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Siva Kumar S, Bradley JA, Mendenhall NP, Mailhot Vega RB, Brooks ED, Okunieff PG, Giap F, Burchianti T, Daily K, Heldermon CD, Galochkina Z, Lee JH, Swarts S, O'Dell WG. Effects on Lung Tissue After Breast Cancer Radiation: Comparing Photon and Proton Therapies. Int J Part Ther 2024; 11:100006. [PMID: 38757081 PMCID: PMC11095095 DOI: 10.1016/j.ijpt.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/27/2023] [Accepted: 02/15/2024] [Indexed: 05/18/2024] Open
Abstract
Purpose In breast cancer, improved treatment approaches that reduce injury to lung tissue and early diagnosis and intervention for lung toxicity are increasingly important in survivorship. The aims of this study are to (1) compare lung tissue radiographic changes in women treated with conventional photon radiation therapy and those treated with proton therapy (PT), (2) assess the volume of lung irradiated to 5 Gy (V5) and 20 Gy (V20) by treatment modality, and (3) quantify the effects of V5, V20, time, and smoking history on the severity of tissue radiographic changes. Patients and Methods A prospective observational study of female breast cancer patients was conducted to monitor postradiation subclinical lung tissue radiographic changes. Repeated follow-up x-ray computed tomography scans were acquired through 2 years after treatment. In-house software was used to quantify an internally normalized measure of pulmonary tissue density change over time from the computed tomography scans, emphasizing the 6- and 12-month time points. Results Compared with photon therapy, PT was associated with significantly lower lung V5 and V20. Lung V20 (but not V5) correlated significantly with increased subclinical lung tissue radiographic changes 6 months after treatment, and neither correlated with lung effects at 12 months. Significant lung tissue density changes were present in photon therapy patients at 6 and 12 months but not in PT patients. Significant lung tissue density change persisted at 12 months in ever-smokers but not in never-smokers. Conclusion Patients treated with PT had significantly lower radiation exposure to the lungs and less statistically significant tissue density change, suggesting decreased injury and/or improved recovery compared to photon therapy. These findings motivate additional studies in larger, randomized, and more diverse cohorts to further investigate the contributions of treatment modality and smoking regarding the short- and long-term radiographic effects of radiation on lung tissue.
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Affiliation(s)
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Nancy P Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Raymond B Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Eric D Brooks
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Paul G Okunieff
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Fantine Giap
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Teena Burchianti
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | - Karen Daily
- Division of Hematology & Oncology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Coy D Heldermon
- Division of Hematology & Oncology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Zhanna Galochkina
- Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Ji-Hyun Lee
- Department of Biostatistics, University of Florida College of Health Profession & Public Health and College of Medicine, Gainesville, FL, USA
| | - Steven Swarts
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Walter G O'Dell
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
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Sun L, Wang Y, Zhu L, Chen J, Chen Z, Qiu Z, Wu C. Analysis of the risk factors of radiation pneumonitis in patients after radiotherapy for esophageal squamous cell carcinoma. Front Oncol 2023; 13:1198872. [PMID: 38023119 PMCID: PMC10662299 DOI: 10.3389/fonc.2023.1198872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To predict the risk factors of radiation pneumonitis (RP) in patients with esophageal squamous cell carcinoma (ESCC) who received radiotherapy. Methods From January 2015 to October 2021, 477 ESCC patients were enrolled and were assessed retrospectively. All these patients received radiotherapy for primary lesions or mediastinal metastatic lymph nodes. Clinical efficacy and adverse events (AEs) were observed. Univariate analysis identified clinical and dosimetric factors associated with the development of RP, and multivariate logistic regression analysis identified independent potential risk factors associated with the development of RP. Nomograms were constructed to predict RP based on the results of multivariate logistic regression analysis. Results Among the 477 ESCC patients, the incidence of RP was 22.2%, and the incidence of grade 4 or higher RP was 1.5%. Univariate analysis indicated that chronic obstructive pulmonary disease (COPD), pulmonary infection, leucopenia, PTV volume, V5, V20, V30 and MLD affected the occurrence of RP. The multivariate logistic regression analysis indicated that COPD (OR:1.821, 95%CI:1.111-2.985; P=0.017), pulmonary infection (OR:2.528, 95%CI:1.530-4.177; P<0.001), higher V20 (OR: 1.129, 95% CI:1.006-1.266; P=0.029) were significant independent predictors of RP in ESCC patients. COPD, pulmonary infection, V20 have been integrated for the RP nomogram. The rate of RP was significantly reduced in the V20<21.45% group. Further analysis indicated that the old age, diabetes, higher V20, and higher MLD were risk factors for grade 4 or higher RP. The area under the curve (AUC) value for V20 was 0.73 (95% CI, 0.567-0.893, P < 0.05). Conclusion We have determined the risk factors of RP and grade 4 or higher RP in ESCC patients after radiotherapy. MLD, V20, COPD were independent factors for RP. It was necessary to take measures to reduce or avoid the occurrence of RP for patients with these risk factors at the early stage.
