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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Comparative efficacy and safety for different chemotherapy regimens used concurrently with thoracic radiation for locally advanced non-small cell lung cancer: a systematic review and network meta-analysis.
TL;DR: A network meta-analysis showed that S-1-cisplatin (SP) was likely to be the most preferable regimen for its best efficacy and low risk of causing SAEs, followed by UP and PP.
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Radiation Therapy Planning of Thoracic Tumors: A Review of Challenges Associated With Lung Toxicities and Potential Perspectives of Gallium-68 Lung PET/CT Imaging.
TL;DR: In this article, a review of recent advances in radiation therapy for the management of primary and secondary lung tumors and in V/Q PET/CT imaging for the assessment of functional lung volumes are reviewed.
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Age dependent prognosis in concurrent chemo-radiation of locally advanced NSCLC
TL;DR: Use of concurrent chemotherapy to radiotherapy of locally advanced NSCLC was associated with a survival benefit in patient younger than 70 years which was not the case for patients older than70 years, indicating the need to be careful when selecting elderly patients for concurrent chemo-radiation.
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Implications of pneumonitis after chemoradiation and durvalumab for locally advanced non-small cell lung cancer
Comron Hassanzadeh,Timothy L. Sita,Rohan Savoor,Pamela Samson,Jeffrey D. Bradley,Michelle S. Gentile,Michael C. Roach,Nisha Mohindra,Saiama N. Waqar,Tim J. Kruser,Clifford G. Robinson +10 more
TL;DR: Pneumonitis did not appear to negatively impact survival, and durvalumab re-challenge appeared feasible after pneumonitis treatment with steroids, in this small case series of LA-NSCLC patients treated with CRT followed by consolidation durvalsumab.
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Angiotensin-converting Enzyme Inhibitors Decrease the Incidence of Radiation-induced Pneumonitis Among Lung Cancer Patients: A Systematic Review and Meta-analysis.
Fengze Sun,Huanhuan Sun,Xiaobin Zheng,Guangwei Yang,Nana Gong,Huaili Zhou,Si-Yang Wang,Zhibin Cheng,Haiqing Ma +8 more
TL;DR: ACE inhibitors could decrease the incidence of symptomatic RP among lung cancer patients, however, the use of ARBs has a slight trend to develop RP but not above statistical significance.
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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.
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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
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
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