Korea
[5] Catholic Univ Korea, Dept Med Oncol, Seoul St Marys Hosp, Coll Med, Seoul 06591, South Korea
来源
CANCER RESEARCH AND TREATMENT | 2015年 / 47卷 / 04期
关键词
Radiation pneumonitis; Interstitial lung diseases; Lung neoplasms; Radiotherapy; THORACIC RADIOTHERAPY; CANCER; METAANALYSIS; DISEASE; ASSOCIATION; PREDICTORS; MECHANISMS; INJURY; TUMORS;
D O I
10.4143/crt.2014.180
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose We examined clinical and dosimetric factors as predictors of symptomatic radiation pneumonitis (RP) in lung cancer patients and evaluated the relationship between interstitial lung changes in the pre-radiotherapy (RT) computed tomography (CT) and symptomatic RP. Materials and Methods Medical records and dose volume histogram data of 60 lung cancer patients from August 2005 to July 2006 were analyzed. All patients were treated with three dimensional (3D) conformal RT of median 56.9 Gy. We assessed the association of symptomatic RP with clinical and dosimetric factors. Results With a median follow-up of 15.5 months (range, 6.1 to 40.9 months), Radiation Therapy Oncology Group grade >= 2 RP was observed in 14 patients (23.3%). Five patients (8.3%) died from RP. The interstitial changes in the pre-RT chest CT, mean lung dose (MLD), and V-30 significantly predicted RP in multivariable analysis (p=0.009, p < 0.001, and p < 0.001, respectively). MLD, V-20, V-30, and normal tissue complication probability normal tissue complication probability (NTCP) were associated with the RP grade but less so for grade 5 RP. The risk of RP grade >= 2, >= 3, or >= 4 was higher in the patients with interstitial lung change (grade 2, 15.6% to 46.7%, p=0.03; grade 3, 4.4% to 40%, p=0.002; grade 4, 4.4% to 33.3%, p=0.008). Four of the grade 5 RP patients had diffuse interstitial change in pre-RT CT and received chemoradiotherapy. Conclusion Our study identified diffuse interstitial disease as a s gnificant clinical risk for RP, particularly fatal RP. We showed the usefulness of MLD, V-20, V-30, and NTCP in predicting the incidence and severity of RP.
引用
收藏
页码:676 / 686
页数:11
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