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
More filters
Journal ArticleDOI
Towards individualized dose constraints: Adjusting the QUANTEC radiation pneumonitis model for clinical risk factors.
TL;DR: A method to combine a published dose-response function with known clinical risk factors and demonstrates the increased predictive power of the combined model is presented, allowing for individualization of dose constraints and individual patient risk estimates.
Journal ArticleDOI
Quantitative assessment of global lung inflammation following radiation therapy using FDG PET/CT: a pilot study.
TL;DR: Global lung parenchymal glycolysis and lung parianchyma SUVmean may serve as potentially useful biomarkers to quantify lung inflammation on FDG PET/CT following thoracic radiation therapy.
Journal ArticleDOI
Inclusion of functional information from perfusion SPECT improves predictive value of dose-volume parameters in lung toxicity outcome after radiotherapy for non-small cell lung cancer: A prospective study.
Katherina P. Farr,Jesper F. Kallehauge,Ditte Sloth Møller,Azza A. Khalil,Stine Kramer,Henrik Bluhme,Anni Morsing,Cai Grau +7 more
TL;DR: SpECT-based functional parameters were better to predict the risk of RP compared to standard CT-based dose-volume parameters, and may be useful to guide radiotherapy planning in order to reduce therisk of radiation-induced toxicity.
Journal ArticleDOI
Predicting radiation pneumonitis in locally advanced stage II-III non-small cell lung cancer using machine learning.
José Marcio Luna,Hann-Hsiang Chao,Eric S. Diffenderfer,Gilmer Valdes,Chidambaram Chinniah,Grace L. Ma,Keith A. Cengel,Timothy D. Solberg,Abigail T. Berman,Charles B. Simone +9 more
TL;DR: Random Forest is highlighted as an accurate machine learning method to identify known and new predictors of symptomatic RP and confirms the importance of lung V20, lung mean and pack-year as predictor of RP while also introducing esophagus max as an important RP predictor.
Journal ArticleDOI
Acute and Late Toxicities of Concurrent Chemoradiotherapy for Locally-Advanced Non-Small Cell Lung Cancer
TL;DR: The acute and late toxicities associated with definitive chemoradiotherapy for LA-NSCLC are detailed and toxicity management and strategies to mitigate the risks of treatment-related toxicities are discussed.
References
More filters
Journal ArticleDOI
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
TL;DR: The three-dimensional dose, volume, and outcome data for lung are reviewed in detail and it is confirmed that there is no evident threshold "tolerance dose-volume" levels and there are strong volume and fractionation effects.
Journal ArticleDOI
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.
Related Papers (5)
Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study
Jeffrey D. Bradley,Rebecca Paulus,Ritsuko Komaki,Gregory A. Masters,George R. Blumenschein,Steven E. Schild,Jeffrey A. Bogart,Chen Hu,Kenneth M. Forster,Anthony M. Magliocco,V.S. Kavadi,Yolanda I. Garces,Samir Narayan,Puneeth Iyengar,Cliff G. Robinson,Raymond B. Wynn,Christopher Koprowski,Joanne Meng,Jonathan J. Beitler,Rakesh Gaur,Walter J. Curran,Hak Choy +21 more
Meta-Analysis of Concomitant Versus Sequential Radiochemotherapy in Locally Advanced Non–Small-Cell Lung Cancer
Anne Auperin,Cécile Le Péchoux,Estelle Rolland,Walter J. Curran,Kiyoyuki Furuse,Pierre Fournel,José Belderbos,Gerald H. Clamon,Hakki Cuneyt Ulutin,Rebecca Paulus,Takeharu Yamanaka,Marie-Cecile Bozonnat,Apollonia L.J. Uitterhoeve,Xiaofei Wang,Lesley A. Stewart,Rodrigo Arriagada,Sarah Burdett,Jean-Pierre Pignon +17 more