Pulmonary Toxicity after Total Body Irradiation-An Underrated Complication? Estimation of Risk via Normal Tissue Complication Probability Calculations and Correlation with Clinical Data

被引:19
作者
Oertel, Michael [1 ]
Kittel, Christopher [1 ]
Martel, Jonas [1 ]
Mikesch, Jan-Henrik [2 ]
Glashoerster, Marco [1 ]
Stelljes, Matthias [2 ]
Eich, Hans Theodor [1 ]
机构
[1] Univ Hosp Muenster, Dept Radiat Oncol, D-48149 Munster, Germany
[2] Univ Hosp Muenster, Dept Med Hematol A, Hemostaseol, Oncol,Pulmonol, D-48149 Munster, Germany
关键词
total body irradiation; stem cell transplantation; lung toxicity; survivorship; BONE-MARROW-TRANSPLANTATION; INTERSTITIAL PNEUMONITIS; DOSE RATE;
D O I
10.3390/cancers13122946
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Simple Summary Total body irradiation is an integral part of many conditioning regimens prior to allogeneic stem cell transplantation. It is a large-field technique affecting all organs at risk, of which the lungs are critical for patient survival. However, the precise rates of long-term pulmonary toxicities are unknown. This analysis provides a large patient cohort with long-term follow-up investigating TBI sequelae. Additionally, we present normal tissue complication probability calculations for acute and chronic lung toxicities to enable comparison between biophysical and real-world data. To our knowledge, this is the first adaption of this model to a total-body irradiation patient cohort, which will help to evaluate the feasibility and appropriateness of this approach. Total body irradiation (TBI) is an essential part of various conditioning regimens prior to allogeneic stem cell transplantation, but is accompanied by relevant (long-term) toxicities. In the lungs, a complex mechanism induces initial inflammation (pneumonitis) followed by chronic fibrosis. The hereby presented analysis investigates the occurrence of pulmonary toxicity in a large patient collective and correlates it with data derived from normal tissue complication probability (NTCP) calculations. The clinical data of 335 hemato-oncological patients undergoing TBI were analyzed with a follow-up of 85 months. Overall, 24.8% of all patients displayed lung toxicities, predominantly pneumonia and pulmonary obstructions (13.4% and 6.0%, respectively). NTCP calculations estimated median risks to be 20.3%, 0.6% and 20.4% for overall pneumonitis (both radiological and clinical), symptomatic pneumonitis and lung fibrosis, respectively. These numbers are consistent with real-world data from the literature and further specify radiological and clinical apparent toxicity rates. Overall, the estimated risk for clinical apparent pneumonitis is very low, corresponding to the probability of non-infectious acute respiratory distress syndrome, although the underlying pathophysiology is not identical. Radiological pneumonitis and lung fibrosis are expected to be more common but require a more precise documentation by the transplantation team, radiologists and radiation oncologists.
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页数:12
相关论文
共 31 条
[1]   Factors Influencing Pulmonary Toxicity in Children Undergoing Allogeneic Hematopoietic Stem Cell Transplantation in the Setting of Total Body Irradiation-Based Myeloablative Conditioning [J].
Abugideiri, Mustafa ;
Nanda, Ronica H. ;
Butker, Charlotte ;
Zhang, Chao ;
Kim, Sungjin ;
Chiang, Kuang-Yueh ;
Butker, Elizabeth ;
Khan, Mohammad K. ;
Haight, Ann E. ;
Chen, Zhengjia ;
Esiashvili, Natia .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2016, 94 (02) :349-359
[2]   INTERSTITIAL PNEUMONITIS FOLLOWING BONE-MARROW TRANSPLANTATION AFTER LOW-DOSE RATE TOTAL-BODY IRRADIATION [J].