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Affiliation(s)
- Lu Sun
- Department of Radiation Oncology, the People's Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yan Wang
- Department of Radiation Oncology, the People's Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Lihua Zhu
- Department of Radiation Oncology, the People's Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Jun Chen
- Department of Radiation Oncology, the People's Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zhifu Chen
- Department of Radiation Oncology, the People's Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zhiyuan Qiu
- Department of Oncology, the People’s Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
| | - Chaoyang Wu
- Department of Radiation Oncology, the People's Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu, China
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Weiss E, Ricco A, Mukhopadhyay N, Rezai Gharai L, Deng X, Jan N, Guy C. Predictors of high-grade radiation pneumonitis following radiochemotherapy for locally advanced non-small cell lung cancer: analysis of clinical, radiographic and radiotherapy-related factors. J Radiother Pract 2023; 22:e70. [DOI: 10.1017/s1460396923000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Isoyama S, Yamaguchi K, Imano N, Sakamoto S, Horimasu Y, Masuda T, Miyamoto S, Nakashima T, Iwamoto H, Fujitaka K, Hamada H, Nagata Y, Hattori N. Predictive role of circulatory levels of high-mobility group box 1 for radiation pneumonitis in patients with non-small cell lung cancer treated with definitive thoracic radiotherapy. Int J Clin Oncol 2022; 27:1698-1705. [PMID: 36057047 DOI: 10.1007/s10147-022-02239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/11/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND High-mobility group box 1 (HMGB1) is a pro-inflammatory protein associated with the pathophysiology of lung injury and lung tumorigenesis. Here, we investigated the predictive potential of serum HMGB1 levels for radiation pneumonitis in patients with lung cancer. METHODS This was a retrospective biomarker study of 73 patients with non-small cell lung cancer treated with definitive thoracic radiotherapy between August 2007 and January 2021. We measured HMGB1 levels in serum stored before treatment, and analyzed its association with the development of grade ≥ 2 or grade ≥ 3 radiation pneumonitis. Additionally, baseline characteristics affecting HMGB1 levels were identified. RESULTS Of the 73 patients, 21 (28.8%) and 6 (8.2%) patients experienced grade 2 and ≥ 3 radiation pneumonitis, respectively. Univariate and multivariate logistic regression analyses revealed that higher baseline levels of serum HMGB1 were significantly associated with a higher risk of grade ≥ 3, but not grade ≥ 2, radiation pneumonitis. The incidence of grade ≥ 3 radiation pneumonitis was higher in patients with HMGB1 levels ≥ 6.2 ng/mL than in those with levels < 6.2 ng/mL (25.0% vs. 3.5%, p = 0.019). Baseline serum levels of HMGB1 were independently and positively associated with gross tumor volume. CONCLUSIONS Higher serum HMGB1 levels were significantly associated with the risk of grade ≥ 3 radiation pneumonitis in patients with lung cancer, and therefore, HMGB1 could be a potential blood biomarker for predicting severe radiation pneumonitis.
