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Toussie D, Ginocchio LA, Cooper BT, Azour L, Moore WH, Villasana-Gomez G, Ko JP. Radiation Therapy for Lung Cancer: Imaging Appearances and Pitfalls. Clin Chest Med 2024; 45:339-356. [PMID: 38816092 DOI: 10.1016/j.ccm.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Radiation therapy is part of a multimodality treatment approach to lung cancer. The radiologist must be aware of both the expected and the unexpected imaging findings of the post-radiation therapy patient, including the time course for development of post- radiation therapy pneumonitis and fibrosis. In this review, a brief discussion of radiation therapy techniques and indications is presented, followed by an image-heavy differential diagnostic approach. The review focuses on computed tomography imaging examples to help distinguish normal postradiation pneumonitis and fibrosis from alternative complications, such as infection, local recurrence, or radiation-induced malignancy.
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Affiliation(s)
- Danielle Toussie
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA.
| | - Luke A Ginocchio
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA
| | - Benjamin T Cooper
- Department of Radiation Oncology, NYU Langone Health/NYU Grossman School of Medicine, 160 East 34th Street, New York, NY 10016, USA
| | - Lea Azour
- Department of Radiology, David Geffen School of Medicine/UCLA Medical Center, 1250 16th Street, Los Angeles, CA 90404, USA
| | - William H Moore
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA
| | - Geraldine Villasana-Gomez
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA
| | - Jane P Ko
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA
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Kong Y, Su M, Zhu Y, Li X, Zhang J, Gu W, Yang F, Zhou J, Ni J, Yang X, Zhu Z, Huang J. Enhancing the prediction of symptomatic radiation pneumonitis for locally advanced non-small-cell lung cancer by combining 3D deep learning-derived imaging features with dose-volume metrics: a two-center study. Strahlenther Onkol 2024:10.1007/s00066-024-02221-x. [PMID: 38498173 DOI: 10.1007/s00066-024-02221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/25/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE This study aims to examine the ability of deep learning (DL)-derived imaging features for the prediction of radiation pneumonitis (RP) in locally advanced non-small-cell lung cancer (LA-NSCLC) patients. MATERIALS AND METHODS The study cohort consisted of 90 patients from the Fudan University Shanghai Cancer Center and 59 patients from the Affiliated Hospital of Jiangnan University. Occurrences of RP were used as the endpoint event. A total of 512 3D DL-derived features were extracted from two regions of interest (lung-PTV and PTV-GTV) delineated on the pre-radiotherapy planning CT. Feature selection was done using LASSO regression, and the classification models were built using the multilayered perceptron method. Performances of the developed models were evaluated by receiver operating characteristic curve analysis. In addition, the developed models were supplemented with clinical variables and dose-volume metrics of relevance to search for increased predictive value. RESULTS The predictive model using DL features derived from lung-PTV outperformed the one based on features extracted from PTV-GTV, with AUCs of 0.921 and 0.892, respectively, in the internal test dataset. Furthermore, incorporating the dose-volume metric V30Gy into the predictive model using features from lung-PTV resulted in an improvement of AUCs from 0.835 to 0.881 for the training data and from 0.690 to 0.746 for the validation data, respectively (DeLong p < 0.05). CONCLUSION Imaging features extracted from pre-radiotherapy planning CT using 3D DL networks could predict radiation pneumonitis and may be of clinical value for risk stratification and toxicity management in LA-NSCLC patients. CLINICAL RELEVANCE STATEMENT Integrating DL-derived features with dose-volume metrics provides a promising noninvasive method to predict radiation pneumonitis in LA-NSCLC lung cancer radiotherapy, thus improving individualized treatment and patient outcomes.
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Affiliation(s)
- Yan Kong
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, 214122, Wuxi, Jiangsu, China
| | - Mingming Su
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, 214122, Wuxi, Jiangsu, China
- Department of Medical Oncology, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People's Hospital, 214187, Wuxi, Jiangsu, China
| | - Yan Zhu
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, 214122, Wuxi, Jiangsu, China
| | - Xuan Li
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, 214122, Wuxi, Jiangsu, China
- Department of Medical Oncology, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People's Hospital, 214187, Wuxi, Jiangsu, China
| | - Jinmeng Zhang
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, 214122, Wuxi, Jiangsu, China
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui, 200032, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Wenchao Gu
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, 305-8577, Ibaraki, Japan
| | - Fei Yang
- Department of Radiation Oncology, University of Miami, 33136, Miami, FL, USA
| | - Jialiang Zhou
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, 214122, Wuxi, Jiangsu, China
| | - Jianjiao Ni
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui, 200032, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Xi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui, 200032, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui, 200032, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China.
| | - Jianfeng Huang
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, 214122, Wuxi, Jiangsu, China.
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Masuo M, Shinohara E, Kitano M, Maruta R, Chonabayashi S, Endo S, Matumoto S, Nishiyama N, Machitori Y, Kobayashi M. A comparison of the incidence of ≥ grade 2 radiation pneumonitis between intensity-modulated radiotherapy and three-dimensional conformal radiotherapy in patients with unresectable non-small cell lung cancer treated with durvalumab after concurrent chemoradiotherapy. Jpn J Clin Oncol 2024; 54:312-318. [PMID: 38010609 DOI: 10.1093/jjco/hyad158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) has been increasingly used as a new radiation modality for unresectable non-small cell lung cancer (NSCLC). The risk factors for radiation pneumonitis (RP) during consolidation durvalumab following concurrent chemoradiotherapy (CCRT) using IMRT have not been thoroughly investigated. METHODS This retrospective study analyzed medical record data from consecutive patients diagnosed with NSCLC who underwent CCRT and consolidation durvalumab at our institution between April 2018 and September 2022. Since we adopted IMRT for the treatment of NSCLC in April 2020, these patients were categorized into two groups: those treated with IMRT after April 2020 and those treated with three-dimensional conformal radiotherapy (3D-CRT) before April 2020. RESULTS A total of 31 patients underwent IMRT (the IMRT group), while 25 patients underwent 3D-CRT (the 3D-CRT group). In both groups, the total dose was 60 Gy in 30 fractions. The cumulative incidence of ≥ grade 2 RP at 12 months was significantly lower in the IMRT group than in the 3D-CRT group (27.0% vs. 64.0%, hazard ratio [HR]: 0.338, 95% confidence interval [CI]: 0.144-0.793, p = 0.013). In the multivariable analysis, V20 (≥ 25.6%, HR: 2.706, 95% CI: 1.168-6.269, p = 0.020) and radiotherapy technique (IMRT, HR: 0.414, 95% CI: 0.172-0.994, p = 0.048) were identified as significant risk factors for ≥ grade 2 RP. CONCLUSIONS IMRT is associated with a lower rate of ≥ grade 2 RP in patients with NSCLC who received CCRT followed by durvalumab.
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Affiliation(s)
- Masahiro Masuo
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
| | - Eiko Shinohara
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
| | - Masataka Kitano
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
| | - Ryusuke Maruta
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
| | - Satoshi Chonabayashi
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
- Department of Respiratory Medicine, Kashiwa City Hospital, Chiba 277-0825, Japan
| | - Shun Endo
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Suhei Matumoto
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
| | - Naoki Nishiyama
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
| | - Yumiko Machitori
- Department of Radiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
| | - Masayoshi Kobayashi
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
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Chen K, Li S, Chen M, Jin Z, Sun X, Zhou S, Yang H. Endostar acts as a pneumonitis protectant in patients with locally advanced non-small cell lung cancer receiving concurrent chemoradiotherapy. BMC Cancer 2024; 24:257. [PMID: 38395838 PMCID: PMC10893751 DOI: 10.1186/s12885-024-12001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND CCRT is presently the standard treatment for LA-NSCLC. RP is one of the main obstacles to the completion of thoracic radiation therapy, resulting in limited survival benefits in NSCLC patients. This research aims to explore the role of Endostar in the occurrence of grade≥2 RP and clinical curative effect in LA-NSCLC patients. METHODS This study retrospectively analyzed 122 patients with stage III NSCLC who received CCRT from December 2008 to December 2017, or Endostar intravenous drip concurrently with chemoradiotherapy (Endostar + CCRT group). Standard toxicity of the pneumonitis endpoint was also collected by CTCAE V5.0. We further summarized other available studies on the role of Endostar in the prognosis of NSCLC patients and the incidence of RP. RESULTS There were 76 cases in the CCRT group and 46 cases in the CCRT+ Endostar group. In the CCRT+ Endostar group, the occurrence of grade ≥2 RP in patients with V20Gy ≥25% was significantly higher than that in patients with V20Gy < 25% (p = 0.001). In the cohorts with V20Gy < 25%, 0 cases of 29 patients treated with Endostar developed grade ≥2 RP was lower than in the CCRT group (p = 0.026). The re-analysis of data from other available studies indicated that Endostar plus CCRT could be more efficient and safely in the occurrence of grade≥2 RP with LA-NSCLC. CONCLUSIONS When receiving CCRT for LA-NSCLC patients, simultaneous combination of Endostar is recommended to enhance clinical benefit and reduce pulmonary toxicity.
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Affiliation(s)
- Kuifei Chen
- Taizhou hospital of Zhejiang Province, Shaoxing University, Zhejiang Province, Taizhou, 317000, China
- Department of Radiation Oncology, Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province, Taizhou, 317000, China
| | - Shuling Li
- Taizhou hospital of Zhejiang Province, Shaoxing University, Zhejiang Province, Taizhou, 317000, China
- Department of Radiation Oncology, Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province, Taizhou, 317000, China
| | - Meng Chen
- Department of Radiation Oncology, Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province, Taizhou, 317000, China
| | - Zhicheng Jin
- Department of Radiation Oncology, Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province, Taizhou, 317000, China
| | - Xuefeng Sun
- Department of Radiation Oncology, Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province, Taizhou, 317000, China
| | - Suna Zhou
- Department of Radiation Oncology, Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province, Taizhou, 317000, China.
| | - Haihua Yang
- Taizhou hospital of Zhejiang Province, Shaoxing University, Zhejiang Province, Taizhou, 317000, China.
- Department of Radiation Oncology, Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province, Taizhou, 317000, China.
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Tang Y, Wang T, Gu L, Xu Y, Yang Z, Zhu W, Zhang Q, Luo J, Cao J, Jiao Y. USP11 Exacerbates Radiation-Induced Pneumonitis by Activating Endothelial Cell Inflammatory Response via OTUD5-STING Signaling. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00307-9. [PMID: 38364946 DOI: 10.1016/j.ijrobp.2024.01.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/18/2024] [Accepted: 01/28/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Radiation-induced pneumonitis (RIP) seriously limits the application of radiation therapy in the treatment of thoracic tumors, and its etiology and pathogenesis remain elusive. This study aimed to elucidate the role of ubiquitin-specific peptidase 11 (USP11) in the progression of RIP and the associated underlying mechanisms. METHODS AND MATERIALS Changes in cytokines and infiltrated immune cells were detected by enzyme-linked immunosorbent assays and immunohistochemistry after exposure to 20 Gy x-ray with whole-thorax irradiation. The effects of USP11 expression on endothelial cell proliferation and apoptosis were analyzed by costaining of CD31/Ki67 and CD31/caspase-3 in vivo, and the production of cytokines and reactive oxygen species was confirmed by reverse-transcription polymerase chain reaction and flow cytometry in vitro. Comprehensive proteome and ubiquitinome analyses were used for USP11 substrate screening after radiation. Results were verified by Western blotting and coimmunoprecipitation experiments. Recombinant adeno-associated virus lung vectors expressing OTUD5 were used for localized overexpression of OTUD5 in mouse pulmonary tissue, and immunohistochemistry was conducted to analyze cytokine expression. RESULTS The progression of RIP was significantly alleviated by reduced expression of proinflammatory cytokines in both Usp11-knockout (Usp11-/-) mice and in mice treated with the USP11 inhibitor mitoxantrone. Likewise, the absence of USP11 resulted in decreased permeability of pulmonary vessels and neutrophils and macrophage infiltration. The proliferation rates of endothelial cells were prominently increased in the Usp11-/- lung, whereas apoptosis in Usp11-/- lungs decreased after irradiation compared with that observed in Usp11+/+ lungs. Conversely, USP11 overexpression increased proinflammatory cytokine expression and reactive oxygen species production in endothelial cells after radiation. Comprehensive proteome and ubiquitinome analyses indicated that USP11 overexpression upregulates the expression of several deubiquitinating enzymes, including USP22, USP33, and OTUD5. We demonstrate that USP11 deubiquitinates OTUD5 and implicates the OTUD5-STING signaling pathway in the progression of the inflammatory response in endothelial cells. CONCLUSIONS USP11 exacerbates RIP by triggering an inflammatory response in endothelial cells both in vitro and in vivo, and the OTUD5-STING pathway is involved in the USP11-dependent promotion of RIP. This study provides experimental support for the development of precision intervention strategies targeting USP11 to mitigate RIP.
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Affiliation(s)
- Yiting Tang
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China; Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, China
| | - Tingya Wang
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Liming Gu
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Ying Xu
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Zhao Yang
- Department of Respiratory Medicine, Suzhou Science & Technology Town Hospital, Suzhou, China
| | - Wei Zhu
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Qi Zhang
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Judong Luo
- Department of Radiotherapy, Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jianping Cao
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China.
| | - Yang Jiao
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China.
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Yin H, Jia W, Yu J, Zhu H. Radiation pneumonitis after concurrent aumolertinib and thoracic radiotherapy in EGFR-mutant non-small cell lung cancer patients. BMC Cancer 2024; 24:197. [PMID: 38347438 PMCID: PMC10863168 DOI: 10.1186/s12885-024-11946-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The superior efficacy of concurrent thoracic radiotherapy (TRT) and epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) has been proven in locally advanced and advanced non-small cell lung cancer (NSCLC) patients with EGFR mutations. However, the high incidence of radiation pneumonitis (RP) reduced by concurrent TRT and TKIs has attracted widespread attention. Thus, this study was designed to investigate the rate and risk factors for RP in EGFR-positive NSCLC patients simultaneously treated with aumolertinib and TRT. METHODS We retrospectively evaluated stage IIIA-IVB NSCLC patients treated with concurrent aumolertinib and TRT between May 2020 and December 2022 at Shandong Cancer Hospital and Institute, Shandong, China. RP was diagnosed by two senior radiologists and then graded from 1 to 5 according to the Common Terminology Criteria for Adverse Events v5.0. All risk factors were evaluated by univariate and multivariate logistic regression analyses. RESULTS A total of 49 patients were included, the incidence of grade ≥ 2 RP was 42.9%. Grade 2 and 3 RP were observed in 28.6% and 14.3% of patients, respectively. Grade 4 to 5 RP were not observed. the gross total volume (GTV) ≥ 21 ml and ipsilateral lung V20 ≥ 25% were risk factors for RP. The median progression-free survival (PFS) in the first-line therapy group and second-line therapy group were 23.5 months and 17.2 months, respectively (p = 0.10). CONCLUSIONS Better local control is achieved with concurrent TRT and aumolertinib, and special attention should be given to controlling ipsilateral lung V20 and GTV to reduce the risk of RP.
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Affiliation(s)
- Hanjing Yin
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Wenxiao Jia
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 109 Machang Road, Wuhan, 430022, Hubei, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China.
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China.
