Predicting radiation pneumonitis after chemoradiation therapy for lung cancer: an international individual patient data meta-analysis.
David A. Palma,Suresh Senan,Kayoko Tsujino,R.B. Barriger,Ramesh Rengan,M. Moreno,Jeffrey D. Bradley,Tae Hyun Kim,Sara Ramella,Lawrence B. Marks,Luigi De Petris,Larry Stitt,George Rodrigues +12 more
TLDR
Several treatment-related risk factors predict the development of symptomatic pneumonitis, and elderly patients who undergo CCRT with carboplatin-paclitaxel chemotherapy are at highest risk.Abstract:
Background Radiation pneumonitis is a dose-limiting toxicity for patients undergoing concurrent chemoradiation therapy (CCRT) for non-small cell lung cancer (NSCLC). We performed an individual patient data meta-analysis to determine factors predictive of clinically significant pneumonitis. Methods and Materials After a systematic review of the literature, data were obtained on 836 patients who underwent CCRT in Europe, North America, and Asia. Patients were randomly divided into training and validation sets (two-thirds vs one-third of patients). Factors predictive of symptomatic pneumonitis (grade ≥2 by 1 of several scoring systems) or fatal pneumonitis were evaluated using logistic regression. Recursive partitioning analysis (RPA) was used to define risk groups. Results The median radiation therapy dose was 60 Gy, and the median follow-up time was 2.3 years. Most patients received concurrent cisplatin/etoposide (38%) or carboplatin/paclitaxel (26%). The overall rate of symptomatic pneumonitis was 29.8% (n=249), with fatal pneumonitis in 1.9% (n=16). In the training set, factors predictive of symptomatic pneumonitis were lung volume receiving ≥20 Gy (V 20 ) (odds ratio [OR] 1.03 per 1% increase, P =.008), and carboplatin/paclitaxel chemotherapy (OR 3.33, P P =.09); the model remained predictive in the validation set with good discrimination in both datasets (c-statistic >0.65). On RPA, the highest risk of pneumonitis (>50%) was in patients >65 years of age receiving carboplatin/paclitaxel. Predictors of fatal pneumonitis were daily dose >2 Gy, V 20 , and lower-lobe tumor location. Conclusions Several treatment-related risk factors predict the development of symptomatic pneumonitis, and elderly patients who undergo CCRT with carboplatin-paclitaxel chemotherapy are at highest risk. Fatal pneumonitis, although uncommon, is related to dosimetric factors and tumor location.read more
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Abnormal pulmonary function tests predict the development of radiation-induced pneumonitis in advanced non-small cell lung Cancer
Luis Torre-Bouscoulet,Wendy Muñoz-Montaño,David Martínez-Briseño,Francisco Lozano-Ruiz,Rosario Fernández-Plata,J. A. Beck-Magaña,Cecilia García-Sancho,Abigail Guzmán-Barragán,Edgar Vergara,Monika Blake-Cerda,Laura Gochicoa-Rangel,Federico Maldonado,Marisol Arroyo-Hernández,Oscar Arrieta +13 more
TL;DR: All patients under CCRT should be assessed by PFT to identify high-risk patients for close follow-up and early treatment, and FEV1, DLCO and FeNO prior to C CRT predict the development of RP in NSCLC.
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Chemoradiotherapy versus radiotherapy alone in elderly patients with stage III non-small cell lung cancer: A systematic review and meta-analysis.
David E. Dawe,David Christiansen,Anand Swaminath,Peter M. Ellis,Janet Rothney,Rasheda Rabbani,Ahmed M Abou-Setta,Ryan Zarychanski,Salaheddin M. Mahmud,Salaheddin M. Mahmud +9 more
TL;DR: Treatment of stage III NSCLC patients 70 years or older with chemotherapy and radiotherapy is associated with improved overall survival compared to radiotherapy alone and CRT appears to be tolerable in fit elderly patients and represents a reasonable standard of clinical care.