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Affiliation(s)
- Shoko Isoyama
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kakuhiro Yamaguchi
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Nobuki Imano
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shinjiro Sakamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasushi Horimasu
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takeshi Masuda
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shintaro Miyamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Taku Nakashima
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hironobu Hamada
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Zhang A, Yang F, Gao L, Shi X, Yang J. Research Progress on Radiotherapy Combined with Immunotherapy for Associated Pneumonitis During Treatment of Non-Small Cell Lung Cancer. Cancer Manag Res 2022; 14:2469-2483. [PMID: 35991677 PMCID: PMC9386171 DOI: 10.2147/cmar.s374648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022] Open
Abstract
Radiation pneumonitis is a common and serious complication of radiotherapy for thoracic tumours. Although radiotherapy technology is constantly improving, the incidence of radiation pneumonitis is still not low, and severe cases can be life-threatening. Once radiation pneumonitis develops into radiation fibrosis (RF), it will have irreversible consequences, so it is particularly important to prevent the occurrence and development of radiation pneumonitis. Immune checkpoint inhibitors (ICIs) have rapidly altered the treatment landscape for multiple tumour types, providing unprecedented survival in some patients, especially for the treatment of non-small cell lung cancer (NSCLC). However, in addition to its remarkable curative effect, ICls may cause immune-related adverse events. The incidence of checkpoint inhibitor pneumonitis (CIP) is 3% to 5%, and its mortality rate is 10% to 17%. In addition, the incidence of CIP in NSCLC is higher than in other tumour types, reaching 7%–13%. With the increasing use of immune checkpoint inhibitors (ICls) and thoracic radiotherapy in the treatment of patients with NSCLC, ICIs may induce delayed radiation pneumonitis in patients previously treated with radiation therapy, or radiation activation of the systemic immune system increases the toxicity of adverse reactions, which may lead to increased pulmonary toxicity and the incidence of pneumonitis. In this paper, the data about the occurrence of radiation pneumonitis, immune pneumonitis, and combined treatment and the latest related research results will be reviewed.
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Affiliation(s)
- Anqi Zhang
- Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, People's Republic of China
| | - Fuyuan Yang
- School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, People's Republic of China
| | - Lei Gao
- Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, People's Republic of China
| | - Xiaoyan Shi
- Department of Gynaecology and Obstetrics, First Affiliated Hospital of Yangtze University, Jingzhou, People's Republic of China
| | - Jiyuan Yang
- Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, People's Republic of China
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Perdyan A, Jassem J. Impact of Tobacco Smoking on Outcomes of Radiotherapy: A Narrative Review. Curr Oncol 2022; 29:2284-300. [PMID: 35448160 PMCID: PMC9031077 DOI: 10.3390/curroncol29040186] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
The carcinogenic role of tobacco smoking is well recognized, but the detrimental effects of continued smoking after a cancer diagnosis have been underestimated. Radiotherapy is among the main treatment modalities for cancer. We reviewed the literature data concerning the impact of tobacco smoking on treatment outcomes in radiotherapy-managed patients with various malignancies. Most of the analyzed studies demonstrated the detrimental effect of smoking on overall survival, tumor control, quality of life, treatment toxicity, and the incidence of second primary malignancies. Healthcare professionals should use the cancer diagnosis and treatment as a teachable moment and recommend their patients to immediately cease smoking. Wherever possible, cancer patients should undergo an intensive smoking-cessation program, including behavioral and pharmacologic therapy.