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Li XJ, Li CR, Ye YC, Zhang YS, Zong XQ, Feng CL. A Dosimetric Comparative Study of Carbon-Ion Radiotherapy Versus X-ray Volumetric Modulated Arc Therapy for Stage III Non-Small-Cell Lung Cancer. Niger J Clin Pract 2024; 27:236-243. [PMID: 38409153 DOI: 10.4103/njcp.njcp_734_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/15/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Compared to photon beam, carbon-ion radiotherapy (CIRT) has both physical and biological advantages. AIM To examine whether two-dimensional (2D) CIRT is dosimetrically superior to photon beam volume-modulated arc therapy (VMAT) in protecting the normal tissues for stage III non-small-cell lung cancer (NSCLC). SUBJECTS AND METHODS A retrospective study was conducted. Thirteen patients with stage III NSCLC treated in our center with curative CIRT and a sham photon beam VMAT treatment planning with the same normal tissue dose constraints were included for analysis. Target dose distributions and the homogeneity index (HI) within the planning target volumes were compared. RESULTS Both CIRT and VMAT plans have good tumor coverage with no significant differences in D98, D95, and D50 of Planning target volume 1 (PTV1) between the two plans. The HIs between the two plans are similar. The HI of PTV2 is superior in the CIRT plan (CIRT vs. VMAT: 0.08 vs. 0.16, P < 0.05). In general, CIRT results in a lower dose of the organ-at-risk (OAR) than the photon plans. The V5, V10, V20, V30, V40, and Dmean of the contralateral lung in the CIRT plan are significantly lower than that of the photon VMAT. For the ipsilateral lung, the V5 of CIRT is significantly lower. The CIRT also had significantly lower spinal cord Dmax, esophageal Dmean and V50, V10 and V30 of bone, and V50 of the trachea and bronchial tree. CONCLUSIONS Compared with photon VMAT, 2D-CIRT using the passive beam scanning technique significantly reduces the radiation dose to the OARs in curative radiotherapy of stage III NSCLC, suggesting a better protection of the normal tissues.
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Affiliation(s)
- X-J Li
- Heavy Ion Radiotherapy Department, Wuwei Cancer Hospital and Institute, Wuwei Academy of Medical Sciences, Wuwei, Gansu, China
| | - C-R Li
- Radiotherapy Center, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Y-C Ye
- Heavy Ion Radiotherapy Department, Wuwei Cancer Hospital and Institute, Wuwei Academy of Medical Sciences, Wuwei, Gansu, China
| | - Y-S Zhang
- Heavy Ion Radiotherapy Department, Wuwei Cancer Hospital and Institute, Wuwei Academy of Medical Sciences, Wuwei, Gansu, China
| | - X-Q Zong
- Heavy Ion Radiotherapy Department, Wuwei Cancer Hospital and Institute, Wuwei Academy of Medical Sciences, Wuwei, Gansu, China
| | - C L Feng
- Heavy Ion Radiotherapy Department, Wuwei Cancer Hospital and Institute, Wuwei Academy of Medical Sciences, Wuwei, Gansu, China
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Aoyama T, Shimizu H, Koide Y, Kamezawa H, Fukunaga JI, Kitagawa T, Tachibana H, Suzuki K, Kodaira T. Deep Learning-based Lung dose Prediction Using Chest X-ray Images in Non-small Cell Lung Cancer Radiotherapy. J Med Phys 2024; 49:33-40. [PMID: 38828071 PMCID: PMC11141742 DOI: 10.4103/jmp.jmp_122_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose This study aimed to develop a deep learning model for the prediction of V20 (the volume of the lung parenchyma that received ≥20 Gy) during intensity-modulated radiation therapy using chest X-ray images. Methods The study utilized 91 chest X-ray images of patients with lung cancer acquired routinely during the admission workup. The prescription dose for the planning target volume was 60 Gy in 30 fractions. A convolutional neural network-based regression model was developed to predict V20. To evaluate model performance, the coefficient of determination (R2), root mean square error (RMSE), and mean absolute error (MAE) were calculated with conducting a four-fold cross-validation method. The patient characteristics of the eligible data were treatment period (2018-2022) and V20 (19.3%; 4.9%-30.7%). Results The predictive results of the developed model for V20 were 0.16, 5.4%, and 4.5% for the R2, RMSE, and MAE, respectively. The median error was -1.8% (range, -13.0% to 9.2%). The Pearson correlation coefficient between the calculated and predicted V20 values was 0.40. As a binary classifier with V20 <20%, the model showed a sensitivity of 75.0%, specificity of 82.6%, diagnostic accuracy of 80.6%, and area under the receiver operator characteristic curve of 0.79. Conclusions The proposed deep learning chest X-ray model can predict V20 and play an important role in the early determination of patient treatment strategies.
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Affiliation(s)
- Takahiro Aoyama
- Department of Radiation Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Yutaro Koide
- Department of Radiation Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Hidemi Kamezawa
- Division of Radiological Sciences, Graduate School of Health Sciences, Teikyo University, Fukuoka, Japan
| | - Jun-Ichi Fukunaga
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Tomoki Kitagawa
- Department of Radiation Oncology, Aichi Cancer Center, Nagoya, Japan
| | | | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center, Nagoya, Japan
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Saito M, Komiyama T, Marino K, Aoki S, Akita T, Matsuda M, Sano N, Suzuki H, Koji U, Nemoto H, Onishi H. Dosimetric comparison of five different radiotherapy treatment planning approaches for locally advanced non-small cell lung cancer with sequential plan changes. Thorac Cancer 2023; 14:3445-3452. [PMID: 37846145 PMCID: PMC10719662 DOI: 10.1111/1759-7714.15137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare the dosimetric characteristics of five different treatment planning techniques for locally advanced non-small cell lung cancer (LA-NSCLC) with sequential plan changes. METHODS A total of 13 stage III NSCLC patients were enrolled in this study. These patients had both computed tomography (CT) images for initial and boost treatment plans. The latter CT images were taken if tumor shrinkage was observed after 2 weeks of treatment. The prescription dose was 60 Gy/30 Fr (initial: 40 Gy/20 Fr, and boost: 20 Gy/10 Fr). Five techniques (forward-planed 3-dimensional conformal radiotherapy [F-3DCRT] on both CT images, inverse-planned 3DCRT [I-3DCRT] on both CT images, volumetric modulated arc therapy [VMAT] on both CT images, F-3DCRT on initial CT plus VMAT on boost CT [bVMAT], and hybrid of fixed intensity-modulated radiotherapy [IMRT] beams and VMAT beams on both CT images [hybrid]) were recalculated for all patients. The accumulated doses between initial and boost plans were compared among all treatment techniques. RESULTS The conformity indexes (CI) of the planning target volume (PTV) of the five planning techniques were 0.34 ± 0.10, 0.57 ± 0.10, 0.86 ± 0.08, 0.61 ± 0.12, and 0.83 ± 0.11 for F-3DCRT, I-3DCRT, VMAT, bVMAT, and hybrid, respectively. In the same manner, lung volumes receiving >20 Gy (V20Gy ) were 21.05 ± 10.56%, 20.86 ± 6.45, 19.50 ± 7.38%, 19.98 ± 10.04%, and 17.74 ± 7.86%. There was significant improvement about CI and V20Gy for hybrid compared with F-3DCRT (p < 0.05). CONCLUSION The IMRT/VMAT hybrid technique for LA-NSCLC patients improved target CI and reduced lung doses. Furthermore, if IMRT was not available initially, starting with 3DCRT might be beneficial as demonstrated in the bVMAT procedure of this study.
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Affiliation(s)
- Masahide Saito
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Kan Marino
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Shinichi Aoki
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Tomoko Akita
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Masaki Matsuda
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Naoki Sano
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Hidekazu Suzuki
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Ueda Koji
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Hikaru Nemoto
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Hiroshi Onishi
- Department of RadiologyUniversity of YamanashiYamanashiJapan
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Hui MCM, Chiu G, Wong S, Lien SL. An analysis of the impact of different levels of inspiratory volume using active breathing control on the intrafraction motion and dose coverage of target volumes in patients undergoing thoracic radiotherapy. J Med Imaging Radiat Sci 2023; 54:653-661. [PMID: 37620180 DOI: 10.1016/j.jmir.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE To determine whether the level of inspiratory volume affect the extent to which active breathing control (ABC) reduces intrafraction motion and the dose coverage of target volumes in patients receiving external beam radiation therapy (EBRT) to the thoracic region MATERIALS/METHODS: 20 patients undergoing thoracic radiotherapy enrolled in a prospective study using ABC for respiratory motion management and volumetric-modulated arc therapy (VMAT) as the treatment technique. They were randomized to one of two groups, the control group of 80% inspiratory volume and the other test group of 70%. At least one set of repeated CBCTs was done weekly. All images including CBCTs and Planning CTs were sent to MIM softwareTM for analysis of intrafraction motion using Dice Similarity Coefficient (DSC). The target dose conformality was assessed using conformation number (CN). Intention-to-treat analysis was employed for statistical purpose. RESULTS The DSC for the 70% and 80% inspiratory volume group were 0.93 and 0.92, respectively. For the 70% group, there was a significant negative correlation (p < 0.05) between DSC and time between two CBCTs, but not for the 80% group. The average percentage change in CN for the 70% and 80% group was 10.91% and 8.14%, respectively, and their difference was significant (p < 0.05). Furthermore, the actual change in volume had a significant positive correlation (p < 0.05) with the percentage change in CN for the 70% inspiratory volume group but not the 80% group. CONCLUSION More evidence suggests that the target volumes from the 80% inspiratory volume group have less intrafraction motion compared to the 70% group. The findings from the percentage change in CN suggest that there could potentially be less tumor motion for higher levels of inspiratory volume and this could possibly contribute to why intrafraction motion is less for the 80% inspiratory volume group.
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Affiliation(s)
- Michael Chun Man Hui
- Department of Radiotherapy, Hong Kong Sanatorium & Hospital, G/F, Li Shu Pui Block, 2 Village Road, Happy Valley, Hong Kong.
| | - George Chiu
- Department of Radiotherapy, Hong Kong Sanatorium & Hospital, G/F, Li Shu Pui Block, 2 Village Road, Happy Valley, Hong Kong
| | - Szeming Wong
- Department of Radiotherapy, Hong Kong Sanatorium & Hospital, G/F, Li Shu Pui Block, 2 Village Road, Happy Valley, Hong Kong
| | - Shao Lung Lien
- Department of Radiotherapy, Hong Kong Sanatorium & Hospital, G/F, Li Shu Pui Block, 2 Village Road, Happy Valley, Hong Kong
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SHIRATO H. Biomedical advances and future prospects of high-precision three-dimensional radiotherapy and four-dimensional radiotherapy. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2023; 99:389-426. [PMID: 37821390 PMCID: PMC10749389 DOI: 10.2183/pjab.99.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Biomedical advances of external-beam radiotherapy (EBRT) with improvements in physical accuracy are reviewed. High-precision (±1 mm) three-dimensional radiotherapy (3DRT) can utilize respective therapeutic open doors in the tumor control probability curve and in the normal tissue complication probability curve instead of the one single therapeutic window in two-dimensional EBRT. High-precision 3DRT achieved higher tumor control and probable survival rates for patients with small peripheral lung and liver cancers. Four-dimensional radiotherapy (4DRT), which can reduce uncertainties in 3DRT due to organ motion by real-time (every 0.1-1 s) tumor-tracking and immediate (0.1-1 s) irradiation, have achieved reduced adverse effects for prostate and pancreatic tumors near the digestive tract and with similar or better tumor control. Particle beam therapy improved tumor control and probable survival for patients with large liver tumors. The clinical outcomes of locally advanced or multiple tumors located near serial-type organs can theoretically be improved further by integrating the 4DRT concept with particle beams.
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Affiliation(s)
- Hiroki SHIRATO
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Liu T, Li S, Ding S, Qiu J, Ren C, Chen J, Wang H, Wang X, Li G, He Z, Dang J. Comparison of post-chemoradiotherapy pneumonitis between Asian and non-Asian patients with locally advanced non-small cell lung cancer: a systematic review and meta-analysis. EClinicalMedicine 2023; 64:102246. [PMID: 37781162 PMCID: PMC10539643 DOI: 10.1016/j.eclinm.2023.102246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/28/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023] Open
Abstract
Background Pneumonitis is a common complication for patients with locally advanced non-small cell lung cancer undergoing definitive chemoradiotherapy (CRT). It remains unclear whether there is ethnic difference in the incidence of post-CRT pneumonitis. Methods PubMed, Embase, Cochrane Library, and Web of Science were searched for eligible studies from January 1, 2000 to April 30, 2023. The outcomes of interest were incidence rates of pneumonitis. The random-effect model was used for statistical analysis. This meta-analysis was registered with PROSPERO (CRD42023416490). Findings A total of 248 studies involving 28,267 patients were included. Among studies of CRT without immunotherapy, the pooled rates of pneumonitis for Asian patients were significantly higher than that for non-Asian patients (all grade: 66.8%, 95% CI: 59.2%-73.9% vs. 28.1%, 95% CI: 20.4%-36.4%; P < 0.0001; grade ≥2: 25.1%, 95% CI: 22.9%-27.3% vs. 14.9%, 95% CI: 12.0%-18.0%; P < 0.0001; grade ≥3: 6.5%, 95% CI: 5.6%-7.3% vs. 4.6%, 95% CI: 3.4%-5.9%; P = 0.015; grade 5: 0.6%, 95% CI: 0.3%-0.9% vs. 0.1%, 95% CI: 0.0%-0.2%; P < 0.0001). Regarding studies of CRT plus immunotherapy, Asian patients had higher rates of all-grade (74.8%, 95% CI: 63.7%-84.5% vs. 34.3%, 95% CI: 28.7%-40.2%; P < 0.0001) and grade ≥2 (34.0%, 95% CI: 30.7%-37.3% vs. 24.6%, 95% CI: 19.9%-29.3%; P = 0.001) pneumonitis than non-Asian patients, but with no significant differences in the rates of grade ≥3 and grade 5 pneumonitis. Results from subgroup analyses were generally similar to that from the all studies. In addition, the pooled median/mean of lung volume receiving ≥20 Gy and mean lung dose were relatively low in Asian studies compared to that in non-Asian studies. Interpretation Asian patients are likely to have a higher incidence of pneumonitis than non-Asian patients, which appears to be due to the poor tolerance of lung to radiation. Nevertheless, these findings are based on observational studies and with significant heterogeneity, and need to be validated in future large prospective studies focusing on the subject. Funding None.
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Affiliation(s)
- Tingting Liu
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
- Department of Radiation Oncology, Anshan Cancer Hospital, Anshan, China
| | - Sihan Li
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Silu Ding
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Jingping Qiu
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Chengbo Ren
- Department of Radiation Oncology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Jun Chen
- Department of Radiation Oncology, Shenyang Tenth People's Hospital, Shenyang, China
| | - He Wang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Xiaoling Wang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Guang Li
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Zheng He
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Jun Dang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
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Kirakli EK, Erdem S, Susam S, Erim E. Ipsilateral lung dose as a correlative measure for radiation pneumonitis in patients treated with definitive concurrent radiochemotherapy. J Cancer Res Ther 2023; 19:1153-1159. [PMID: 37787278 DOI: 10.4103/jcrt.jcrt_618_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Objective Mean lung dose (MLD) and percent of total lung (TL) volume that receive a dose greater than 20 Gy (V20) have been the most validated parameters in the prediction of radiation pneumonitis (RP). However, these parameters present mean values of TL parenchyma and predict the right and the left lung as a unique functional organ unit, not take into account the difference in function and dose density between the lungs. Furthermore, there have been very limited data evaluating ipsilateral lung dosimetric constraints in addition to TL parameters to predict RP in non-small cell lung cancer (NSCLC) patients treated with radiochemotherapy (RCT). Methods Between 2010 and 2017, clinical-radiological findings of NSCLC patients treated with RCT were evaluated in terms of RP, retrospectively. MLD, V20, and V30 values of ipsilateral lung were assessed from dose-volume histogram and registered. The primary endpoint was to assess the relation between ipsilateral lung dose constraints and RP risk. Results There were 75 patients. There was ≥Grade 2 RP in 33 cases (%44). In univariate analysis, ipsilateral MLD, ipsilateral V20, ipsilateral V30, and TL V30 were found to be significant. Ipsilateral MLD and PTV were found to be the independent risk factors for RP. Cutoff values for RP risk were determined as 18Gy, 35%, and 28% for ipsilateral MLD, ipsilateral V20, and ipsilateral V30, respectively. Predictive values for ipsilateral MLD and ipsilateral V20 were higher than TL. Conclusions In NSCLC patients treated with RCT, MLD, V20, and V30 values of ipsilateral lung parameters might increase the predictability of RP risk in addition to TL parameters. Advances in Knowledge Cutoff values for RP risk were determined as 18Gy, 35%, and 28% for ipsilateral MLD, ipsilateral V20, and ipsilateral V30, respectively. Predictive values for ipsilateral MLD and ipsilateral V20 were higher than TL.
