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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Single-arm prospective interventional study assessing feasibility of using gallium-68 ventilation and perfusion PET/CT to avoid functional lung in patients with stage III non-small cell lung cancer.
Nicholas W Bucknell,Nicholas W Bucknell,Nicholas Hardcastle,Nicholas Hardcastle,Price Jackson,Price Jackson,Michael S Hofman,Michael S Hofman,Jason Callahan,P Eu,P Eu,Amir Iravani,Amir Iravani,Rhonda Lawrence,Olga A. Martin,Mathias Bressel,Beverley Woon,Benjamin Blyth,Benjamin Blyth,Michael MacManus,Michael MacManus,Keelan Byrne,Daniel P Steinfort,Daniel P Steinfort,Tomas Kron,Tomas Kron,Gerard G Hanna,Gerard G Hanna,David Ball,David Ball,Shankar Siva,Shankar Siva +31 more
TL;DR: This prospective interventional study will investigate the use of ventilation and perfusion PET/CT to identify highly functioning lung volumes and avoidance of these using VMAT planning to enable safe moderate dose escalation with an aim of improving local control and concurrently decreasing treatment related toxicity.
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Genetic variants in the plasminogen activator inhibitor-1 gene are associated with an increased risk of radiation pneumonitis in lung cancer patients.
TL;DR: It is indicated that PAI‐1:rs7242 in the 3′‐untranslated region of PAI-1 can be a predictor of grade ≥3 RP before radiotherapy.
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Fabio Gomes,Melisa L. Wong,Nicolò Matteo Luca Battisti,Tiana Kordbacheh,M. Kiderlen,Alastair Greystoke,Andrea Luciani +6 more
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Matthew R. McFarlane,Kimberly A. Hochstedler,A.M. Laucis,Yilun Sun,Aulina Chowdhury,Martha M. Matuszak,James A. Hayman,D P Bergsma,T.P. Boike,Larry L. Kestin,Benjamin Movsas,Inga S. Grills,Michael M. Dominello,Robert T. Dess,C.A. Schonewolf,Daniel E. Spratt,Lori J. Pierce,Peter Paximadis,Shruti Jolly,Matthew J. Schipper +19 more
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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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