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Zhang S, Lv B, Zheng X, Li Y, Ge W, Zhang L, Mo F, Qiu J. Dosimetric Study of Deep Learning-Guided ITV Prediction in Cone-beam CT for Lung Stereotactic Body Radiotherapy. Front Public Health 2022; 10:860135. [PMID: 35392465 PMCID: PMC8980420 DOI: 10.3389/fpubh.2022.860135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the accuracy of a lung stereotactic body radiotherapy (SBRT) treatment plan with the target of a newly predicted internal target volume (ITVpredict) and the feasibility of its clinical application. ITVpredict was automatically generated by our in-house deep learning model according to the cone-beam CT (CBCT) image database. Method A retrospective study of 45 patients who underwent SBRT was involved, and Mask R-CNN based algorithm model helped to predict the internal target volume (ITV) using the CBCT image database. The geometric accuracy of ITVpredict was verified by the Dice Similarity Coefficient (DSC), 3D Motion Range (R3D), Relative Volume Index (RVI), and Hausdorff Distance (HD). The PTVpredict was generated by ITVpredict, which was registered and then projected on free-breath CT (FBCT) images. The PTVFBCT was margined from the GTV on FBCT images gross tumor volume on free-breath CT (GTVFBCT). Treatment plans with the target of Predict planning target volume on CBCT images (PTVpredict) and planning target volume on free-breath CT (PTVFBCT) were respectively re-established, and the dosimetric parameters included the ratio of the volume of patients receiving at least the prescribed dose to the volume of PTV (R100%), the ratio of the volume of patients receiving at least 50% of the prescribed dose to the volume of PTV in the Radiation Therapy Oncology Group (RTOG) 0813 Trial (R50%), Gradient Index (GI), and the maximum dose 2 cm from the PTV (D2cm), which were evaluated via Plan4DCT, plan which based on PTVpredict (Planpredict), and plan which based on PTVFBCT (PlanFBCT). Result The geometric results showed that there existed a good correlation between ITVpredict and ITV on the 4-dimensional CT [ITV4DCT; DSC= 0.83 ±0.18]. However, the average volume of ITVpredict was 10% less than that of ITV4DCT (p = 0.333). No significant difference in dose coverage was found in V100% for the ITV with 99.98 ± 0.04% in the ITV4DCT vs. 97.56 ± 4.71% in the ITVpredict (p = 0.162). Dosimetry parameters of PTV, including R100%, R50%, GI and D2cm showed no statistically significant difference between each plan (p > 0.05). Conclusion Dosimetric parameters of Planpredict are clinically comparable to those of the original Plan4DCT. This study confirmed that the treatment plan based on ITVpredict produced by our model could automatically meet clinical requirements. Thus, for patients undergoing lung SBRT, the model has great potential for using CBCT images for ITV contouring which can be used in treatment planning.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wang H, Huang Y, Chen H, Shao Y, Duan Y, Feng A, Gu H, Ma X, Xu Z, Kong Q, Zhou Y. Voxel-Level BED Corrected Dosimetric and Radiobiological Assessment of 2 Kinds of Hybrid Radiotherapy Planning Methods for Stage III NSCLC. Technol Cancer Res Treat 2022; 21:15330338221107966. [PMID: 35731648 PMCID: PMC9228645 DOI: 10.1177/15330338221107966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background/purpose: To access the comparative dosimetric and radiobiological advantages of two methods of intensity-modulated radiation therapy (IMRT)-based hybrid radiotherapy planning for stage III nonsmall cell lung cancer (NSCLC). Methods: Two hybrid planning methods were respectively characterized by conventional fraction radiotherapy (CFRT) and stereotactic body radiotherapy (SBRT) and CFRT and simultaneous integrated boost (SIB) planning. All plans were retrospectively completed using the 2 methods for 20 patients with stage III NSCLC. CFRT and SBRT dose regimes 2 Gy × 30 f and 12.5 Gy × 4 f were, respectively, used for planning target volume of lymph node (PTVLN) and planning target volume of the primary tumor (PTVPT), while dose regimes 2 Gy × 26 f for PTVLN and sequential 2 Gy × 4 f for PTVLN combined with 12.5 Gy × 4 f for PTVPT were adopted for CFRT and SIB plans. SBRT and SIB EQD2 dose were calculated voxel by voxel, and then, respectively, superimposed with 30-fraction and 26-fraction CFRT plan dose to achieve biological equivalent dose (BED) dosimetric parameters of CFRT and SBRT and CFRT and SIB plans. Tumor control probability (TCP)/normal tissue complication probability (NTCP) was, respectively, calculated by equivalent uniform dose/Lyman–Kutcher–Burman models. BED plan parameters and TCP/NTCP were analyzed between 2 methods of hybrid planning. Primary tumor/lymph node (LN)/total TCP values were, respectively, evaluated as a function of the radiation dose needed to control 50% of tumor (TCD50) for 20 patients. Dosimetric errors were analyzed by nontransit electronic portal imaging device dosimetry measurement during hybrid plan delivery. Results: Statistically lower BED plan parameters of PTVLN D2 and homogeneity index resulted in slightly lower averaged LN/total TCP curves by CFRT and SIB planning. The gaps between Max and Min LN/total TCP curves were significantly closer for CFRT and SIB planning, which indicated better robustness of LN/total TCPs. A lower esophagus dose resulted in a lower esophagus NTCP by CFRT and SIB planning, which may be compromised by 1 week shorter overall treatment time by CFRT and SIB irradiation. Spinal cord Dmax was significantly reduced by CFRT and SIB plans. The dose verification results of the subplans involved in hybrid plans were acceptable, which showed that the 2 methods of hybrid planning could be delivered accurately in our center. Conclusion: CFRT and SIB plannings have more advantages on BED plan parameters and TCP/NTCP than CFRT and SBRT planning, and both methods of IMRT-based hybrid planning could be executed accurately for stage III NSCLC. The effectiveness of the results needs to be validated in the hybrid trial.
