Ipsilateral lung dose volume parameters predict radiation pneumonitis in addition to classical dose volume parameters in locally advanced NSCLC treated with combined modality therapy

Sushma Agrawal; Sunil Kumar; Able Lawrence; Maria K.J. Das; Shaleen Kumar

doi:10.4103/2278-330X.126503

South Asian Journal of Cancer, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · South Asian J Cancer 2014; 03(01): 013-015
DOI: 10.4103/2278-330X.126503

QUEST FOR AN ANTIDOTE TO RADIATION TOXICITY : Original Article

Ipsilateral lung dose volume parameters predict radiation pneumonitis in addition to classical dose volume parameters in locally advanced NSCLC treated with combined modality therapy

Authors

Sushma Agrawal

Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014
Sunil Kumar

Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014
Able Lawrence

Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014
Maria K.J. Das

Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014
Shaleen Kumar

Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014

Abstract

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Abstract

Purpose: The purpose was to determine the correlation of clinical factors and lung dose volume parameters with significant radiation pneumonitis (RP) in non-small cell lung cancer patients treated with combined modality therapy. Materials and Methods: Between January 2008 and December 2010, 52 patients of non-small cell lung cancer were treated with combined modality therapy with radical intent. Radiation pneumonitis was correlated with ipsilateral (V ₂₀ ipsi, V ₅ ipsi and MLD ipsi) and whole lung (V ₂₀ , V ₅ , and MLD) dose volume parameters. Clinical factors like pulmonary function tests (PFT), site of tumor, planning target volume, and type of treatment were also correlated with incidence of significant pneumonitis. Results: Out of 52 patients, 35.3% developed grade 2 or more pneumonitis. On univariate analysis, factors significantly correlating with radiation pneumonitis were V ₅ (P = 0.002), V ₅ ipsi (P = 0.000), V ₂₀ (P = 0.019), V ₂₀ ipsi (P = 0.004), MLD (P = 0.008) and MLD ipsi (P = 0.008). On multivariate analysis, V ₅ ipsi was retained as the most significant factor. Concurrent chemoradiation caused significantly more RP than neoadjuvant chemoradiation (P = 0.004). A cutoff of 65% for V ₅ ipsi had a sensitivity of 65% and a specificity of 91%. Conclusion: The correlation between pneumonitis and dosimetric constraints has been validated. Adding ipsilateral V ₂₀ , V ₅ , and MLD to the classical total lung constraints identifies patients likely to develop pulmonary toxicity in patients undergoing chemoradiation.

Key words

Chemoradiation - ipsilateral dose volume parameters - locally advanced non small cell lung cancers - radiation pneumonitis

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Referenzen

1 Robinson LA, Ruckdeschel JC, Wagner H Jr, Stevens CW; American College of Chest Physicians. Treatment of non-small cell lung cancer-stage IIIA: ACCP evidence-based clinical practice guidelines (2 nd edition). Chest 2007;132:243S-65.
2 Albain KS, Crowley JJ, Turrisi AT 3 rd , Gandara DR, Farrar WB, Clark JI, et al. Concurrent cisplatin, etoposide, and chest radiotherapy in pathologic stage IIIB non-small-cell lung cancer: A Southwest Oncology Group phase II study, SWOG 9019. J Clin Oncol 2002;20:3454-60.
3 Kong FM, Hayman JA, Griffith KA. Final toxicity results of a radiation-dose escalation study in patients with non-small-cell lung cancer (nsclc): Predictors for radiation pneumonitis and fibrosis. Int J Radiation Oncology Biol Phys 2006;65:1075-86.
4 Graham MV, Purdy JA, Emami B, Harms W, Bosch W, Lockett MA, et al. Clinical dose-volume histogram analysis for pneumonitis after 3d treatment for non-small cell lung cancer. Int J Radiation Oncology Biol Phys 1999;45:323-9.
5 Hernando ML, Marks LB, Bentel GC, Zhou SM, Hollis D, Das SK, et al. Radiation-induced pulmonary toxicity: A dose-volume histogram analysis in 201 patients with lung cancer. Int J Radiat Oncol Biol Phys 2001;51:650-9.
6 Trotti A, Colevas AD, Setser A, Rusch V, Jaques D, Budach V, et al. CTCAE v3.0: Development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 2003;13:176-81.
7 Cox DR. Regression models and life-table. J R Stat Soc 1972; 334:187-220.
8 Senan S, De Ruysscher D, Giraud P, Mirimanoff R, Budach V; Radiotherapy Group of European Organization for Research and Treatment of Cancer. Literature-based recommendations for treatment planning and execution in high-dose radiotherapy for lung cancer. Radiother Oncol 2004;71:139-46.
9 Tsujino K, Hirota S, Endo M, Obayashi K, Kotani Y, Satouchi M, et al. Predictive value of dose-volume histogram parameters for predicting radiation pneumonitis after concurrent chemoradiation for lung cancer. Int J Radiat Oncol Biol Phys 2003;55:110-5.
10 Ramella S, Trodella L, Mineo TC, Pompeo E, Stimato G, Gaudino D, et al. Adding ipsilateral V20 and V30 to conventional dosimetric constraints predicts radiation pneumonitis in stage III a-b NSCLC treated with combined-modality therapy. Int J Radiation Oncology Biol Phys 2010;76:110-5.
11 Oetzel D, Schraube P, Hensley F, Sroka-Pérez G, Menke M, Flentje M. Estimation of pneumonitis risk in three-dimensional treatment planning using dose volume histogram analysis. Int J Radiat Oncol Biol Phys 1995;33:455-60.
12 Seppenwoolde Y, De Jaeger K, Boersma LJ, Belderbos JS, Lebesque JV. Regional differences in lung radiosensitivity after radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2004;60:748-58.
13 Yorke ED, Jackson A, Rosenzweig KE, Braban L, Leibel SA, Ling CC. Correlation of dosimetric factors and radiation pneumonitis for non-small-cell lung cancer patients in a recently completed dose escalation study. Int J Radiat Oncol Biol Phys 2005;63:672-82.
14 Brunelli A, Charloux A, Bolliger CT, Rocco G, Sculier JP, Varela G, et al. ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy) Eur Respir J 2009;34:17-41.
15 Hope AJ, Lindsay PE, El Naqa I, Alaly JR, Vicic M, Bradley JD, et al. Modeling radiation pneumonitis risk with clinical, dosimetric, and spatial parameters. Int J Radiat Oncol Biol Phys 2006;65:112-24.
16 Marks LB, Bentzen SM, Deasy JO, Kong FM, Bradley JD, Vogelius IS, et al. Radiation dose-volume effects in the lung. Int J Radiation Oncology Biol Phys 2010;76:S70-6.