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Affiliation(s)
- Esra Korkmaz Kirakli
- Department of Radiation, Dr. Suat Seren Chest Diseases and Surgery Research and Training Hospital, Konak, Izmir, Turkey
| | - Sevilay Erdem
- Department of Radiation, Dr. Suat Seren Chest Diseases and Surgery Research and Training Hospital, Konak, Izmir, Turkey
| | - Seher Susam
- Department of Radiology, Dr. Suat Seren Chest Diseases and Surgery Research and Training Hospital, Konak, Izmir, Turkey
| | - Eser Erim
- Department of Radiation, Dr. Suat Seren Chest Diseases and Surgery Research and Training Hospital, Konak, Izmir, Turkey
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Alaswad M. Locally advanced non-small cell lung cancer: current issues and recent trends. Rep Pract Oncol Radiother 2023; 28:286-303. [PMID: 37456701 PMCID: PMC10348324 DOI: 10.5603/rpor.a2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/29/2023] [Indexed: 07/18/2023] Open
Abstract
The focus of this paper was to review and summarise the current issues and recent trends within the framework of locally advanced (LA) non-small cell lung cancer (NSCLC). The recently proposed 8th tumour-node-metastases (TNM) staging system exhibited significant amendments in the distribution of the T and M descriptors. Every revision to the TNM classification should contribute to clinical improvement. This is particularly necessary regarding LA NSCLC stratification, therapy and outcomes. While several studies reported the superiority of the 8th TNM edition in comparison to the previous 7th TNM edition, in terms of both the discrimination ability among the various T subgroups and clinical outcomes, others argued against this interpretation. Synergistic cytotoxic chemotherapy with radiotherapy is most prevalent in treating LA NSCLC. Clinical trial experience from multiple references has reported that the risk of locoregional relapse and distant metastasis was less evident for patients treated with concomitant radiochemotherapy than radiotherapy alone. Nevertheless, concern persists as to whether major incidences of toxicity may occur due to the addition of chemotherapy. Cutting-edge technologies such as four-dimensional computed tomography (4D-CT) and volumetric modulated arc therapy (VMAT) should yield therapeutic gains due to their capability to conform radiation doses to tumours. On the basis of the preceding notion, the optimum radiotherapy technique for LA NSCLC has been a controversial and much-disputed subject within the field of radiation oncology. Notably, no single-perspective research has been undertaken to determine the optimum radiotherapy modality for LA NSCLC. The landscape of immunotherapy in lung cancer is rapidly expanding. Currently, the standard of care for patients with inoperable LA NSCLC is concurrent chemoradiotherapy followed by maintenance durvalumab according to clinical outcomes from the PACIFIC trial. An estimated 42.9% of patients randomly assigned to durvalumab remained alive at five years, and free of disease progression, thereby establishing a new benchmark for the standard of care in this setting.
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Affiliation(s)
- Mohammed Alaswad
- Comprehensive Cancer Centre, Radiation Oncology, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
- Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
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15
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Chen F, Niu J, Wang M, Zhu H, Guo Z. Re-evaluating the risk factors for radiation pneumonitis in the era of immunotherapy. J Transl Med 2023; 21:368. [PMID: 37287014 DOI: 10.1186/s12967-023-04212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
As one of the common complications of radiotherapy, radiation pneumonia (RP) limits the prognosis of patients. Therefore, better identifying the high-risk factors that lead to RP is essential to effectively prevent its occurrence. However, as lung cancer treatment modalities are being replaced and the era of immunotherapy has arrived, literature that reviews the parameters and mode of radiotherapy, chemotherapy drugs, targeted drugs and current hot immune checkpoint inhibitors related to RP is lacking. This paper summarizes the risk factors for radiation pneumonia by retrieving and analysing previously published literature and the results of large clinical trials. The literature primarily included retrospective analyses, including clinical trials in different periods and a part of the literature review. A systematic literature search of Embase, PubMed, Web of Science, and Clinicaltrials.gov was performed for relevant publications up to 6 Dec. 2022. Search keywords include, but are not limited to, "radiation pneumonia", "pneumonia", "risk factors", "immunotherapy", etc. The factors related to RP in this paper include physical parameters of radiotherapy, including V5, V20, and MLD; chemoradiotherapy mode and chemotherapy drugs, including paclitaxel and gemcitabine; EGFR-TKI; ALK inhibitors; antiangiogenic drugs; immune drugs and the underlying disease of the patient. We also introduce the possible mechanism of RP. In the future, we hope that this article not only sounds the alarm for clinicians but also helps to identify a method that can effectively intervene and reduce the occurrence of RP, significantly improve the quality of life and prognosis of patients, and more effectively improve the therapeutic effect of radiation therapy.
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Affiliation(s)
- Feihu Chen
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Jiling Niu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Min Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China.
| | - Zhijun Guo
- Department of Intensive Care Unit, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China.
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Sakagami M, Inokuchi H, Mukumoto N, Itoyama H, Hamaura N, Yamagishi M, Mukumoto N, Matsuda S, Kabata D, Shibuya K. Clinical features and risk factors for interstitial lung disease spreading in low-dose irradiated areas after definitive radiotherapy with or without durvalumab consolidation therapy for patients with non-small cell lung cancer. Radiat Oncol 2023; 18:87. [PMID: 37217919 DOI: 10.1186/s13014-023-02276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND The current standard of care for patients with unresectable locally advanced non-small cell lung cancer (NSCLC) is chemoradiotherapy (CRT) combined with durvalumab consolidation therapy. However, radiotherapy (RT) always carries the risk of radiation pneumonitis (RP), which can preclude durvalumab continuation. In particular, the spread of interstitial lung disease (ILD) in low-dose areas or extending beyond the RT field often makes it difficult to determine the safety of continuation or rechallenging of durvalumab. Thus, we retrospectively analyzed ILD/RP after definitive RT with and without durvalumab, with assessment of radiologic features and dose distribution in RT. METHODS We retrospectively evaluated the clinical records, CT imaging, and radiotherapy planning data of 74 patients with NSCLC who underwent definitive RT at our institution between July 2016 and July 2020. We assessed the risk factors for recurrence within one year and occurrence of ILD/RP. RESULTS Kaplan-Meier method showed that ≥ 7 cycles of durvalumab significantly improved 1-year progression free survival (PFS) (p < 0.001). Nineteen patients (26%) were diagnosed with ≥ Grade 2 and 7 (9.5%) with ≥ Grade 3 ILD/RP after completing RT. There was no significant correlation between durvalumab administration and ≥ Grade 2 ILD/RP. Twelve patients (16%) developed ILD/RP that spread outside the high-dose (> 40 Gy) area, of whom 8 (67%) had ≥ Grade 2 and 3 (25%) had Grade 3 symptoms. In unadjusted and multivariate Cox proportional-hazards models adjusted for V20 (proportion of the lung volume receiving ≥ 20 Gy), high HbA1c level was significantly correlated with ILD/RP pattern spreading outside the high-dose area (hazard ratio, 1.842; 95% confidence interval, 1.35-2.51). CONCLUSIONS Durvalumab improved 1-year PFS without increasing the risk of ILD/RP. Diabetic factors were associated with ILD/RP distribution pattern spreading in the lower dose area or outside RT fields, with a high rate of symptoms. Further study of the clinical background of patients including diabetes is needed to safely increase the number of durvalumab doses after CRT.
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Affiliation(s)
- Mai Sakagami
- Department of Radiation Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
| | - Haruo Inokuchi
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Nobutaka Mukumoto
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroshige Itoyama
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Nobunari Hamaura
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Mutsumi Yamagishi
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Naoki Mukumoto
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shogo Matsuda
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Keiko Shibuya
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Azumi R, Soyama M, Saito M. Early Detection of Radiation Pneumonitis on Cone-Beam CT Images During a Course of Radiotherapy: A Case Series Report. Cureus 2023; 15:e38275. [PMID: 37261180 PMCID: PMC10227775 DOI: 10.7759/cureus.38275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
Background and aim Radiation pneumonitis (RP) is a critical pulmonary toxicity following dose delivery to the lung, and it is usually diagnosed after radiotherapy courses are completed. Because RP may result in a lethal complication, a practical method for detecting early-phase RP is awaited. In this article, we describe our experience through a variety of clinical cases and discuss treatment decisions and lessons we have made and learned. Materials and methods A daily cone-beam computed tomography (CBCT) scan was employed with a lung window setting to detect the early-phase RP during treatment courses. For the past five years, thirty patients were diagnosed with RP, and eight patients were detected during radiotherapy courses on the CBCT images. Our best efforts were made in detecting early ground-glass opacity and early RP on CBCT images prior to symptoms. The eight cases were described in more detail with CBCT or CT images. Results and discussion Initially, RP was detected at 50 Gy or greater. However, more careful CBCT observation resulted in earlier detection at around 40 Gy. Then, a new problem arose whether the treatment should be terminated. It was reported that early RP development was associated with higher-grade complications, and therefore it is preferable to terminate radiotherapy once we detect even early-phase RP. However, termination in the middle of the treatment course may significantly reduce the therapeutic effect. In our experience, patients with favorable clinical status may continue to receive radiotherapy with careful observation of lung parenchyma on CBCT images and clinical data, such as Krebs Von den Lungen-6 (KL-6) and C-reactive protein (CRP). Conclusion We have shown that early detection of RP may be feasible during radiotherapy courses by daily monitoring of CBCT lung images. Further studies are awaited to proceed.
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Affiliation(s)
- Rieko Azumi
- Radiology, National Hospital Organization (NHO) Nishiniigata Chuo Hospital, Niigata, JPN
| | - Maki Soyama
- Radiology, National Hospital Organization (NHO) Nishiniigata Chuo Hospital, Niigata, JPN
| | - Mari Saito
- Radiology, Niigata Diagnostic Imaging Center, Niigata, JPN
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Kraus KM, Oreshko M, Bernhardt D, Combs SE, Peeken JC. Dosiomics and radiomics to predict pneumonitis after thoracic stereotactic body radiotherapy and immune checkpoint inhibition. Front Oncol 2023; 13:1124592. [PMID: 37007119 PMCID: PMC10050584 DOI: 10.3389/fonc.2023.1124592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/01/2023] [Indexed: 03/17/2023] Open
Abstract
IntroductionPneumonitis is a relevant side effect after radiotherapy (RT) and immunotherapy with checkpoint inhibitors (ICIs). Since the effect is radiation dose dependent, the risk increases for high fractional doses as applied for stereotactic body radiation therapy (SBRT) and might even be enhanced for the combination of SBRT with ICI therapy. Hence, patient individual pre-treatment prediction of post-treatment pneumonitis (PTP) might be able to support clinical decision making. Dosimetric factors, however, use limited information and, thus, cannot exploit the full potential of pneumonitis prediction.MethodsWe investigated dosiomics and radiomics model based approaches for PTP prediction after thoracic SBRT with and without ICI therapy. To overcome potential influences of different fractionation schemes, we converted physical doses to 2 Gy equivalent doses (EQD2) and compared both results. In total, four single feature models (dosiomics, radiomics, dosimetric, clinical factors) were tested and five combinations of those (dosimetric+clinical factors, dosiomics+radiomics, dosiomics+dosimetric+clinical factors, radiomics+dosimetric+clinical factors, radiomics+dosiomics+dosimetric+clinical factors). After feature extraction, a feature reduction was performed using pearson intercorrelation coefficient and the Boruta algorithm within 1000-fold bootstrapping runs. Four different machine learning models and the combination of those were trained and tested within 100 iterations of 5-fold nested cross validation.ResultsResults were analysed using the area under the receiver operating characteristic curve (AUC). We found the combination of dosiomics and radiomics features to outperform all other models with AUCradiomics+dosiomics, D = 0.79 (95% confidence interval 0.78-0.80) and AUCradiomics+dosiomics, EQD2 = 0.77 (0.76-0.78) for physical dose and EQD2, respectively. ICI therapy did not impact the prediction result (AUC ≤ 0.5). Clinical and dosimetric features for the total lung did not improve the prediction outcome.ConclusionOur results suggest that combined dosiomics and radiomics analysis can improve PTP prediction in patients treated with lung SBRT. We conclude that pre-treatment prediction could support clinical decision making on an individual patient basis with or without ICI therapy.
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Affiliation(s)
- Kim Melanie Kraus
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU) GmbH German Research Center for Environmental Health, Neuherberg, Germany
- Partner Site Munich, German Consortium for Translational Cancer Research (DKTK), Munich, Germany
- *Correspondence: Kim Melanie Kraus,
| | - Maksym Oreshko
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- Medical Faculty, University hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- Partner Site Munich, German Consortium for Translational Cancer Research (DKTK), Munich, Germany
| | - Stephanie Elisabeth Combs
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU) GmbH German Research Center for Environmental Health, Neuherberg, Germany
- Partner Site Munich, German Consortium for Translational Cancer Research (DKTK), Munich, Germany
| | - Jan Caspar Peeken
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU) GmbH German Research Center for Environmental Health, Neuherberg, Germany
- Partner Site Munich, German Consortium for Translational Cancer Research (DKTK), Munich, Germany
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Predictors of high-grade radiation pneumonitis following radiochemotherapy for locally advanced non-small cell lung cancer: analysis of clinical, radiographic and radiotherapy-related factors. JOURNAL OF RADIOTHERAPY IN PRACTICE 2023. [DOI: 10.1017/s1460396923000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Abstract
Purpose:
In this study, the relation between radiation pneumonitis (RP) and a wide spectrum of clinical, radiographic and treatment-related factors was investigated. As scoring of low-grade RP can be subjective, RP grade ≥3 (RP ≥ G3) was chosen as a more objective and clinically significant endpoint for this study.
Methods and Materials:
105 consecutive patients with locally advanced non-small cell lung cancer underwent conventionally fractionated radio-(chemo-)therapy to a median dose of 64 Gy. A retrospective analysis of 25 clinical (gender, race, pulmonary function, diabetes, statin use, smoking history), radiographic (emphysema, interstitial lung disease) and radiotherapy dose- and technique-related factors was performed to identify predictors of RP ≥ G3. Following testing of all variables for statistical association with RP using univariate analysis (UVA), a forward selection algorithm was implemented for building a multivariate predictive model (MVA) with limited sample size.
Results:
Median follow-up of surviving patients was 33 months (9–132 months). RP ≥ G3 was diagnosed in 10/105 (9·5%) patients. Median survival was 28·5 months. On UVA, predictors for RP ≥ G3 were diabetes, lower lobe location, planning target volume, volumetric modulated arc therapy (VMAT), lung V5 Gy (%), lung Vspared5 Gy (mL), lung V20 Gy (%) and heart V5 Gy (% and mL). On MVA, VMAT was the only significant predictor for RP ≥ G3 (p = 0·042). Lung V5 Gy and lung V20 Gy were borderline significant for RP ≥ G3. Patients with RP ≥ 3 had a median survival of 10 months compared to 29·5 months with RP < G3 (p = 0·02).
