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 Thoracic Radiotherapy an Absolute Contraindication for Treatment of Lung Cancer Patients With Interstitial Lung Disease? A Systematic Review.
TL;DR: In this article , the authors conducted a systematic search in PubMed, Medline, Embase and the Cochrane database for articles published between January 2000 and April 2021 and found that the presence of interstitial lung disease (ILD) was an independent predictor of severe radiation pneumonitis.
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Variations Between Dose-Ventilation and Dose-Perfusion Metrics in Radiation Therapy Planning for Lung Cancer.
Yujiro Nakajima,Noriyuki Kadoya,Tomoki Kimura,Kazunari Hioki,Kazunari Hioki,Keiichi Jingu,Tokihiro Yamamoto +6 more
TL;DR: Strong correlations were present between the dose-ventilation and dose-perfusion metrics, suggesting that ventilation-based radiation therapy plan evaluation may not be comparable to that based on perfusion.
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Monitoring DNA Damage and Repair in Peripheral Blood Mononuclear Cells of Lung Cancer Radiotherapy Patients.
Pavel Lobachevsky,Nicholas W Bucknell,Nicholas W Bucknell,Joel Mason,Diane Russo,Xiaoyu Yin,Xiaoyu Yin,Lisa Selbie,David Ball,David Ball,Tomas Kron,Tomas Kron,Michael S Hofman,Michael S Hofman,Shankar Siva,Shankar Siva,Olga A. Martin,Olga A. Martin +17 more
TL;DR: Thoracic radiotherapy is required for the curative management of inoperable lung cancer, however, treatment delivery is limited by normal tissue toxicity, and prior studies suggest that using radiation-induced DNA damage response (DDR) in peripheral blood mononuclear cells (PBMC) has potential to predict RT-associated toxicities.
Radiation-induced lung toxicity in non-small-cell lung cancer: Understanding the interactions of clinical factors and cytokines with the dose-toxicity relationship
Peter G. Hawkins,Philip S. Boonstra,S. Hobson,Jason W.D. Hearn,James A. Hayman,Randall K. Ten Haken,Martha M. Matuszak,Paul Stanton,Gregory P. Kalemkerian,Nithya Ramnath,Theodore S. Lawrence,Matthew J. Schipper,Feng-Ming Spring Kong,Shruti Jolly +13 more
TL;DR: In this article, the effect of mean lung dose (MLD) on RILT was investigated by incorporating clinical and cytokine data, and to investigate how these factors may interact with the effect.
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Adverse respiratory outcomes following conventional long‐course radiotherapy for non‐small‐cell lung cancer in patients with pre‐existing pulmonary fibrosis: A comparative retrospective study
Clare Bajraszewski,Renee Manser,Renee Manser,James Chu,R Ashley Cox,Phillip Tran,Mary Duffy,Louis Irving,Louis Irving,Alan Herschtal,Shankar Siva,Shankar Siva,David Ball,David Ball +13 more
TL;DR: There is some evidence to suggest that patients with underlying pulmonary fibrosis have increased risk of adverse respiratory and survival outcomes, when treated with conventional, long‐course radiotherapy (RT) for non‐small‐cell lung cancer (NSCLC).
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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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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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