Radiation-induced lung toxicity predictors: Retrospective analysis of 90 patients treated with stereotactic body radiation therapy for stage I non-small-cell lung carcinoma.
Aged
Aged, 80 and over
Analysis of Variance
Angiotensin Receptor Antagonists
/ therapeutic use
Angiotensin-Converting Enzyme Inhibitors
/ therapeutic use
Carcinoma, Non-Small-Cell Lung
/ pathology
Female
Humans
Lung
/ radiation effects
Lung Neoplasms
/ pathology
Male
Middle Aged
Models, Theoretical
Pulmonary Disease, Chronic Obstructive
/ complications
Pulmonary Fibrosis
/ etiology
Radiation Pneumonitis
/ etiology
Radiosurgery
/ adverse effects
Radiotherapy, Intensity-Modulated
/ adverse effects
Retrospective Studies
Smoking
Carcinome bronchique non à petites cellules
Facteurs prédictifs
Non-small-cell lung carcinoma
Predictors
Radiation-induced lung toxicity
Radiothérapie stéréotaxique
Stereotactic radiotherapy
Toxicité pulmonaire radio-induite
Journal
Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique
ISSN: 1769-6658
Titre abrégé: Cancer Radiother
Pays: France
ID NLM: 9711272
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
28
08
2019
revised:
04
11
2019
accepted:
06
11
2019
pubmed:
17
3
2020
medline:
14
5
2020
entrez:
17
3
2020
Statut:
ppublish
Résumé
The main complication after hypofractionated radiotherapy for lung carcinoma is radiation-induced lung toxicity, which can be divided into radiation pneumonitis (acute toxicity, occurring within 6 months) and lung fibrosis (late toxicity, occurring after 6 months). The literature describes several predictive factors related to the patient, to the tumor (volume, central location), to the dosimetry and to biological factors. This study is a retrospective analysis of 90 patients treated with stereotactic body irradiation for stage I non-small-cell lung carcinoma between December 2010 and May 2015. Radiation pneumonitis was observed in 61.5% of the patients who were mainly asymptomatic (34%). Chronic obstructive pulmonary disease was not predictive of radiation pneumonitis, whereas active smoking was protective. Centrally located tumors were not more likely to result in this complication if the radiation schedule utilized adapted fractionation. In our study, no predictive factor was identified. Whereas the mean lung dose was a predictive factor in 3D radiotherapy, the lung volume irradiated at high doses seemed to be involved in the pathogenesis after hypofractionated radiotherapy. The discovery of predictive factors for radiation pneumonitis is difficult due to the rarity of this complication, especially with an 8×7.5Gy schedule. Radiation pneumonitis seems to be correlated with the volume irradiated at high doses, which is in contrast to the known knowledge about the organs in parallel. This finding leads us to raise the hypothesis that vessel damage, organs in series, occurring during hypofractionated radiotherapy could be responsible for this toxicity.
Sections du résumé
BACKGROUND
BACKGROUND
The main complication after hypofractionated radiotherapy for lung carcinoma is radiation-induced lung toxicity, which can be divided into radiation pneumonitis (acute toxicity, occurring within 6 months) and lung fibrosis (late toxicity, occurring after 6 months). The literature describes several predictive factors related to the patient, to the tumor (volume, central location), to the dosimetry and to biological factors.
MATERIALS AND METHODS
METHODS
This study is a retrospective analysis of 90 patients treated with stereotactic body irradiation for stage I non-small-cell lung carcinoma between December 2010 and May 2015.
RESULTS
RESULTS
Radiation pneumonitis was observed in 61.5% of the patients who were mainly asymptomatic (34%). Chronic obstructive pulmonary disease was not predictive of radiation pneumonitis, whereas active smoking was protective. Centrally located tumors were not more likely to result in this complication if the radiation schedule utilized adapted fractionation. In our study, no predictive factor was identified. Whereas the mean lung dose was a predictive factor in 3D radiotherapy, the lung volume irradiated at high doses seemed to be involved in the pathogenesis after hypofractionated radiotherapy.
CONCLUSION
CONCLUSIONS
The discovery of predictive factors for radiation pneumonitis is difficult due to the rarity of this complication, especially with an 8×7.5Gy schedule. Radiation pneumonitis seems to be correlated with the volume irradiated at high doses, which is in contrast to the known knowledge about the organs in parallel. This finding leads us to raise the hypothesis that vessel damage, organs in series, occurring during hypofractionated radiotherapy could be responsible for this toxicity.
Identifiants
pubmed: 32173269
pii: S1278-3218(20)30059-7
doi: 10.1016/j.canrad.2019.11.003
pii:
doi:
Substances chimiques
Angiotensin Receptor Antagonists
0
Angiotensin-Converting Enzyme Inhibitors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
120-127Informations de copyright
Copyright © 2020 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.