Conclusions:
In this study, VMAT was the only factor that was significantly correlated with RP ≥ G3. Avoiding RP ≥ G3 is important as a toxicity per se and as a risk factor for poor survival. To reduce RP, caution needs to be taken to reduce low-dose lung volumes in addition to other well-established dose constraints.
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Mukai-Sasaki Y, Liao Z, Yang D, Inoue T. Modulators of radiation-induced cardiopulmonary toxicities for non-small cell lung cancer: Integrated cytokines, single nucleotide variants, and HBP systems imaging. Front Oncol 2022; 12:984364. [PMID: 36591530 PMCID: PMC9797663 DOI: 10.3389/fonc.2022.984364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Radiation therapy (RT)-induced cardiopulmonary toxicities remain dose-limiting toxicities for patients receiving radiation dosages to the thorax, especially for lung cancer. Means of monitoring and predicting for those receiving RT or concurrent chemoradiation therapy before treatment begins in individual patients could benefit early intervention to prevent or minimize RT-induced side effects. Another aspect of an individual's susceptibility to the adverse effects of thoracic irradiation is the immune system as reflected by phenotypic factors (patterns of cytokine expressions), genotypic factors (single nucleotide variants SNVs; formerly single nucleotide polymorphisms [SNPs]), and aspects of quantitative cellular imaging. Levels of transcription, production, and functional activity of cytokines are often influenced by SNVs that affect coding regions in the promoter or regulatory regions of cytokine genes. SNVs can also lead to changes in the expression of the inflammatory cytokines, interferons, interleukins (IL-6, IL-17) and tumor necrosis factors (TNF-α) at the protein level. RT-induced cardiopulmonary toxicities could be quantified by the uptake of 18F-fluorodeoxyglucose (FDG), however, FDG is a sensitive but not specific biomarker in differential diagnosis between inflammation/infection and tumor recurrence. FDG is suitable for initial diagnosis of predisposed tissue injuries in non-small cell lung cancer (NSCLC). 99mTc-ethylenedicysteine-glucosamine (99mTc-EC-G) was able to measure tumor DNA proliferation and myocardial ischemia via hexosamine biosynthetic pathways (HBP). Thus, 99mTc-EC-G could be an alternative to FDG in the assessment of RT doses and select patients in HBP-directed targets for optimal outcomes. This article reviewed correlative analyses of pro-inflammatory cytokines, genotype SNVs, and cellular imaging to improve the diagnosis, prognosis, monitoring, and prediction of RT-induced cardiopulmonary toxicities in NSCLC.
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Affiliation(s)
- Yuki Mukai-Sasaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,Advanced Medical Center, Shonan Kamakura General Hospital, Kamakura, Japan,*Correspondence: Yuki Mukai-Sasaki,
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - David Yang
- Advanced Medical Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Tomio Inoue
- Advanced Medical Center, Shonan Kamakura General Hospital, Kamakura, Japan
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Doshita K, Tabuchi Y, Kenmotsu H, Omori S, Kawabata T, Kodama H, Nishioka N, Miyawaki E, Iida Y, Mamesaya N, Kobayashi H, Ko R, Wakuda K, Ono A, Naito T, Murakami H, Mori K, Harada H, Kaneko T, Takahashi T. Incidence and Treatment Outcome of Radiation Pneumonitis in Patients With Limited-stage Small Cell Lung Cancer Treated With Concurrent Accelerated Hyperfractionated Radiation Therapy and Chemotherapy. Adv Radiat Oncol 2022; 8:101129. [PMID: 36845617 PMCID: PMC9943774 DOI: 10.1016/j.adro.2022.101129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose This study aimed to clarify the characteristics of and evaluate the risk factors for radiation pneumonitis (RP) induced by chemoradiation therapy (CRT) using accelerated hyperfractionated (AHF) radiation therapy (RT) in patients with limited-stage small cell lung cancer (LS-SCLC). Methods and Materials Between September 2002 and February 2018, 125 patients with LS-SCLC were treated with early concurrent CRT using AHF-RT. Chemotherapy was comprised of carboplatin/cisplatin with etoposide. RT was administered twice daily (45 Gy/30 fractions). We collected data regarding onset and treatment outcomes for RP, and analyzed the relationship between RP and total lung dose-volume histogram findings. Uni- and multivariate analyses were performed to assess patient- and treatment-related factors for grade ≥2 RP. Results The median age of patients was 65 years, and 73.6% of participants were men. In addition, 20% and 80.0% of participants presented with disease stage II and III, respectively. The median follow-up time was 73.1 months. Grades 1, 2, and 3 RP were observed in 69, 17, and 12 patients, respectively. Grades 4 to 5 RP were not observed. RP was treated with corticosteroids in patients with grade ≥2 RP, without recurrence. The median time from initiation of RT to onset of RP was 147 days. Three patients developed RP within 59 days, 6 within 60 to 89 days, 16 within 90 to 119 days, 29 within 120 to 149 days, 24 within 150 to 179 days, and 20 within ≥180 days. Among the dose-volume histogram parameters, the percentage of lung volume receiving >30 Gy (V30) was most strongly related to the incidence of grade ≥2 RP, and the optimal threshold to predict RP incidence was V30 ≥20%. On multivariate analysis, V30 ≥20% was an independent risk factor for grade ≥2 RP. Conclusions The incidence of grade ≥2 RP correlated strongly with a V30 of ≥20%. Contrarily, the onset of RP induced by concurrent CRT using AHF-RT may occur later. RP is manageable in patients with LS-SCLC.
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Affiliation(s)
- Kosei Doshita
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan,Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Yuya Tabuchi
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Nagaizumi-cho Suntou-gun, Shizuoka, Japan
| | - Hirotsugu Kenmotsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan,Corresponding author: Hirotsugu Kenmotsu, PhD
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Takanori Kawabata
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Hiroaki Kodama
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Naoya Nishioka
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Eriko Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Yuko Iida
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Ryo Ko
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Keita Mori
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Hideyuki Harada
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Nagaizumi-cho Suntou-gun, Shizuoka, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Toshiaki Takahashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
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Berg J, Halvorsen AR, Bengtson MB, Lindberg M, Halvorsen B, Aukrust P, Helland Å, Ueland T. Circulating T Cell Activation and Exhaustion Markers Are Associated With Radiation Pneumonitis and Poor Survival in Non-Small-Cell Lung Cancer. Front Immunol 2022; 13:875152. [PMID: 35911763 PMCID: PMC9329944 DOI: 10.3389/fimmu.2022.875152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Persistent inflammation and immune activation in the lungs are associated with adverse outcomes such as radiation pneumonitis (RP) and poor survival in non-small-cell lung cancer (NSCLC) patients. However, it is unknown how this is reflected by leukocyte activation markers in serum. Objective The aim was to evaluate the serum levels of activation of different leukocyte subsets and to examine those in relation to the pathogenesis of RP and survival in NSCLC. Methods We analyzed the serum levels of MPO, sCD25, sTIM-3, sPD-L1, sCD14, sCD163, CCL19 and CCL21 in 66 inoperable NSCLC patients with stage IA-IIIA disease. The patients were treated with stereotactic body radiation therapy (SBRT) or concurrent chemoradiation therapy (CCRT), followed by regular blood sampling for 12 months after treatment and for 5 years for survival. Results Nineteen (29%) patients developed RP, which occurred more frequently and earlier in patients receiving CCRT than in those receiving SBRT. Increases in sCD25, sTIM-3 and CCL21 levels were observed at the last 6 months of follow-up in patients who had RP after SBRT. Patients who had RP after CCRT had higher sTIM-3 levels during the first 3 months of follow-up. Baseline sCD25 was independently associated with both 2- and 5-year mortality outcomes, while baseline sTIM-3 was independently associated with 2-year mortality. Conclusion We showed that T cell activation and exhaustion markers such as sCD25 and sTIM-3 are enhanced in patients developing RP and are associated with poor survival in NSCLC.
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Affiliation(s)
- Janna Berg
- Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Cancer Genetics, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
- *Correspondence: Janna Berg,
| | - Ann Rita Halvorsen
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Morten Lindberg
- Department of Medical Biochemistry, Vestfold Hospital Trust, Tønsberg, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Åslaug Helland
- Department of Cancer Genetics, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
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YANG X, MEI T, YU M, GONG Y. Symptomatic Radiation Pneumonitis in NSCLC Patients Receiving EGFR-TKIs and Concurrent Once-daily Thoracic Radiotherapy: Predicting the Value of Clinical and Dose-volume Histogram Parameters. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:409-419. [PMID: 35747920 PMCID: PMC9244499 DOI: 10.3779/j.issn.1009-3419.2022.102.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The incidence of symptomatic radiation pneumonitis (RP) and its relationship with dose-volume histogram (DVH) parameters in non-small cell lung cancer (NSCLC) patients receiving epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) and concurrent once-daily thoracic radiotherapy (TRT) remain unclear. We aim to analyze the values of clinical factors and dose-volume histogram (DVH) parameters to predict the risk for symptomatic RP in these patients. METHODS Between 2011 and 2019, we retrospectively analyzed and identified 85 patients who had received EGFR-TKIs and once-daily TRT simultaneously (EGFR-TKIs group) and 129 patients who had received concurrent chemoradiotherapy (CCRT group). The symptomatic RP was recorded according to the Common Terminology Criteria for Adverse Event (CTCAE) criteria (grade 2 or above). Statistical analyses were performed using SPSS 26.0. RESULTS In total, the incidences of symptomatic (grade≥2) and severe RP (grade≥3) were 43.5% (37/85) and 16.5% (14/85) in EGFR-TKIs group vs 27.1% (35/129) and 10.1% (13/129) in CCRT group respectively. After 1:1 ratio between EGFR-TKIs group and CCRT group was matched by propensity score matching, chi-square test suggested that the incidence of symptomatic RP in the MATCHED EGFR-TKIs group was higher than that in the matched CCRT group (χ2=4.469, P=0.035). In EGFR-TKIs group, univariate and multivariate analyses indicated that the percentage of ipsilateral lung volume receiving ≥30 Gy (ilV30) [odds ratio (OR): 1.163, 95%CI: 1.036-1.306, P=0.011] and the percentage of total lung volume receiving ≥20 Gy (tlV20) (OR: 1.171, 95%CI: 1.031-1.330, P=0.015), with chronic obstructive pulmonary disease (COPD) or not (OR: 0.158, 95%CI: 0.041-0.600, P=0.007), were independent predictors of symptomatic RP. Compared to patients with lower ilV30/tlV20 values (ilV30 and tlV20<cut-off point values) and without COPD, patients with higher ilV30/tlV20 values (ilV30 and tlV20>cut-off point values) and COPD had a significantly higher risk for developing symptomatic RP, with a hazard ratio (HR) of 1.350 (95%CI: 1.190-1.531, P<0.001). CONCLUSIONS Patients receiving both EGFR-TKIs and once-daily TRT were more likely to develop symptomatic RP than patients receiving concurrent chemoradiotherapy. The ilV30, tlV20, and comorbidity of COPD may predict the risk of symptomatic RP among NSCLC patients receiving EGFR-TKIs and conventionally fractionated TRT concurrently.
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Affiliation(s)
- Xuexi YANG
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ting MEI
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Min YU
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Youling GONG
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China,Youling GONG, E-mail:
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Dosimetric predictors of pneumonitis in locally advanced non-small cell lung cancer patients treated with chemoradiation followed by durvalumab. Lung Cancer 2022; 170:58-64. [PMID: 35716632 DOI: 10.1016/j.lungcan.2022.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The incidence and predictors of pneumonitis for patients with unresectable, locally advanced non-small cell lung cancer (NSCLC) in the era of consolidation durvalumab have yet to be fully elucidated. In this large single institution analysis, we report the incidence of and factors associated with grade 2 + pneumonitis in NSCLC patients treated with the PACIFIC regimen. MATERIALS AND METHODS We identified all patients treated at our institution with definitive CRT followed by durvalumab from 2018 to 2021. Clinical documentation and imaging studies were reviewed to determine grade 2 + pneumonitis events, which required the following: 1) pulmonary symptoms warranting prolonged steroid taper, oxygen dependence, and/or hospital admission and 2) radiographic findings consistent with pneumonitis. RESULTS One-hundred ninety patients were included. The majority received 60 Gray (Gy) in 30 fractions with concurrent carboplatin and paclitaxel. Median number of durvalumab cycles received was 12 (IQR: 4-22). At a median follow-up of 14.8 months, 50 (26.3%) patients experienced grade 2 + pneumonitis with a 1-year cumulative incidence of 27.8% (95% CI: 21.9-35.4). Seventeen (8.9%) patients experienced grade 3 + pneumonitis and 4 grade 5 (2.1%). Dosimetric predictors of pneumonitis included ipsilateral and total lung volume receiving 5 Gy or greater (V5Gy), V10Gy, V20Gy, V40Gy, and mean dose and contralateral V40Gy. Heart V5Gy, V10Gy, and mean dose were also significant variables. Overall survival estimates at 1 and 3 years were 87.4% (95% CI: 82.4-92.8) and 60.3% (95% CI: 47.9-74.4), respectively. CONCLUSION We report a risk of pneumonitis higher than that seen on RTOG 0617 and comparable to the PACIFIC study. Multiple lung and heart dosimetric factors were predictive of pneumonitis.
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Li F, Luo Y, Chen J, He L, Liang Y, Lai J, Guo F. Association between tumor morphology and dosimetric parameters of organs at risk after intensity-modulated radiotherapy in esophagus cancer. J Appl Clin Med Phys 2022; 23:e13612. [PMID: 35635800 PMCID: PMC9278670 DOI: 10.1002/acm2.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 02/26/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE We explored the effects of geometrical topological properties of tumors such as tumor length and "axial cross-sectional area (ACSA)" of tumors (planning target volume [PTV] volume /PTV length) on the dosimetric parameters of organs at risk (lung and heart) in patients with esophagus cancer (EPC) treated by way of intensity-modulated radiation therapy (IMRT), so as to provide a guideline for the dosimetric limitation for organs at risk in IMRT treatment. METHODS A retrospective analysis was done on 103 cases of patients with EPC who were treated by IMRT from November 2010 to August 2019, in which PTV-G stood for the externally expanded planning target volume (PTV) of the gross tumor volume (GTV) and PTV-C for the externally expanded volume of the clinical target volume (CTV). A linear regression model was employed to analyze the several pairs of correlation: the 1st one between the relative length of tumors (PTV length/lung length) and pulmonary dose-volume parameters, the 2nd one between ACSA of tumors and pulmonary dose-volume parameters, the 3rd one between PTV length and the dosimetric parameters of the heart, and the last one between ACSA of tumors and the dosimetric parameters of the heart. RESULTS (i) There was a strong positive correlation between the relative length of tumors (PTV length/lung length) and V5 (p < 0.001, r = 0.73), and V10 (p < 0.001, r = 0.66) of the lung. There was a moderate positive correlation between the relative length of tumors and V30 (p < 0.001, r = 0.44) of the lung, and a weak positive correlation between the relative length of tumors and V20 (p < 0.001, r = 0.39) of the lung. (ii) There was a strong positive correlation between ACSA of tumors (PTV volume/PTV length) and V30 (p < 0.001, r = 0.67) of the lung, a moderate positive correlation between ACSA of tumors and V20 (p <0.001, r = 0.51) of the lung, and a weak positive correlation between ACSA of tumors and V10 (p = 0.019, r = 0.23) of the lung, yet there was not an obvious correlation between ACSA of tumors and V5 p > 0.05) of the lung. (iii) There was a moderate positive correlation between PTV length and V40 (p < 0.001, r = 0.58), and Dmean (p < 0.001, r = 0.52) of the heart, yet there was no obvious correlation between ACSA of tumors and Dmean and V40 of the heart (p > 0.05). CONCLUSIONS (i) Compared with the high-dose region of the lung, the relative length of tumors (PTV length/lung length) has a greater impact on the low-dose region of the lung. The linear regression equation of scatter plot showed that when the relative length of tumors increased by 0.1, the lung dose-volume parameters of V5 , V10 , V20 , and V30 increased by approximately 5.37%, 3.59%, 1.05%, and 1.08%, respectively. When PTV length increased by 1 cm, Dmean and V40 of the heart increased by approximately 153.6 cGy and 2.03%, respectively. (ii) Compared with the low-dose region of the lung, the value of ACSA of tumors (PTV volume/PTV length) has a greater impact on the high-dose region of the lung. However, the value of ACSA of tumors has no significant effect on the dosimetric parameters of the heart (Dmean and V40 ). The linear regression equation of scatter plot showed that when ACSA of tumors increased by 10 cm2 , the lung dose-volume parameters of V10 , V20, and V30 increased by approximately 3.11%, 3.37%, and 4.01%, respectively.