BARRETT, A ;
DEPLEDGE, MH ;
POWLES, RL .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1983, 9 (07) :1029-1033
[3]  
Byun HK, 2017, RADIAT ONCOL J, V35, P257, DOI 10.3857/roj.2017.00290
[4]   Total body irradiation and pneumonitis risk: a review of outcomes [J].
Carruthers, SA ;
Wallington, M .
BRITISH JOURNAL OF CANCER, 2004, 90 (11) :2080-2084
[5]   Reduced incidence of interstitial pneumonitis after allogeneic hematopoietic stem cell transplantation using a modified technique of total body irradiation [J].
Chiang, Yun ;
Tsai, Cheng-Hong ;
Kuo, Sung-Hsin ;
Liu, Chieh-Yu ;
Yao, Ming ;
Li, Chi-Cheng ;
Huang, Shang-Yi ;
Ko, Bor-Sheng ;
Lin, Chien-Ting ;
Hou, Hsin-An ;
Chou, Wen-Chien ;
Liu, Jia-Hau ;
Lin, Chien-Chin ;
Wu, Shang-Ju ;
Hsu, Szu-Chun ;
Chen, Yao-Chang ;
Lin, Kai-Hsin ;
Lin, Dong-Tsamn ;
Chou, Hsien-Tang ;
Lu, Meng-Yu ;
Yang, Yung-Li ;
Chang, Hsiu-Hao ;
Liu, Ming-Chih ;
Liao, Xiu-Wen ;
Wu, Jian-Kuen ;
Chou, Sheng-Chieh ;
Cheng, Chieh-Lung ;
Chen, Chien-Yuan ;
Tsay, Woei ;
Tien, Hwei-Fang ;
Tang, Jih-Luh ;
Chen, Yu-Hsuan .
SCIENTIFIC REPORTS, 2016, 6
[6]   SINGLE DOSE VERSUS HYPERFRACTIONATED TOTAL-BODY IRRADIATION BEFORE ALLOGENEIC BONE-MARROW TRANSPLANTATION - A NON-RANDOMIZED COMPARATIVE-STUDY OF 54 PATIENTS AT THE INSTITUT GUSTAVE-ROUSSY [J].
COSSET, JM ;
BAUME, D ;
PICO, JL ;
SHANK, B ;
GIRINSKI, T ;
BENHAMOU, E ;
BRIOT, E ;
MALAISE, E ;
HAYAT, M ;
DUTREIX, J .
RADIOTHERAPY AND ONCOLOGY, 1989, 15 (02) :151-160
[7]   Determining the incidence of interstitial pneumonitis and chronic kidney disease following full intensity haemopoetic stem cell transplant conditioned using a forward-planned intensity modulated total body irradiation technique [J].
Durie, Emily ;
Nicholson, Emma ;
Anthias, Chloe ;
Dunne, Emma M. ;
Potter, Mike ;
Ethell, Mark ;
Messiou, Christina ;
Brennan, Joy ;
Eagle, Sally ;
Talbot, James ;
Smyth, Gregory ;
Ingram, Westley ;
Saran, Frank ;
Mandeville, Henry C. .
RADIOTHERAPY AND ONCOLOGY, 2021, 158 :97-103
[8]   Influence of Total Body Irradiation Dose Rate on Idiopathic Pneumonia Syndrome in Acute Leukemia Patients Undergoing Allogeneic Hematopoietic Cell Transplantation [J].
Gao, Robert W. ;
Weisdorf, Daniel J. ;
DeFor, Todd E. ;
Ehler, Eric ;
Dusenbery, Kathryn E. .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2019, 103 (01) :180-189
[9]  
Gogna N K, 1992, Australas Radiol, V36, P317, DOI 10.1111/j.1440-1673.1992.tb03208.x
[10]   Radiation-Induced Lung Injury Assessment and Management [J].
Hanania, Alexander N. ;
Mainwaring, Walker ;
Ghebre, Yohannes T. ;
Hanania, Nicola A. ;
Ludwig, Michelle .
CHEST, 2019, 156 (01) :150-162