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
Citations
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Is Intermediate Radiation Dose Escalation With Concurrent Chemotherapy for Stage III Non-Small-Cell Lung Cancer Beneficial? A Multi-Institutional Propensity Score Matched Analysis
George Rodrigues,Cary Oberije,Suresh Senan,Kayoko Tsujino,T. Wiersma,Marta Moreno-Jiménez,Tae Hyun Kim,Lawrence B. Marks,Ramesh Rengan,Luigi De Petris,Sara Ramella,Kim DeRuyck,Nuria Rodríguez de Dios,Andrew Warner,Jeffrey D. Bradley,David A. Palma +15 more
TL;DR: No significant overall survival benefits were found with intermediateDE; however, more grade III or greater lung toxicity was observed and the separation of survival curves after 15 months of follow-up suggests that a small overall survival improvement associated with intermediate DE cannot be excluded.
Journal ArticleDOI
Differences in lung injury after IMRT or proton therapy assessed by 18FDG PET imaging.
Nadya Shusharina,Zhongxing Liao,Radhe Mohan,Amy Liu,Andrzej Niemierko,Noah C. Choi,Thomas Bortfeld +6 more
TL;DR: Compared lung injury among non-small cell lung cancer patients treated with IMRT or proton therapy as revealed by 18F-FDG post-treatment uptake and to determine factors predictive for clinically symptomatic radiation pneumonitis, patients who developed radiation pneumonia had statistically significantly higher MLD and higher slope regardless of treatment modality.
Journal ArticleDOI
Phase I and Pharmacologic Study of Olaparib in Combination with High-dose Radiotherapy with and without Concurrent Cisplatin for Non-Small Cell Lung Cancer.
Rosemarie de Haan,Michel M. van den Heuvel,Judi N.A. van Diessen,Heike Peulen,Erik van Werkhoven,Adrianus J. de Langen,Ferry Lalezari,Dick Pluim,Manon Verwijs-Janssen,Conchita Vens,Jan H.M. Schellens,Neeltje Steeghs,Marcel Verheij,Baukelien van Triest +13 more
TL;DR: Combined mildly hypofractionated radiotherapy and low-dose daily cisplatin and olaparib was not tolerable due to esophageal and hematologic toxicity and more conformal radiotherapy schedules with improved pulmonary and esophagal sparing should be explored.
Journal ArticleDOI
Association Between White Blood Cell Count Following Radiation Therapy With Radiation Pneumonitis in Non-Small Cell Lung Cancer
Chad Tang,Daniel R. Gomez,Hongmei Wang,Hongmei Wang,Lawrence B. Levy,Y. Zhuang,Ting Xu,Quynh-Nhu Nguyen,Ritsuko Komaki,Zhongxing Liao +9 more
TL;DR: Post-RT WBC counts were significantly and independently associated with RP and have potential utility as a diagnostic or predictive marker for this toxicity.
Journal ArticleDOI
Real-world survey of pneumonitis and its impact on durvalumab consolidation therapy in patients with non-small cell lung cancer who received chemoradiotherapy after durvalumab approval (HOPE-005/CRIMSON).
Go Saito,Yuko Oya,Yoshihiko Taniguchi,Hayato Kawachi,Fujimoto Daichi,Hirotaka Matsumoto,Shunichiro Iwasawa,Hidekazu Suzuki,Takayuki Niitsu,Eisaku Miyauchi,Takashi Yokoi,Toshihide Yokoyama,Takeshi Uenami,Yoshihiko Sakata,Daisuke Arai,Asuka Okada,Kenji Nagata,Shunsuke Teraoka,Masaki Kokubo +18 more
TL;DR: In this article, the authors retrospectively evaluated the medical records of 302 consecutive patients diagnosed with non-small cell lung cancer who started chemoradiotherapy between May 2018 and May 2019.
References
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Radiation dose-volume effects in the lung.
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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Cisplatin- Versus Carboplatin-Based Chemotherapy in First-Line Treatment of Advanced Non–Small-Cell Lung Cancer: An Individual Patient Data Meta-analysis
Andrea Ardizzoni,Luca Boni,Marcello Tiseo,Frank V. Fossella,Joan H. Schiller,Marianne Paesmans,Davorin Radosavljevic,Adriano Paccagnella,Petr Zatloukal,Paola Mazzanti,Donald Bisset,Rafael Rosell +11 more
TL;DR: Cisplatin-based third-generation regimens should remain the standard reference for the treatment of selected patients with advanced-stage NSCLC and of those with earlier-stage disease.
Journal ArticleDOI
Prediction of radiation pneumonitis by dose - volume histogram parameters in lung cancer--a systematic review.
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.
Journal ArticleDOI
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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