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Affiliation(s)
- Fahui Li
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yuxuan Luo
- The Medical Technology and Engineering Academy of Fujian Medical University, Fuzhou, China
| | - Jing Chen
- The Medical Technology and Engineering Academy of Fujian Medical University, Fuzhou, China
| | - Liping He
- The Medical Technology and Engineering Academy of Fujian Medical University, Fuzhou, China
| | - Yiying Liang
- The Medical Technology and Engineering Academy of Fujian Medical University, Fuzhou, China
| | - Junjie Lai
- The Medical Technology and Engineering Academy of Fujian Medical University, Fuzhou, China
| | - Feibao Guo
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,The Medical Technology and Engineering Academy of Fujian Medical University, Fuzhou, China
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Rules of Chinese Herbal Intervention of Radiation Pneumonia Based on Network Pharmacology and Data Mining. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:7313864. [PMID: 35509624 PMCID: PMC9060976 DOI: 10.1155/2022/7313864] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 02/11/2022] [Accepted: 04/02/2022] [Indexed: 12/30/2022]
Abstract
Objective To explore the mechanism and principles of traditional Chinese medicine (TCM) in the management of radiation pneumonia. Methods The targets of radiation pneumonia were obtained by screening the GeneCards, OMIM, TTD, DrugBank, and HERB databases, analyzing ADME parameters. In addition, compounds and Chinese herbs that can act on the targets were screened from the TCMSP database. The core target compounds for TCM were used to construct the target-compound, compound-traditional Chinese medicine, and target-compound-traditional Chinese medicine networks. These networks were further used to select the core targets, compounds, and TCM. The binding strength between the core targets and compounds was determined using AutoDock Vina. The trajectory for the molecular dynamics simulation was completed by Desmond version 2020. Results A total of 55 active targets in radiation pneumonia were identified. Subsequently, 137 candidate compounds and 469 Chinese herbs were matched. Frequency statistics showed that the Chinese herbs that could interfere with radiation pneumonia were mainly bitter, spicy, and sweet, with both cold and warm properties. Moreover, they mainly belonged to liver and lung channels. The core targets included TNF, IL-6, TGF-β1, and TP53. The most important components were quercetin, resveratrol, and (-)-epigallocatechin-3-gallate. Moreover, the most significant traditional Chinese herbs were Perilla pueraria, ephedra, Lonicerae japonicae, and sea buckthorn. Furthermore, analysis of 222 sets of receptor-ligand docking results suggested that the compounds had good docking activity to their core targets. By combining the docking binding energy, we determined that the chemical compounds had strong binding energy to the targets. Conclusion Using network pharmacology, we explored the potential mechanism of TCM in the treatment of radiation pneumonia. The general rules for application of TCM in the treatment of radiation pneumonia were summarized. This study provides baseline information for future research on the development of TCM for the management of radiation pneumonia.
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Kubo N, Kobayashi D, Iwanaga M, Matsuura M, Higuchi K, Eishima J, Muramatsu H, Okano N, Shioya M, Onishi M, Aoki T, Oike T, Ohno T. Radiotherapy Patterns of Care for Locally-advanced Non-small Cell Lung Cancer in the Pre- and Post-durvalumab Era: A Region-wide Survey in a Japanese Prefecture. JOURNAL OF RADIATION RESEARCH 2022; 63:264-271. [PMID: 34970980 PMCID: PMC8944323 DOI: 10.1093/jrr/rrab116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/13/2021] [Indexed: 05/08/2023]
Abstract
The promising results of the PACIFIC study led to the approval of consolidation durvalumab for coverage by the National Health Insurance (NHI) in 2018 for patients with locally-advanced unresectable non-small cell lung carcinoma (NSCLC) treated with definitive concurrent chemoradiotherapy (CCRT). However, the effect of NHI coverage on the patterns of care for this population remains unclear. Here, we conducted a questionnaire-based survey to determine the patterns of care for patients with stage II-III NSCLC treated with definitive radiotherapy in 2017 (pre-durvalumab era) or in 2019 (post-durvalumab era). Data were obtained from 11 radiotherapy facilities in Gunma prefecture, which has a population of 1.94 million. We identified 80 and 83 patients with stage II-III NSCLC who received definitive radiotherapy in Gunma in 2017 and 2019, respectively. At a given facility, CCRT was the treatment of choice in a significantly greater proportion of patients in 2019 than in 2017 (66% ± 20% vs 51% ± 29%, P = 0.041). Intensity-modulated radiotherapy (IMRT) was more frequent in 2019 than in 2017 (24% vs 1.2%). Carboplatin plus paclitaxel was used for CCRT at higher rate in 2019 than in 2017 (73% vs 44%). Consolidation durvalumab was performed in 73% (40/55) of CCRT-treated patients in 2019, and the treatment was performed for the planned 12 months in 45% (18/40) of patients. These data indicate that NHI coverage of durvalumab might be a possible reason for choosing CCRT in patients with stage II-III NSCLC in the real-world setting.
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Affiliation(s)
- Nobuteru Kubo
- Corresponding author: Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan, Tel.: 81-27-220-8383, Fax: 81-27-220-8397, E-mail:
| | - Daijiro Kobayashi
- Department of Radiation Oncology, Gunma Prefectural Cancer Center, 617-1, Takahayashi-nishicho, Ota, Gunma 373-8550, Japan
| | - Mototaro Iwanaga
- Department of Radiation Oncology, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-machi, Maebashi, Gunma 371-0811, Japan
| | - Masana Matsuura
- Department of Radiation Therapy, National Hospital Organization Shibukawa Medical Center, 383 Shirai, Shibukawa, Gunma 377-0280, Japan
| | - Keiko Higuchi
- Department of Radiation Oncology, Isesaki Municipal Hospital, 12-1, Tsunatorimoto-machi, Isesaki, Gunma, 372-0817, Japan
| | - Jun Eishima
- Department of Radiation Oncology, National Hospital Organization Takasaki General Medical Center, 36, Takamatsu-cho, Takasaki, Gunma 370-0829, Japan
| | - Hiroyuki Muramatsu
- Department of Radiology, Kiryu Kosei General Hospital, 6-3, Orihime-cho, Kiryu, Gunma 376-0024, Japan
| | - Naoko Okano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
- Department of Radiotherapy, Public Tomioka General Hospital, 2073-1, Tomioka, Tomioka, Gunma, Japan
| | - Mariko Shioya
- Department of Radiation Oncology, Fujioka General Hospital, 813-1, Nakakurisu, Fujioka, Gunma 375-8503, Japan
| | - Masahiro Onishi
- Oncology Center, Hidaka Hospital, 886, Nakao-machi, Takasaki, Gunma 370-0001, Japan
| | - Tetsuya Aoki
- Department of Radiation Oncology, Tatebayashi Kosei General Hospital, 262-1 Narushima-cho, Tatebayashi, Gunma 374-8533, Japan
| | - Takahiro Oike
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
- Gunma University Heavy Ion Medical Center, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
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Mayahara H, Uehara K, Harada A, Kitatani K, Yabuuchi T, Miyazaki S, Ishihara T, Kawaguchi H, Kubota H, Okada H, Ninomaru T, Shindo C, Hata A. Predicting factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non-small cell lung cancer. Radiat Oncol 2022; 17:7. [PMID: 35033139 PMCID: PMC8760798 DOI: 10.1186/s13014-021-01979-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background Concurrent chemoradiotherapy (CCRT) followed by durvalumab is the standard of care for unresectable locally-advanced non-small cell carcinoma (LA-NSCLC). However, a major concern about administration of durvalumab after CCRT is whether the incidence of symptomatic radiation pneumonitis (RP) may increase or not. In the present analysis, we report the initial results of CCRT followed by durvalumab in patients with LA-NSCLC in a real-world setting with focus on predicting factors for symptomatic RP. Methods Patients who were pathologically diagnosed as NSCLC and initiated treatment with CCRT followed by durvalumab between July 2018 to December 2019 were eligible for this study. Patients were included if they completed the planned CRT course and administered at least one course of durvalumab. We retrospectively investigated the preliminary survival outcome and incidence and predicting factors for symptomatic RP. Results Of the 67 patients who planned CCRT, 63 patients completed the entire CCRT course. Of these, 56 patients proceeded to consolidation with durvalumab. The median time to eternal discontinuation of durvalumab was 9.7 months. The cumulative proportion of the patients who exhibited symptomatic RP was 30, 40 and 44% at 3, 6 and 12 months, respectively. In multivariate analyses, pulmonary fibrosis score and lung V40 were significant predictive factors for symptomatic RP (p < 0.001, HR: 7.83, 95% CI: 3.38–18.13, and p = 0.034, HR: 3.17, 95% CI: 1.09–9.19, respectively). Conclusions Pulmonary fibrosis sore and lung V40 were significant predictive factors for symptomatic RP. We should be cautious about the administration of durvalumab for patients having subclinical pulmonary fibrosis. To our best knowledge, this is one of the first report showing the predictive value of high dose volumes to the lung in patients with LA-NSCLC who received CCRT followed by durvalumab. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01979-z.
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Affiliation(s)
- Hiroshi Mayahara
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan.
| | - Kazuyuki Uehara
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Aya Harada
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Keiji Kitatani
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Tomonori Yabuuchi
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Shuichirou Miyazaki
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Takeaki Ishihara
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, Japan
| | - Hiroki Kawaguchi
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, Japan
| | - Hikaru Kubota
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, Japan
| | - Hideaki Okada
- Department of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, Japan
| | - Taira Ninomaru
- Department of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, Japan
| | - Chihiro Shindo
- Department of Diagnostic Radiology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, Japan
| | - Akito Hata
- Department of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, Japan
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Tatsuno S, Doi H, Okada W, Inoue E, Nakamatsu K, Tanooka M, Tanaka M, Nishimura Y. Risk factors for radiation pneumonitis after rotating gantry intensity-modulated radiation therapy for lung cancer. Sci Rep 2022; 12:590. [PMID: 35022506 PMCID: PMC8755838 DOI: 10.1038/s41598-021-04601-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022] Open
Abstract
The risk factors for severe radiation pneumonitis (RP) in patients with lung cancer who undergo rotating gantry intensity-modulated radiation therapy (IMRT) using volumetric modulated arc therapy (VMAT) or helical tomotherapy (HT) are poorly understood. Fifty-two patients who received rotating gantry IMRT for locally advanced lung cancer were included in this retrospective study. In total, 31 and 21 patients received VMAT and HT, respectively. The median follow-up duration was 14 months (range, 5.2–33.6). Twenty (38%) and eight (15%) patients developed grade ≥ 2 and ≥ 3 RP, respectively. In multivariate analysis, lung V5 ≥ 40% was associated with grade ≥ 2 RP (P = 0.02), and past medical history of pneumonectomy and total lung volume ≤ 3260 cc were independently associated with grade ≥ 3 RP (P = 0.02 and P = 0.03, respectively). Rotating gantry IMRT was feasible and safe in patients with lung cancer undergoing definitive radiotherapy. Reducing lung V5 may decrease the risk of symptomatic RP, and care should be taken to avoid severe RP after radiotherapy in patients with a past medical history of pneumonectomy and small total lung volume.
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Affiliation(s)
- Saori Tatsuno
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Wataru Okada
- Department of Radiotherapy, Takarazuka City Hospital, 4-5-2 Kohama, Takarazuka, Hyogo, Japan
| | - Eri Inoue
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Kiyoshi Nakamatsu
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masao Tanooka
- Department of Radiotherapy, Takarazuka City Hospital, 4-5-2 Kohama, Takarazuka, Hyogo, Japan
| | - Masahiro Tanaka
- Department of Radiotherapy, Takarazuka City Hospital, 4-5-2 Kohama, Takarazuka, Hyogo, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
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Feng A, Shao Y, Wang H, Chen H, Gu H, Duan Y, Gan W, Xu Z. A novel lung-avoidance planning strategy based on 4DCT ventilation imaging and CT density characteristics for stage III non-small-cell lung cancer patients. Strahlenther Onkol 2021; 197:1084-1092. [PMID: 34351454 PMCID: PMC8604857 DOI: 10.1007/s00066-021-01821-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Functional planning based merely on 4DCT ventilation imaging has limitations. In this study, we proposed a radiotherapy planning strategy based on 4DCT ventilation imaging and CT density characteristics. MATERIALS AND METHODS For 20 stage III non-small-cell lung cancer (NSCLC) patients, clinical plans and lung-avoidance plans were generated. Through deformable image registration (DIR) and quantitative image analysis, a 4DCT ventilation map was calculated. High-, medium-, and low-ventilation regions of the lung were defined based on the ventilation value. In addition, the total lung was also divided into high-, medium-, and low-density areas according to the HU threshold. The lung-avoidance plan aimed to reduce the dose to functional and high-density lungs while meeting standard target and critical structure constraints. Standard and dose-function metrics were compared between the clinical and lung-avoidance plans. RESULTS Lung avoidance plans led to significant reductions in high-function and high-density lung doses, without significantly increasing other organ at risk (OAR) doses, but at the expense of a significantly degraded homogeneity index (HI) and conformity index (CI; p < 0.05) of the planning target volume (PTV) and a slight increase in monitor units (MU) as well as in the number of segments (p > 0.05). Compared with the clinical plan, the mean lung dose (MLD) in the high-function and high-density areas was reduced by 0.59 Gy and 0.57 Gy, respectively. CONCLUSION A lung-avoidance plan based on 4DCT ventilation imaging and CT density characteristics is feasible and implementable, with potential clinical benefits. Clinical trials will be crucial to show the clinical relevance of this lung-avoidance planning strategy.
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Affiliation(s)
- AiHui Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO.241 West Huaihai Road, Xuhui District, 20030, Shanghai, China
| | - Yan Shao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO.241 West Huaihai Road, Xuhui District, 20030, Shanghai, China
| | - Hao Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO.241 West Huaihai Road, Xuhui District, 20030, Shanghai, China
| | - Hua Chen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO.241 West Huaihai Road, Xuhui District, 20030, Shanghai, China
| | - HengLe Gu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO.241 West Huaihai Road, Xuhui District, 20030, Shanghai, China
| | - YanHua Duan
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO.241 West Huaihai Road, Xuhui District, 20030, Shanghai, China
| | - WuTian Gan
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO.241 West Huaihai Road, Xuhui District, 20030, Shanghai, China
| | - ZhiYong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO.241 West Huaihai Road, Xuhui District, 20030, Shanghai, China.