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Affiliation(s)
- Hao Wang
- Institute of Modern Physics, Fudan University, Shanghai, China.,Department of Radiation Oncology, 71141Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Ying Huang
- Department of Radiation Oncology, 71141Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hua Chen
- Department of Radiation Oncology, 71141Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yan Shao
- Department of Radiation Oncology, 71141Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yanhua Duan
- Department of Radiation Oncology, 71141Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Aihui Feng
- Department of Radiation Oncology, 71141Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hengle Gu
- Department of Radiation Oncology, 71141Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xiurui Ma
- Department of Radiation Oncology, 92323Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiyong Xu
- Department of Radiation Oncology, 71141Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Qing Kong
- Institute of Modern Physics, Fudan University, Shanghai, China
| | - Yongkang Zhou
- Department of Radiation Oncology, 92323Zhongshan Hospital, Fudan University, Shanghai, China
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10
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Meng J, Li Y, Wan C, Sun Y, Dai X, Huang J, Hu Y, Gao Y, Wu B, Zhang Z, Jiang K, Xu S, Lovell JF, Hu Y, Wu G, Jin H, Yang K. Targeting senescence-like fibroblasts radiosensitizes non-small cell lung cancer and reduces radiation-induced pulmonary fibrosis. JCI Insight 2021; 6:146334. [PMID: 34877934 PMCID: PMC8675198 DOI: 10.1172/jci.insight.146334] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
Cancer cell radioresistance is the primary cause of the decreased curability of non–small cell lung cancer (NSCLC) observed in patients receiving definitive radiotherapy (RT). Following RT, a set of microenvironmental stress responses is triggered, including cell senescence. However, cell senescence is often ignored in designing effective strategies to resolve cancer cell radioresistance. Herein, we identify the senescence-like characteristics of cancer-associated fibroblasts (CAFs) after RT and clarify the formidable ability of senescence-like CAFs in promoting NSCLC cell proliferation and radioresistance through the JAK/STAT pathway. Specific induction of senescence-like CAF apoptosis using FOXO4-DRI, a FOXO4-p53–interfering peptide, resulted in remarkable effects on radiosensitizing NSCLC cells in vitro and in vivo. In addition, in this study, we also uncovered an obvious therapeutic effect of FOXO4-DRI on alleviating radiation-induced pulmonary fibrosis (RIPF) by targeting senescence-like fibroblasts in vivo. In conclusion, by targeting senescence, we offer a strategy that simultaneously decreases radioresistance of NSCLC and the incidence of RIPF.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ke Jiang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Jonathan F Lovell
- Department of Chemical and Biological Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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11
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Jahangiri P, Dreyfuss AD, Duan F, Snyder BS, Borja AJ, Pournazari K, Kothekar E, Arani L, Al-Zaghal A, Seraj SM, Hancin EC, Pinheiro B, Werner TJ, Swisher-McClure S, Feigenberg SJ, Torigian DA, Revheim ME, Simone CB, Alavi A. Implementation of FDG-PET/CT imaging methodology for quantification of inflammatory response in patients with locally advanced non-small cell lung cancer: results from the ACRIN 6668/RTOG 0235 trial. Am J Nucl Med Mol Imaging 2021; 11:415-427. [PMID: 34754612 PMCID: PMC8569334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/08/2021] [Indexed: 06/13/2023]
Abstract