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How can we optimise concurrent chemoradiotherapy for inoperable stage III non-small cell lung cancer?
TL;DR: A review was carried out to address three questions considered fundamental to improving outcome in patients with stage III non-small cell lung cancer: can radiotherapy regimens be optimised using advanced radiotherapy techniques to improve local control rate and overall survival?
Journal ArticleDOI
Factors Associated With Early Mortality in Patients Treated With Concurrent Chemoradiation Therapy for Locally Advanced Non-Small Cell Lung Cancer
Andrew Warner,Max Dahele,Bo Hu,David A. Palma,Suresh Senan,Cary Oberije,Kayoko Tsujino,Marta Moreno-Jiménez,Tae Hyun Kim,Lawrence B. Marks,Ramesh Rengan,Luigi De Petris,Sara Ramella,Kim De Ruyck,Nuria Rodríguez de Dios,Jeffrey D. Bradley,George Rodrigues +16 more
TL;DR: This analysis identified several risk factors associated with early mortality and suggests that future research in the optimization of pretreatment pulmonary function and/or functional lung avoidance treatment may alter the therapeutic ratio in this patient population.
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Ga-68 MAA Perfusion 4D-PET/CT Scanning Allows for Functional Lung Avoidance Using Conformal Radiation Therapy Planning.
Shankar Siva,Thomas Devereux,David Ball,Michael MacManus,Nicholas Hardcastle,Tomas Kron,Mathias Bressel,Farshad Foroudi,Nikki Plumridge,Daniel P Steinfort,M. Shaw,Jason Callahan,Rodney J. Hicks,Michael S Hofman +13 more
TL;DR: This study demonstrates proof of principle that 4D-perfusion PET/CT may enable functional lung avoidance during treatment planning of patients with NSCLC.
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Lawrence B. Marks,Søren M. Bentzen,Joseph O. Deasy,Feng-Ming Spring Kong,Jeffrey D. Bradley,I. Vogelius,Issam El Naqa,Jessica L. Hubbs,Joos V. Lebesque,Robert Timmerman,Mary K. Martel,Andrew Jackson +11 more
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TL;DR: An association between DVH parameters and RP risk has been demonstrated in the literature, but the ideal DVH metric with excellent operating characteristics, either alone or in a model with other predictive variables, for RP risk prediction has not yet been identified.
Journal ArticleDOI
Predictive value of dose-volume histogram parameters for predicting radiation pneumonitis after concurrent chemoradiation for lung cancer
Kayoko Tsujino,Saeko Hirota,Masahiro Endo,Kayoko Obayashi,Yoshikazu Kotani,Miyako Satouchi,Tetsuji Kado,Yoshiki Takada +7 more
TL;DR: The incidence and grade of RP are significantly related to the V20 value, and V20 appears to be a factor that can be used to predict RP after concurrent chemoradiation for lung cancer.
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Phase III Study Comparing Second- and Third-Generation Regimens With Concurrent Thoracic Radiotherapy in Patients With Unresectable Stage III Non–Small-Cell Lung Cancer: West Japan Thoracic Oncology Group WJTOG0105
Nobuyuki Yamamoto,Kazuhiko Nakagawa,Yasumasa Nishimura,Kayoko Tsujino,Miyako Satouchi,Shinzoh Kudo,Toyoaki Hida,Masaaki Kawahara,Koji Takeda,Nobuyuki Katakami,Toshiyuki Sawa,Soichiro Yokota,Takashi Seto,Fumio Imamura,Hideo Saka,Yasuo Iwamoto,Hiroshi Semba,Yasutaka Chiba,Hisao Uejima,Masahiro Fukuoka +19 more
TL;DR: Arm C was equally efficacious and exhibited a more favorable toxicity profile among three arms and should be considered a standard regimen in the management of locally advanced unresectable NSCLC.
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