International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: LungFactors predicting severe radiation pneumonitis in patients receiving definitive chemoradiation for lung cancer
Introduction
Radiation therapy is a mainstay of treatment for patients with locally advanced lung cancer 1, 2. Unfortunately, in addition to the disappointing cure rates with definitive radiation therapy (XRT), treatment can cause toxicity which may threaten quality of life. Serious treatment-related side effects are potentially lethal. Radiation pneumonopathy or radiation pneumonitis (RP) is a term used to describe the constellation of clinical, radiographic, and histologic findings reflecting lung injury from radiation. Symptomatic RP can be classified as a continuum of clinical findings ranging from mild cough/exertional dyspnea to death caused by respiratory failure (Table 1). Because locally advanced, unresectable lung cancer is usually rapidly fatal without treatment, most patients and physicians will accept the risk of mild to moderate RP. A very high risk of severe RP, however, may require deviating one’s plan away from standard chemoradiotherapy. Our report thus focuses on the risk of severe RP and attempts to identify factors predicting for this event. We also focus exclusively on patients treated with combined modality treatment (chemoradiotherapy), which has now become the standard of care for good-performance status patients with Stage III lung cancer (3).
Section snippets
Methods and materials
The University of Pennsylvania radiation oncology electronic database (PROCLIPS) was queried for lung cancer patients treated with chemoradiation between 6/92 and 6/98. The starting date for this study was selected to correspond to the time period when chemoradiation replaced XRT alone in the management of most patients with Stage III non–small cell lung carcinoma (NSCLC) in our institution. Our definition of severe RP corresponds most closely to Radiation Therapy Oncology Group (RTOG) Grade ≥
Results
The median overall survival was 14.7 months. Of the 144 patients, 12 experienced severe RP (8.3%). Of these cases, 7 were Grade 3, 3 were Grade 4, and 2 were Grade 5 (fatal).
Discussion
The incidence of moderate-to-severe (RTOG Grade 2 or greater) radiation pneumonitis in patients receiving XRT alone for lung cancer has been estimated to be between 2% and 9% 8, 9, 10, 11. Preclinical data suggest that the combination of chemotherapy and irradiation enhances the risk of pulmonary injury 12, 13. This is supported by clinical data from the RTOG experience, studying a variety of chemoradiation regimens in a series of Phase I, II, and III clinical studies (14). However, not all
References (26)
The evolution of Radiation Therapy Oncology Group (RTOG) protocols for nonsmall cell lung cancer
Int J Radiat Oncol Biol Phys
(1995)- et al.
The influence of field size and other treatment factors on pulmonary toxicity following hyperfractionated irradiation for inoperable non–small cell lung cancer (NSCLC)Analysis of a Radiation Therapy Oncology Group (RTOG) protocol
Int J Radiat Oncol Biol Phys
(1993) - et al.
Chronic bronchitis and radiotherapy of the lung
Lancet
(1964) - et al.
The effect of dose rate and Adriamycin on the tolerance of thoracic radiation in mice
Int J Radiat Oncol Biol Phys
(1982) - et al.
Response, toxicity, failure patterns, and survival in five Radiation Therapy Oncology Group (RTOG) trials of sequential and/or concurrent chemotherapy and radiotherapy for locally advanced non–small cell carcinoma of the lung
Int J Radiat Oncol Biol Phys
(1998) - et al.
Radiation and the lungA reevaluation of the mechanisms mediating pulmonary injury
Int J Radiat Oncol Biol Phys
(1995) - et al.
Strategy for dose escalation using 3-dimensional conformal radiation therapy for lung cancer
Ann Oncol
(1995) - et al.
Radiation pneumonitis as a function of mean lung doseAn analysis of pooled data of 540 patients
Int J Radiat Oncol Biol Phys
(1998) - et al.
DVH and 3-D treatment planning evaluation of patients with pneumonitits
Int J Radiat Oncol Biol Phys
(1994) - et al.
Dose escalation for non–small cell lung cancer using conformal radiation therapy
Int J Radiat Oncol Biol Phys
(1997)
Characteristics of long-term survivors after treatment for inoperable carcinoma of the lung
Am J Clin Oncol
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