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Nishimura A, Ono A, Wakuda K, Kawabata T, Yabe M, Miyawaki T, Miyawaki E, Kodama H, Nishioka N, Mamesaya N, Kobayashi H, Omori S, Kenmotsu H, Naito T, Murakami H, Harada H, Takahashi T. Prognostic impact of pneumonitis after durvalumab therapy in patients with locally advanced non-small cell lung cancer. Invest New Drugs 2021; 40:403-410. [PMID: 34633575 PMCID: PMC8993741 DOI: 10.1007/s10637-021-01191-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/03/2021] [Indexed: 12/19/2022]
Abstract
Background. Prognostic data on Japanese patients receiving durvalumab after chemoradiotherapy (CRT) for locally advanced non-small cell lung cancer (LA-NSCLC) are insufficient. Whether pneumonitis has prognostic implications in patients with LA-NSCLC who have received durvalumab also remains unclear. Methods. We retrospectively assessed the data of 82 consecutive patients who had received durvalumab after CRT at our institution between May 2018 and August 2020. A multi-state model was used to establish the associations between co-variables and progression-free survival (PFS). Results. The median observation period for all the censored cases was 14.5 months (5.7–28.9 months), the median PFS was 22.7 months, and the 12-month PFS rate was 62.3% (95% CI: 50.2%-72.3%). The median percentage of the lung volume receiving a radiation dose in excess of 20 Gray (V20) was 22% (4%-35%). Thirteen patients (16%) had Grade 1 pneumonitis before receiving durvalumab, and 62 patients developed pneumonitis after durvalumab (Grades 1, 2, and 3 in 25 [30%], 32 [39%], and 4 [5%], respectively). Twenty-four patients (29%) completed the 1-year durvalumab treatment period, 16 patients (20%) were continuing to receive treatment, and 42 (51%) had discontinued treatment. In a multi-state analysis, patients with pneumonitis before durvalumab therapy had a poorer PFS than those without pneumonitis (HR: 4.29, p = 0.002). The development of Grade 2 or higher pneumonitis after durvalumab was not a significant prognostic factor for PFS (HR: 0.71, p = 0.852). Conclusion. Grade 2 or higher pneumonitis after durvalumab was not a prognostic factor of PFS in LA-NSCLC patients received durvalumab.
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Affiliation(s)
- Ari Nishimura
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
| | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Michitoshi Yabe
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Taichi Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Eriko Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroaki Kodama
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Naoya Nishioka
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideyuki Harada
- Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan
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Imano N, Kimura T, Kawahara D, Nishioka R, Fukumoto W, Kawano R, Kubo K, Katsuta T, Takeuchi Y, Nishibuchi I, Murakami Y, Horimasu Y, Masuda T, Fujitaka K, Hattori N, Nagata Y. Potential benefits of volumetric modulated arc therapy to reduce the incidence of ≥ grade 2 radiation pneumonitis in radiotherapy for locally advanced non-small cell lung cancer patients. Jpn J Clin Oncol 2021; 51:1729-1735. [PMID: 34625805 DOI: 10.1093/jjco/hyab163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/29/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The use of volumetric modulated arc therapy is gradually widespread for locally advanced non-small cell lung cancer. The purpose of this study was to identify the factors that caused ≥ grade 2 radiation pneumonitis and evaluate the impact of using volumetric modulated arc therapy on the incidence of ≥ grade 2 radiation pneumonitis by comparing three-dimensional conformal radiation therapy. METHODS We retrospectively evaluated 124 patients who underwent radical radiotherapy for locally advanced non-small cell lung cancer in our institution between 2008 and 2019. The following variables were analysed to detect the factors that affected ≥ grade 2 radiation pneumonitis; age, sex, the presence of interstitial lung disease, pulmonary emphysema, tumour location, stage, PTV/lung volume, lung V20Gy, total dose, concurrent chemoradiotherapy, adjuvant immune checkpoint inhibitor, radiotherapy method. Radiation pneumonitis was evaluated using the common terminology criteria for adverse events (version 5.0). RESULTS A total of 84 patients underwent three-dimensional conformal radiation therapy (3D-CRT group) and 40 patients underwent volumetric modulated arc therapy (VMAT group). The cumulative incidence of ≥ grade 2 radiation pneumonitis at 12 months was significantly lower in the VMAT group than in the 3D-CRT group (25% vs. 49.1%). The use of volumetric modulated arc therapy was a significant factor for ≥ grade 2 radiation pneumonitis (HR:0.32, 95% CI: 0.15-0.65, P = 0.0017) in addition to lung V20Gy (≥ 24%, HR:5.72 (95% CI: 2.87-11.4), P < 0.0001) and total dose (≥ 70 Gy, HR:2.64 (95% CI: 1.39-5.03), P = 0.0031) even after adjustment by multivariate analysis. CONCLUSIONS We identified factors associated with ≥ grade 2 radiation pneumonitis in radiotherapy for patients with locally advanced non-small cell lung cancer. Volumetric modulated arc therapy has potential benefits to reduce the risk of ≥ grade 2 radiation pneumonitis.
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Affiliation(s)
- Nobuki Imano
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Radiation Oncology, Kochi Medical School, Kochi University, Nankoku-shi, Kochi, Japan
| | - Daisuke Kawahara
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Riku Nishioka
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Wataru Fukumoto
- Department of Diagnostic Radiology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Reo Kawano
- Clinical Research Center in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan
| | - Katsumaro Kubo
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tsuyoshi Katsuta
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuki Takeuchi
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasushi Horimasu
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Masuda
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
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Mehnati P, Ghorbanipoor M, Mohammadzadeh M, Nasiri Motlagh B, Mesbahi A. Predicting the Risk of Radiation Pneumonitis and Pulmonary Function Changes after Breast Cancer Radiotherapy. J Biomed Phys Eng 2021; 11:459-464. [PMID: 34458193 PMCID: PMC8385223 DOI: 10.31661/jbpe.v0i0.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/29/2018] [Indexed: 11/16/2022]
Abstract
Background Radiotherapy plays an important role in the treatment of breast cancer. In the process of radiotherapy, the underling lung tissue receives higher doses from treatment field, which led to incidence of radiation pneumonitis. Objective The present study aims to evaluate the predictive factors of radiation pneumonitis and related changes in pulmonary function after 3D-conformal radiotherapy of breast cancer. Material and Methods In prospective basis study, thirty-two patients with breast cancer who received radiotherapy after surgery, were followed up to 6 months. Respiratory symptoms, lung radiologic changes and pulmonary function were evaluated. Radiation pneumonitis (RP) was graded according to common terminology criteria for adverse events (CTCAE) version 3.0. Dose-volume parameters, which included percentage of lung volume receiving dose of d Gy (V5-V50) and mean lung dose (MLD), were evaluated for RP prediction. Pulmonary function evaluated by spirometry test and changes of FEV1 and FVC parameters. Results Eight patients developed RP. Among the dose-volume parameters, V10 was associated to RP incidence. When V10<40% and V10≥40% the incidences of RP were 5.26% and 61.54%, respectively. The FEV1 and FVC had a reduction 3 and 6 months after radiotherapy, while only FEV1 showed significant reduction. The FEV1 had more reduction in the patients who developed RP than patients without RP (15.25±3.81 vs. 9.2±0.93). Conclusion Pulmonary function parameters, especially FEV1, significantly decreased at 3 and 6 months after radiotherapy. Since most patients with breast cancer who developed RP did not show obvious clinical symptoms, so spirometry test is beneficial to identify patients with risk of radiation pneumonitis.
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Affiliation(s)
- Parinaz Mehnati
- PhD, Immunology research center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Ghorbanipoor
- MSc, Department of Medical Physics, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Mohammadzadeh
- MD, Department of Radiology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behnam Nasiri Motlagh
- MD, Department of Radiology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Asghar Mesbahi
- PhD, Medical Radiation Sciences Research team, Department of Medical Physics, School of Medicine, Tabriz, Iran
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Saito S, Abe T, Iino M, Aoshika T, Ryuno Y, Ohta T, Igari M, Hirai R, Kumazaki Y, Yamaguchi O, Kaira K, Kagamu H, Noda SE, Kato S. Incidence and risk factors for pneumonitis among patients with lung cancer who received immune checkpoint inhibitors after palliative thoracic radiotherapy. JOURNAL OF RADIATION RESEARCH 2021; 62:669-675. [PMID: 34121123 PMCID: PMC8273801 DOI: 10.1093/jrr/rrab051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/06/2021] [Indexed: 06/12/2023]
Abstract
The aim of this study is to analyze the incidence and risk factors for pneumonitis when immune checkpoint inhibitors (ICIs) are combined with palliative thoracic radiotherapy (RT) for lung cancer. We retrospectively evaluated 29 patients with lung cancer who received ICIs after palliative thoracic RT (30 Gy in 10 fractions). Their ICIs were pembrolizumab (n = 17), nivolumab (n = 8) and atezolizumab (n = 4). Median follow-up period was 10 months. The median interval between starting RT and starting ICI was 25 days. Pneumonitis events were grade 1 (n = 10; 34%), grade 2 (n = 4; 14%) and grade 3 (n = 3; 10%). Obstructive pneumonia was significantly associated with grade ≥ 2 pneumonitis (P = 0.036). Age, sex, ICI agent, interval between RT and ICI and history of ICI before RT were not associated with grade ≥ 2 pneumonitis. Tumor volume; Brinkman index; dosimetric factors, such as lung V5, V10, V20, V30 and mean lung dose (MLD); lactate dehydrogenase; and C-reactive protein did not significantly differ between the grade ≤ 1 and grade ≥ 2 pneumonitis groups. Levels of sialylated carbohydrate antigen KL-6 were evaluated in 27 patients before RT; they significantly differed between patients with grade ≤ 2 pneumonitis (mean: 431 U/ml) and those with grade ≥ 3 pneumonitis (mean: 958 U/ml; P < 0.001). Patients who receive ICI after palliative thoracic RT should be carefully followed-up, especially those who have had obstructive pneumonia or high KL-6 levels.
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Affiliation(s)
| | - Takanori Abe
- Corresponding author: Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan. Fax: +81 42 984 4136; E-mail:
| | - Misaki Iino
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Tomomi Aoshika
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Yasuhiro Ryuno
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Tomohiro Ohta
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Mitsunobu Igari
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Ryuta Hirai
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Yu Kumazaki
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Ou Yamaguchi
- Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Kyoichi Kaira
- Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Hiroshi Kagamu
- Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Shin-ei Noda
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Shingo Kato
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
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Utsumi N, Takahashi T, Hatanaka S, Hariu M, Saito M, Kondo S, Soda R, Nishimura K, Yamano T, Watanabe W, Shimbo M, Honda N. VMAT Planning With Xe-CT Functional Images Enables Radiotherapy Planning With Consideration of Lung Function. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:193-200. [PMID: 35399314 PMCID: PMC8962790 DOI: 10.21873/cdp.10026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/25/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM The most severe adverse event of radiotherapy in lung cancer is radiation pneumonitis (RP). Some indices commonly used to prevent RP are evaluated based on the anatomical lung volume. The irradiation dose may be more accurately assessed by using functional lung volume. We evaluated the usefulness of computed tomography (CT) incorporating functional ventilation images acquired by the inhalation of xenon (Xe) gas (Xe-CT functional images). PATIENTS AND METHODS Two plans were created for twelve patients: volumetric modulated arc therapy (VMAT) planning using conventional chest CT images (anatomical plans) and VMAT planning using Xe-CT functional images (functional plans), and the dosimetric parameters were compared. RESULTS Compared to the anatomical plans, the functional plans had significantly reduced V 20Gy in the high-functional lungs (p=0.005), but significant differences were not seen in the moderate-functional and low-functional lungs. CONCLUSION The incorporation of Xe-CT functional images into VMAT plans enables radiotherapy planning with consideration of lung function.
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Affiliation(s)
- Nobuko Utsumi
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
- Department of Radiation Therapy, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Takeo Takahashi
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shogo Hatanaka
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masatsugu Hariu
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Mio Saito
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shuichi Kondo
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Rikana Soda
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Keiichiro Nishimura
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Takafumi Yamano
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Wataru Watanabe
- Department of Radiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Munefumi Shimbo
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Norinari Honda
- Department of Radiology, Saitama Sekishinkai Hospital, Saitama, Japan
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36
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Strange CD, Shroff GS, Truong MT, Nguyen QN, Vlahos I, Erasmus JJ. Imaging of the post-radiation chest in lung cancer. Clin Radiol 2021; 77:19-30. [PMID: 34090709 DOI: 10.1016/j.crad.2021.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/29/2021] [Indexed: 12/25/2022]
Abstract
Radiation therapy using conventional fractionated external-beam or high-precision dose techniques including three-dimensional conformal radiotherapy, stereotactic body radiation therapy, intensity-modulated radiation therapy, and proton therapy, is a key component in the treatment of patients with lung cancer. Knowledge of the radiation technique used, radiation treatment plan, expected temporal evolution of radiation-induced lung injury and patient-specific parameters, such as previous radiotherapy, concurrent chemoradiotherapy, and/or immunotherapy, is important in imaging interpretation. This review discusses factors that affect the development and severity of radiation-induced lung injury and its radiological manifestations with emphasis on the differences between conventional radiation and high-precision dose radiotherapy techniques.
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Affiliation(s)
- C D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - G S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - M T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - Q-N Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - I Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - J J Erasmus
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA.
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Oshiro Y, Mizumoto M, Sekino Y, Maruo K, Ishida T, Sumiya T, Nakamura M, Ohkawa A, Takizawa D, Okumura T, Tamaki Y, Sakurai H. Risk factor of pneumonitis on dose-volume relationship for chemoradiotherapy with durvalumab: Multi-institutional research in Japan. Clin Transl Radiat Oncol 2021; 29:54-59. [PMID: 34151033 PMCID: PMC8190008 DOI: 10.1016/j.ctro.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives To estimate appropriate dose-volume parameters for avoidance of pneumonitis in use of chemoradiotherapy and durvalumab for treatment of lung cancer. Materials and methods Patients with non-small cell lung cancer treated with concurrent chemoradiotherapy followed by durvalumab at 9 centers were enrolled in the study. Three-dimensional radiotherapy, intensity modulated radiotherapy, and proton beam therapy were used. The frequency and severity of pneumonitis and the dose-volume relationship for normal lung were evaluated. Univariable and multivariable analyses were conducted to identify risk factors. A covariate adjusted hazard ratio was then estimated for the percentages of normal lung volume irradiated at ≥ X Gy (Vx) (X = 5-40) and lung volume non-irradiated at ≥ X Gy (X = 5-40), with the covariates selected in the variable selection. Cumulative incidence functions and covariate adjusted hazard ratios were also estimated for dichotomized variables, with estimated cut-off points. Results A total of 91 patients were enrolled in the study. The median time from the start of radiotherapy to development of pneumonitis was 4.1 months. Pneumonitis was observed in 80 patients (88%), including grade 2 or severe pneumonitis in 31 (34%) and ≥ grade 3 pneumonitis in 11 (12%). Pneumonitis was inside the irradiation field in 73 of the 80 patients (91%). The selected factors for ≥ grade 2 pneumonitis were V20, and primary site (upper lobe) in multivariable analysis. The cut off value of V20 was 18.99%, and there was a significant difference between V20 of < 18.77 and ≥ 18.77. Conclusion Though there are some limitation of this study, the basic concept of concurrent chemoradiotherapy with an emphasis on V20 remains unchanged in use of durvalumab. However, we recommend reduction of V20 to as small a value as possible in use of this therapy.
