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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Lukas Käsmann,Alexander Dietrich,Claudia A. Staab-Weijnitz,Farkhad Manapov,Jürgen Behr,Andreas Rimner,Branislav Jeremic,Suresh Senan,Dirk De Ruysscher,Kirsten Lauber,Claus Belka +10 more
TL;DR: In this review, the current understanding of radiation-induced pneumonitis and pulmonary fibrosis is summarized, predictive factors as well as recent diagnostic and therapeutic advances are presented, and novel candidates for molecularly targeted approaches to prevent and/or treat radiation-related toxicities are discussed.
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Katelyn M. Atkins,Katelyn M. Atkins,Tafadzwa L. Chaunzwa,Nayan Lamba,Danielle S. Bitterman,Bhupendra Rawal,Jeremy S. Bredfeldt,Christopher L. Williams,David Kozono,Elizabeth H. Baldini,Anju Nohria,Udo Hoffmann,Hugo J.W.L. Aerts,Raymond H. Mak +13 more
TL;DR: The findings of this cohort study suggest that optimal cardiac dose constraints may differ based on preexisting CHD, particularly in patients without CHD.
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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
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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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