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Affiliation(s)
- Yoshiko Oshiro
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Ibaraki, Japan.,Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan.,Department of Radiation Oncology, Ibarakihigashi National Hospital, Ibaraki Japan
| | - Yuta Sekino
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan.,Department of Radiation Oncology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Toshiki Ishida
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan.,Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Ibaraki, Japan
| | - Taisuke Sumiya
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan.,Department of Radiation Oncology, Mito Kyodo General Hospital, Ibaraki, Japan
| | | | - Ayako Ohkawa
- Department of Radiation Oncology, Mito Medical Center Hospital, Ibaraki, Japan
| | - Daichi Takizawa
- Department of Radiation Oncology, Hitachi General Hospital, Ibaraki, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan.,Department of Radiation Oncology, Ibaraki Seinan Medical Center Hospital, Ibaraki, Japan
| | - Yoshio Tamaki
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan.,Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan
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38
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Tsukita Y, Yamamoto T, Mayahara H, Hata A, Takeda Y, Nakayama H, Tanaka S, Uchida J, Usui K, Toyoda T, Tamiya M, Morimoto M, Oya Y, Kodaira T, Miyauchi E, Jingu K, Sugiura H. Intensity-modulated radiation therapy with concurrent chemotherapy followed by durvalumab for stage III non-small cell lung cancer: A multi-center retrospective study. Radiother Oncol 2021; 160:266-272. [PMID: 34023330 DOI: 10.1016/j.radonc.2021.05.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Intensity-modulated radiation therapy (IMRT) is increasingly applied in concurrent chemoradiotherapy (CCRT) for locally-advanced non-small cell lung cancer (NSCLC), with improvement of target coverage and better sparing of normal tissue. IMRT tends to have a larger low-dose irradiation volume than 3D conformal radiotherapy, but the incidence of and risk factors for pneumonitis remain unclear, especially following the approval of durvalumab. MATERIALS AND METHODS We retrospectively reviewed the records of NSCLC patients treated by CCRT using IMRT at seven Japanese institutions. Primary outcomes were incidence of symptomatic pneumonitis and progression-free survival (PFS). Multivariate logistic regression analysis was used to identify risk factors for ≥grade 2 pneumonitis. RESULTS Median follow-up from the start of CCRT was 14.3 months (n = 107 patients; median age 70 years, 29% female). Median lung V5 and V20 was 49.2% and 19.5%, respectively. Durvalumab was administered to 87 patients (81%). Pneumonitis developed in 95 (89%) patients of which 53% had grade 1, 28% grade 2, 6.5% grade 3, and 0.9% grade 4. Durvalumab had been discontinued in 16 patients (18.4%) due to pneumonitis. By multivariate analysis, age ≥70 years, male sex, and V5 ≥58.9% were identified as significantly associated with ≥grade 2 pneumonitis (p = 0.0065, 0.036 and 0.0013 respectively). The median PFS from the start of CCRT was not reached (95% CI, 14.2 months to not reached) in patients receiving durvalumab. CONCLUSION CCRT using IMRT followed by durvalumab was generally effective and tolerable; V5 <60% would be recommended to avoid symptomatic pneumonitis.
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Affiliation(s)
- Yoko Tsukita
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Mayahara
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, Kobe, Japan
| | - Akito Hata
- Department of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer Center, Kobe, Japan
| | - Yuichiro Takeda
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hidetsugu Nakayama
- Department of Radiation Oncology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Tanaka
- Department of Respiratory Medicine, Osaka General Medical Center, Osaka, Japan
| | - Junji Uchida
- Department of Respiratory Medicine, Osaka General Medical Center, Osaka, Japan
| | - Kazuhiro Usui
- Division of Respirology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tatsuya Toyoda
- Department of Radiology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Motohiro Tamiya
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiro Morimoto
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yuko Oya
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Eisaku Miyauchi
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hisatoshi Sugiura
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Katsui K, Ogata T, Sugiyama S, Yoshio K, Kuroda M, Yamane M, Hiraki T, Kiura K, Toyooka S, Kanazawa S. Visceral Adipose Mass and Radiation Pneumonitis After Concurrent Chemoradiotherapy in Patients With Non-small-cell Lung Cancer. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:61-67. [PMID: 35403132 PMCID: PMC8962768 DOI: 10.21873/cdp.10009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/26/2021] [Indexed: 04/25/2023]
Abstract
AIM To investigate whether muscle and adipose mass are associated with radiation pneumonitis (RP) in patients with non-small cell lung cancer undergoing preoperative concurrent chemoradiotherapy. PATIENTS AND METHODS We calculated body mass index and determined skeletal muscle, psoas muscle, visceral adipose tissue (VAI), and subcutaneous adipose tissue indices, and visceral-to-subcutaneous adipose tissue area ratio for patients using computed tomography. We examined their relationship with grade 2 or more RP. RESULTS Among 94 patients, 28 experienced grade 2 or more RP. On multivariate analysis, only VAI was associated with grade 2 or more RP (all p=0.026). The 6-month incidence rates of grade 2 or more RP were 21.4% and 36.8% in patients with VAI <39 and ≥39 cm 2 /m 2 , respectively. CONCLUSION High visceral adipose mass is associated with grade 2 or more RP in patients undergoing preoperative concurrent chemoradiotherapy. Measuring visceral adipose mass may help to predict RP occurrence. Further studies are needed to validate our findings.
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Affiliation(s)
- Kuniaki Katsui
- Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takeshi Ogata
- Department of Radiology, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Soichi Sugiyama
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Kotaro Yoshio
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Masahiro Kuroda
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama, Japan
| | - Masaomi Yamane
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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40
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Imano N, Nishibuchi I, Kawabata E, Kinugasa Y, Shi L, Sakai C, Ishida M, Sakane H, Akita T, Ishida T, Kimura T, Murakami Y, Tanaka K, Horikoshi Y, Sun J, Nagata Y, Tashiro S. Evaluating Individual Radiosensitivity for the Prediction of Acute Toxicities of Chemoradiotherapy in Esophageal Cancer Patients. Radiat Res 2021; 195:244-252. [PMID: 33400798 DOI: 10.1667/rade-20-00234.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/16/2020] [Indexed: 11/03/2022]
Abstract
In this work, individual radiosensitivity was evaluated using DNA damage response and chromosomal aberrations (CAs) in peripheral blood lymphocytes (PBLs) for the prediction of acute toxicities of chemoradiotherapy (CRT) in esophageal cancer patients. Eighteen patients with esophageal cancer were enrolled in this prospective study. Prescribed doses were 60 Gy in 11 patients and 50 Gy in seven patients. Patients received 2 Gy radiotherapy five days a week. PBLs were obtained during treatment just before and 15 min after 2 Gy radiation therapy on the days when the cumulative dose reached 2, 20, 40 Gy and 50 or 60 Gy. PBLs were also obtained four weeks and six months after radiotherapy in all and 13 patients, respectively. Dicentric and ring chromosomes in PBLs were counted to evaluate the number of CAs. Gamma-H2AX foci per cell were scored to assess DNA double-strand breaks. We analyzed the association between these factors and adverse events. The number of γ-H2AX foci before radiotherapy showed no significant increase during CRT, while their increment was significantly reduced with the accumulation of radiation dose. The mean number of CAs increased during CRT up to 1.04 per metaphase, and gradually decreased to approximately 60% six months after CRT. Five patients showed grade 3 toxicities during or after CRT (overreactors: OR), while 13 had grade 2 or less toxicities (non-overreactors: NOR). The number of CAs was significantly higher in the OR group than in the NOR group at a cumulative dose of 20 Gy (mean value: 0.63 vs. 0.34, P = 0.02), 40 Gy (mean value: 0.90 vs. 0.52, P = 0.04), and the final day of radiotherapy (mean value: 1.49 vs. 0.84, P = 0.005). These findings suggest that number of CAs could be an index for predicting acute toxicities of CRT for esophageal cancer.
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Affiliation(s)
- Nobuki Imano
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.,Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Emi Kawabata
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yasuha Kinugasa
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Lin Shi
- Institute of Medical Imaging and Digital Medicine, School of Medical Imaging, Xuzhou Medical University, Xuzhou, China
| | - Chiemi Sakai
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mari Ishida
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroaki Sakane
- Department of Diagnostic Radiology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kimio Tanaka
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yasunori Horikoshi
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Jiying Sun
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoshi Tashiro
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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Kobayashi D, Abe T, Saitoh JI, Oike T, Sato H, Musha A, Mizukami T, Shimizu T, Nakano T, Ohno T. Stereotactic body radiotherapy for adenoid cystic carcinoma metastatic to the lung: a case report. J Med Case Rep 2021; 15:156. [PMID: 33838695 PMCID: PMC8037832 DOI: 10.1186/s13256-021-02781-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Adenoid cystic carcinoma (ACC) is a rare malignant tumor involving mostly the head and neck region, and frequently the salivary glands. The development of lung metastasis after treatment of the primary tumor is a common occurrence in ACC. Although lung metastases show a slow rate of growth, approximately 10% of patients die from distant metastases. The radioresistance of ACC limits the efficacy of conventional radiotherapy for lung metastases, and the optimal dose remains to be determined. Stereotactic body radiotherapy (SBRT) using CyberKnife can deliver a high dose to the lung tumor, while sparing the surrounding normal lung tissues, leading to favorable local control in non-squamous cell lung cancer and metastatic lung tumors. We report a case of lung metastases from ACC treated successfully with SBRT using CyberKnife. Case presentation A 76-year-old Japanese man with ACC who was treated with carbon ion radiotherapy for a primary oropharynx tumor presented with three metastatic lesions in the lung. The tumor masses were located in the right upper, right lower, and left lower lobes of the lungs. Surgical resection was not indicated because of the presence of multiple tumors. The patient underwent SBRT at 60 Gy in 10 sequential fractions for each tumor. The biologically effective dose based on an alpha/beta ratio of 2 Gy was 240 Gy per tumor. The percentage of the total lung volume irradiated with >20 Gy was 4.9%, 3.2%, and 2.6% for each tumor. The patient developed acute radiation pneumonitis during the initial therapy, which resolved at 6 months after the CyberKnife treatment. At 21 months after the first CyberKnife treatment, three tumors showed no signs of recurrence. No late toxicity was observed. Conclusions SBRT using CyberKnife is an effective and feasible approach to the management of multiple lung metastases of ACC.
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Affiliation(s)
- Daijiro Kobayashi
- CyberKnife Center, Kanto Neurosurgical Hospital, 1120 Dai, Kumagaya, Saitama, 360-0804, Japan. .,Department of Radiation Oncology, Gunma Prefectural Cancer Center, 617-1 Takahayashi-nishicho, Ota, Gunma, 373-8550, Japan.
| | - Takanori Abe
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Jun-Ichi Saitoh
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Takahiro Oike
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiro Sato
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Atsushi Musha
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tatsuji Mizukami
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Tsuneo Shimizu
- CyberKnife Center, Kanto Neurosurgical Hospital, 1120 Dai, Kumagaya, Saitama, 360-0804, Japan
| | - Takashi Nakano
- National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage, Chiba, 263-8555, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.,Gunma University Heavy Ion Medical Center, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Ma M, Ren W, Li M, Niu C, Dai J. Dosimetric comparison of coplanar and noncoplanar beam arrangements for radiotherapy of patients with lung cancer: A meta-analysis. J Appl Clin Med Phys 2021; 22:34-43. [PMID: 33634946 PMCID: PMC8035566 DOI: 10.1002/acm2.13197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/06/2021] [Accepted: 01/18/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Radiotherapy plays an important role in the treatment of lung cancer, and both coplanar beam arrangements (CBA) and noncoplanar beam arrangements (NCBA) are adopted in clinic practice. The aim of this study is to answer the question whether NCBA are dosimetrically superior to CBA. Methods Search of publications were performed in PubMed, Web of Science, and the Cochran Library till March 2020. The searching terms were as following: ((noncoplanar) or ("non coplanar") or ("4pi") or ("4π")) AND (("lung cancer") or ("lung tumor") or ("lung carcinoma")) AND ((radiotherapy) or ("radiation therapy")). The included studies and extracted data were manually screened. All forest and funnel plots were carried out with RevMan software, and the Egger’s regression asymmetry tests were conducted with STATA software. Results Nine studies were included and evaluated in the meta‐analysis and treatment plans were designed with both CBA and NCBA. For the planning target volumes (PTV), D98%, D2%, the conformity index (CI), and the gradient index (GI) had no statistically significant difference. For organs‐at‐risk (OAR), V20 of the whole lung and the maximum dose of the spinal cord were significantly reduced in NCBA plans compared with CBA ones. But V10, V5, and mean dose of the whole lung, the maximum dose of the heart, and the maximum dose of the esophagus exhibited no significant difference when the two types of beam arrangements were compared. Conclusion After combining multicenter results, NCBA plans have significant advantages in reducing V20 of the whole lung and max dose of spinal cord.
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Affiliation(s)
- Min Ma
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenting Ren
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minghui Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chuanmeng Niu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianrong Dai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Jia W, Gao Q, Wang M, Li J, Jing W, Yu J, Zhu H. Overlap time is an independent risk factor of radiation pneumonitis for patients treated with simultaneous EGFR-TKI and thoracic radiotherapy. Radiat Oncol 2021; 16:41. [PMID: 33622352 PMCID: PMC7903606 DOI: 10.1186/s13014-021-01765-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background The exact rate and relevant risk factors of radiation pneumonitis (RP) for non-small-cell cancer (NSCLC) patients treated with the combination of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) and thoracic radiotherapy have not been reported. Thus, this study aimed to investigate the rate and risk factors of RP for EGFR-positive NSCLC patients simultaneously treated with first-generation EGFR-TKI and TRT. Patients and methods We retrospectively evaluated NSCLC patients simultaneously treated with first-generation EGFR-TKI and thoracic radiotherapy between January 2012 and December 2019 at Shandong Cancer Hospital and Institute, Shandong, China. RP was diagnosed via computed tomography and was classified according to the Common Terminology Criteria for Adverse Events v5.0. The risk factors of RP were identified using uni- and multivariate analyses. Results Of the 67 patients included, 44.78% (30/67) developed grade ≥ 2 RP. Grade ≥ 2 RP occurred within a median of 3.48 (range 1.07–13.6) months. The EGFR-TKI icotinib, ipsilateral lung V30 > 34%, and overlap time of > 20 days between EGFR-TKI and thoracic radiotherapy were identified to be independent predictive factors of grade ≥ 2 RP. Conclusions Grade ≥ 2 RP is highly frequent in NSCLC patients simultaneous treated with first-generation EGFR-TKI and thoracic radiotherapy. Icotinib, ipsilateral lung V30 ≤ 34%, and overlap time of ≤ 20 days for EGFR-TKI and thoracic radiotherapy will be helpful to lower the risk of RP in these patients. The addition of thoracic radiotherapy should be cautious, and the treatment strategies can be optimized to reduce the rate of RP for patients treat with simultaneous EGFR-TKI and thoracic radiotherapy.
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Affiliation(s)
- Wenxiao Jia
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute Affiliated to Shandong University, Shandong First Medical University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Qianqian Gao
- Department of Obstetrics and Gynecology, Qilu Hospital Affiliated to Shandong University, Jinan, 250012, Shandong Province, China
| | - Min Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China
| | - Ji Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China
| | - Wang Jing
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute Affiliated to Shandong University, Shandong First Medical University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China. .,Department of Radiation Oncology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China.
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute Affiliated to Shandong University, Shandong First Medical University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China. .,Department of Radiation Oncology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China.
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Shintani T, Kishi N, Matsuo Y, Ogura M, Mitsuyoshi T, Araki N, Fujii K, Okumura S, Nakamatsu K, Kishi T, Atsuta T, Sakamoto T, Narabayashi M, Ishida Y, Sakamoto M, Fujishiro S, Katagiri T, Kim YH, Mizowaki T. Incidence and Risk Factors of Symptomatic Radiation Pneumonitis in Non-Small-Cell Lung Cancer Patients Treated with Concurrent Chemoradiotherapy and Consolidation Durvalumab. Clin Lung Cancer 2021; 22:401-410. [PMID: 33678582 DOI: 10.1016/j.cllc.2021.01.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Data on the risk factors for symptomatic radiation pneumonitis (RP) in non-small-cell lung cancer (NSCLC) patients treated with concurrent chemoradiotherapy (CCRT) and consolidation durvalumab are limited; we aimed to investigate these risk factors. MATERIALS AND METHODS This multicenter retrospective study, conducted at 15 institutions in Japan, included patients who were ≥20 years of age; who started definitive CCRT for NSCLC between July 1, 2018, and July 31, 2019; and who then received durvalumab. The primary endpoint was grade 2 or worse (grade 2+) RP. RESULTS In the 146 patients analyzed, the median follow-up period was 16 months. A majority of the patients had stage III disease (86%), received radiation doses of 60 to 66 Gy equivalent in 2-Gy fractions (93%) and carboplatin and paclitaxel/nab-paclitaxel (77%), and underwent elective nodal irradiation (71%) and 3-dimensional conformal radiotherapy (75%). RP grade 2 was observed in 44 patients (30%); grade 3, in four patients (3%); grade 4, in one patient (1%); and grade 5, in one patient (1%). In the multivariable analysis, lung V20 was a significant risk factor, whereas age, sex, smoking history, irradiation technique, and chemotherapy regimen were not. The 12-month grade 2+ RP incidence was 34.4% (95% confidence interval [CI], 26.7%-42.1%); the values were 50.0% (95% CI, 34.7%-63.5%) and 27.1% (95% CI, 18.8%-36.2%) in those with lung V20 ≥ 26% and < 26%, respectively (P = .007). CONCLUSION The incidence of grade 2+ RP was relatively high in this multicenter real-world study, and its risk increased remarkably at elevated lung V20. Our findings can aid in RP risk prediction and the safe radiotherapy treatment planning.
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Affiliation(s)
- Takashi Shintani
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, Japan
| | - Noriko Kishi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Masakazu Ogura
- Department of Radiation Oncology, Kishiwada City Hospital, Kishiwada, Japan
| | - Takamasa Mitsuyoshi
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Norio Araki
- Department of Radiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kota Fujii
- Department of Radiation Oncology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Setsuko Okumura
- Department of Radiation Oncology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kiyoshi Nakamatsu
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Takahiro Kishi
- Department of Radiation Oncology, Osaka Red Cross Hospital, Osaka, Japan
| | - Tomoko Atsuta
- Department of Radiology, Tazuke Kofukai, Medical Research Institute, Osaka, Japan
| | - Takashi Sakamoto
- Department of Radiation Oncology, Kyoto Katsura Hospital, Kyoto, Japan
| | | | - Yuichi Ishida
- Department of Radiation Oncology, Tenri Hospital, Tenri, Japan
| | - Masato Sakamoto
- Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, Japan
| | | | - Tomohiro Katagiri
- Department of Radiation Oncology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Young Hak Kim
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Uchida Y, Tsugawa T, Tanaka-Mizuno S, Noma K, Aoki K, Fukunaga K, Nakagawa H, Kinose D, Yamaguchi M, Osawa M, Nagao T, Ogawa E, Nakano Y. Prediction of radiation pneumonitis using dose-volume histogram parameters with high attenuation in two types of cancer: A retrospective study. PLoS One 2020; 15:e0244143. [PMID: 33370345 PMCID: PMC7769248 DOI: 10.1371/journal.pone.0244143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/03/2020] [Indexed: 11/19/2022] Open
Abstract
The constraint values of dose-volume histogram (DVH) parameters for radiation pneumonitis (RP) prediction have not been uniform in previous studies. We compared the differences between conventional DVH parameters and DVH parameters with high attenuation volume (HAV) in CT imaging in both esophageal cancer and lung cancer patients to determine the most suitable DVH parameters in predicting RP onset. Seventy-seven and 72 patients who underwent radiation therapy for lung cancer and esophageal cancer, respectively, were retrospectively assessed. RP was valued according to the Common Terminology Criteria for Adverse Events. We quantified HAV with quantitative computed tomography analysis. We compared conventional DVH parameters and DVH parameters with HAV in both groups of patients. Then, the thresholds of DVH parameters that predicted symptomatic RP and the differences in threshold of DVH parameters between lung cancer and esophageal cancer patient groups were compared. The predictive performance of DVH parameters for symptomatic RP was compared using the area under the receiver operating characteristic curve. Mean lung dose, HAV30% (the proportion of the lung with HAV receiving ≥30 Gy), and HAV20% were the top three parameters in lung cancer, while HAV10%, HAV5%, and V10 (the percentage of lung volume receiving 10 Gy or more) were the top three in esophageal cancer. By comparing the differences in the threshold for parameters predicting RP between the two cancers, we saw that HAV30% retained the same value in both cancers. DVH parameters with HAV showed narrow differences in the threshold between the two cancer patient groups compared to conventional DVH parameters. DVH parameters with HAV may have higher commonality than conventional DVH parameters in both patient groups tested.
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Affiliation(s)
- Yasuki Uchida
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takuya Tsugawa
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Sachiko Tanaka-Mizuno
- Department of Medical Statistics, Shiga University of Medical Science, Otsu, Shiga, Japan
- The Center for Data Science Education and Research, Shiga University, Hikone, Shiga, Japan
| | - Kazuo Noma
- Department of Radiology, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Ken Aoki
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kentaro Fukunaga
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hiroaki Nakagawa
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Daisuke Kinose
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masafumi Yamaguchi
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Makoto Osawa
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
- Division of Infection Control and Prevention, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Taishi Nagao
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Emiko Ogawa
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
- Health Administration Center, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
- * E-mail:
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Liu YC, Chang HM, Lin HH, Lu CC, Lai LH. Dosimetric Comparison of Intensity-Modulated Radiotherapy, Volumetric Modulated Arc Therapy and Hybrid Three-Dimensional Conformal Radiotherapy/Intensity-Modulated Radiotherapy Techniques for Right Breast Cancer. J Clin Med 2020; 9:E3884. [PMID: 33260404 PMCID: PMC7760558 DOI: 10.3390/jcm9123884] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 12/21/2022] Open
Abstract
This study aimed to compare different types of right breast cancer radiotherapy planning techniques and to estimate the whole-body effective doses and the critical organ absorbed doses. The three planning techniques are intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT; two methods) and hybrid 3D-CRT/IMRT (three-dimensional conformal radiotherapy/intensity-modulated radiotherapy). The VMAT technique includes two methods to deliver a dose: non-continuous partial arc and continuous partial arc. A thermoluminescent dosimeter (TLD) is placed in the RANDO phantom to estimate the organ absorbed dose. Each planning technique applies 50.4 Gy prescription dose and treats critical organs, including the lung and heart. Dose-volume histogram was used to show the planning target volume (V95%), homogeneity index (HI), conformity index (CI), and other optimized indices. The estimation of whole-body effective dose was based on the International Commission on Radiation Protection (ICRP) Publication 60 and 103. The results were as follows: Continuous partial arc and non-continuous partial arc showed the best CI and HI. The heart absorbed doses in the continuous partial arc and hybrid 3D-CRT/IMRT were 0.07 ± 0.01% and 0% (V5% and V10%, respectively). The mean dose of the heart was lowest in hybrid 3D-CRT/IMRT (1.47 Gy ± 0.02). The dose in the left contralateral lung (V5%) was lowest in continuous partial arc (0%). The right ipsilateral lung average dose and V20% are lowest in continuous partial arc. Hybrid 3D-CRT/IMRT has the lowest mean dose to contralateral breast (organs at risk). The whole-body effective doses for ICRP-60 and ICRP-103 were highest in continuous partial arc (2.01 Sv ± 0.23 and 2.89 Sv ± 0.15, respectively). In conclusion, the use of VMAT with continuous arc has a lower risk of radiation pneumonia, while hybrid 3D-CRT/IMRT attain lower secondary malignancy risk and cardiovascular complications.
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Affiliation(s)
- Yi-Chi Liu
- Institute of Nuclear Engineering and Science, National Tsing Hua University, Hsinchu 30015 Taiwan;
- Department of Radiation Oncology, Wei Gong Memorial Hospital, Miaoli 35148, Taiwan
| | - Hung-Ming Chang
- Department of General Surgery, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan;
| | - Hsin-Hon Lin
- Medical Physics Research Center, Institute for Radiological Research, Chang Gung University/Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan;
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Chia-Chun Lu
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan;
| | - Lu-Han Lai
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu 30015, Taiwan
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Radiomic prediction of radiation pneumonitis on pretreatment planning computed tomography images prior to lung cancer stereotactic body radiation therapy. Sci Rep 2020; 10:20424. [PMID: 33235324 PMCID: PMC7686358 DOI: 10.1038/s41598-020-77552-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/10/2020] [Indexed: 12/25/2022] Open
Abstract
This study developed a radiomics-based predictive model for radiation-induced pneumonitis (RP) after lung cancer stereotactic body radiation therapy (SBRT) on pretreatment planning computed tomography (CT) images. For the RP prediction models, 275 non-small-cell lung cancer patients consisted of 245 training (22 with grade ≥ 2 RP) and 30 test cases (8 with grade ≥ 2 RP) were selected. A total of 486 radiomic features were calculated to quantify the RP texture patterns reflecting radiation-induced tissue reaction within lung volumes irradiated with more than x Gy, which were defined as LVx. Ten subsets consisting of all 22 RP cases and 22 or 23 randomly selected non-RP cases were created from the imbalanced dataset of 245 training patients. For each subset, signatures were constructed, and predictive models were built using the least absolute shrinkage and selection operator logistic regression. An ensemble averaging model was built by averaging the RP probabilities of the 10 models. The best model areas under the receiver operating characteristic curves (AUCs) calculated on the training and test cohort for LV5 were 0.871 and 0.756, respectively. The radiomic features calculated on pretreatment planning CT images could be predictive imaging biomarkers for RP after lung cancer SBRT.
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An especially high rate of radiation pneumonitis observed in patients treated with thoracic radiotherapy and simultaneous osimertinib. Radiother Oncol 2020; 152:96-100. [DOI: 10.1016/j.radonc.2020.07.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 12/25/2022]
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Kawakami W, Takamatsu S, Taka M, Ishii K, Nakaichi T, Funamoto K, Yokoyama K. Factors Associated With Radiation Pneumonitis in Patients Receiving Electron Boost Radiation for Breast-Conserving Therapy: A Retrospective Review. Adv Radiat Oncol 2020; 5:1141-1146. [PMID: 33305074 PMCID: PMC7718517 DOI: 10.1016/j.adro.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/07/2022] Open
Abstract
Purpose This study aimed to investigate risk factors for radiation pneumonitis (RP) caused by electron beam (EB) boost irradiation during breast-conserving therapy. Methods and Materials This single-institution retrospective study included patients with breast cancer treated with breast-conserving therapy from 2013 to 2019. Radiation therapy comprised whole-breast irradiation with a dose of 50 Gy and 10 Gy EB boost dose to the tumor bed. EB energies were 4, 6, 9, 12, and 15 MeV. The lung volume receiving ≥1.25 Gy (V1.25) was calculated and considered because the EB energies have a short range. All patients underwent computed tomography and positron emission tomography/computed tomography within 1 year of irradiation. Imaging evaluation was based on the Common Terminology Criteria for Adverse Events, version 5.0. Results Overall, 105 patients (median age, 62 years; range, 33-85) were included for analysis with a median follow-up period of 5 months. Average area of EB boost irradiation was 72 cm2 (range, 36-196). Grade 1 RP developed in the EB irradiation field in 22 (20.6%) patients; grade 2 RP developed in 1 (0.93%) patient. Even in patients with central lung distance (CLD) ≥1.8 cm, a positive correlation was found between RP and both energy (r = 0.36; P = .005) and V1.25 (r = 0.26; P = .04). No correlation was found between RP and irradiation field size (P = .47). The EB energy and V1.25 cutoff values were 12 MeV and 24 cm3, respectively. Conclusions CLD of ≥1.8 cm, EB energy of ≥12 MeV, and V1.25 of ≥24 cm3 were risk factors associated with RP. Although the frequency of severe RP was not high, patients receiving high-energy electron treatment and those with a large CLD should be closely monitored.
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Affiliation(s)
- Wataru Kawakami
- Department of Radiation Oncology, Public Central Hospital of Matto Ishikawa, Ishikawa, Japan
| | - Shigeyuki Takamatsu
- Department of Radiation Oncology, Public Central Hospital of Matto Ishikawa, Ishikawa, Japan.,Department of Radiation Oncology, Kanazawa University Hospital, Ishikawa, Japan
| | - Masashi Taka
- Department of Radiation Oncology, Kanazawa University Hospital, Ishikawa, Japan.,Department of Radiation Oncology, Kouseiren Takaoka Hospital, Toyama, Japan
| | - Kaname Ishii
- Department of Surgery, Public Central Hospital of Matto Ishikawa, Ishikawa, Japan
| | - Tetsu Nakaichi
- Department of Radiation Oncology, Public Central Hospital of Matto Ishikawa, Ishikawa, Japan
| | - Kazuaki Funamoto
- Department of Radiation Oncology, Public Central Hospital of Matto Ishikawa, Ishikawa, Japan
| | - Kunihiko Yokoyama
- PET Imaging Center, Public Central Hospital of Matto Ishikawa, Ishikawa, Japan
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Chronic Lung Injury After Trimodality Therapy for Locally Advanced Non-Small Cell Lung Cancer. Ann Thorac Surg 2020; 112:279-288. [PMID: 33068542 DOI: 10.1016/j.athoracsur.2020.07.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/25/2020] [Accepted: 07/14/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Trimodality therapy is a treatment option for patients with locally advanced non-small cell lung cancer (LA-NSCLC). Thoracic radiation has both early (radiation pneumonitis) and late (chronic lung injury [CLI]) adverse effects on the lung. While CLI is expected to result in various problems in long-term survivors, these manifestations have not been precisely investigated. METHODS We enrolled 112 LA-NSCLC patients who had received induction chemoradiotherapy followed by surgery, and then undergone follow-up computed tomography (CT) every 6 months for greater than 1 year. All chest CT images were reviewed to evaluate any injury of the pulmonary parenchyma. RESULTS CLI at 1 year after surgery and its progression were observed in 94 (84%) and 38 (34%) patients, respectively. Progressive lung fibrosis as the first manifestation of CLI progression was most frequent after right middle and lower lobectomy. Cavity formation was the subsequent manifestation after progressive lung fibrosis , and chronic infection was the final stage of CLI. The cumulative rate of chronic infection was 76.4% at 10 years in patients with cavity formation. Ten patients with chronic infection included 7 cases of pulmonary aspergillosis and 2 cases of cavity infections with methicillin-resistant Staphylococcus aureus or Stenotrophomonas maltophilia. Among them, 4 patients required surgical interventions including completion pneumonectomy or fenestration. CONCLUSIONS CLI is a common incidence after trimodality therapy for LA-NSCLC. CLI frequently results in cavity formation, which is a precursor of highly refractory chronic infections requiring surgical intervention. Appropriate management needs to be established for CLI developing after trimodality therapy.
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