We measured changes in 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) images in the lung parenchyma to quantify the degree of lung inflammation in patients with locally advanced non-small cell lung cancer (NSCLC) who received radiotherapy (RT). The goal of this study was to demonstrate successful implementation of this imaging methodology on NSCLC patients and to report quantitative statistics between pre-RT and post-RT. Seventy-one patients with NSCLC underwent FDG-PET/CT imaging before and after RT in a prospective study (ACRIN 6668/RTOG 0235). Comparisons between pre-RT and post-RT PET/CT were conducted for partial volume corrected (PVC)-mean standardized uptake value (SUVmean), PVC-global lung parenchymal glycolysis (GLPG), and lung volume for both ipsilateral and contralateral lungs using the nonparametric Wilcoxon signed-rank test. Regression modeling was conducted to associate clinical characteristics with post-RT PET/CT parameters. There was a significant increase in average SUVmean and GLPG of the ipsilateral lung (relative change 40% and 20%) between pre-RT and post-RT PET/CT scans (P<0.0001 and P=0.004). Absolute increases in PVC-SUVmean and PVC-GLPG were more pronounced (ΔPVC-SUVmean 0.32 versus ΔSUVmean 0.28; ΔPVC-GLPG 463.34 cc versus ΔGLPG 352.90 cc) and highly significant (P<0.0001). In contrast, the contralateral lung demonstrated no significant difference between pre-RT to post-RT in either GLPG (P=0.12) or SUVmean (P=0.18). The only clinical feature significantly associated with post-RT PET/CT parameters was clinical staging. Our study demonstrated inflammatory response in the ipsilateral lung of NSCLC patients treated with photon RT, suggesting that PET/CT parameters may serve as biomarkers for radiation pneumonitis (RP).
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Affiliation(s)
- Pegah Jahangiri
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - Alexandra D Dreyfuss
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public HealthProvidence 02912, RI, USA
| | - Bradley S Snyder
- Center for Statistical Sciences, Brown University School of Public HealthProvidence 02912, RI, USA
| | - Austin J Borja
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - Kamyar Pournazari
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - Esha Kothekar
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - Leila Arani
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - Abdullah Al-Zaghal
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | | | - Emily C Hancin
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - Benjamin Pinheiro
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - Samuel Swisher-McClure
- Department of Radiation Oncology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - Steven J Feigenberg
- Department of Radiation Oncology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - Drew A Torigian
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
- Division of Radiology and Nuclear Medicine, Oslo University HospitalOslo 0424, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of OsloOslo 0424, Norway
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton CenterNew York 10035, NY, USA
| | - Abass Alavi
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia 19104, PA, USA
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Lan K, Xu C, Liu S, Zhu J, Yang Y, Zhang L, Guo S, Xi M. Modeling the risk of radiation pneumonitis in esophageal squamous cell carcinoma treated with definitive chemoradiotherapy. Esophagus 2021; 18:861-871. [PMID: 34128129 DOI: 10.1007/s10388-021-00860-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND To develop and validate a nomogram for the prediction of symptomatic radiation pneumonitis (RP) in patients with esophageal squamous cell carcinoma (ESCC) who received definitive concurrent chemoradiotherapy. METHODS Clinical factors, dose-volume histogram parameters, and pulmonary function parameters were collected from 402 ESCC patients between 2010 and 2017, including 321 patients in the primary cohort and 81 in the validation cohort. The end-point was the occurrence of symptomatic RP (grade ≥ 2) within the first 12 months after radiotherapy. Univariate and multivariate logistic regression analyses were applied to evaluate the predictive value of each factor for RP. A prediction model was generated in the primary cohort, which was internally validated to assess its performance. RESULTS In the primary cohort, 31 patients (9.7%) experienced symptomatic RP. Based on logistic regression model, patients with larger planning target volumes (PTVs) or higher lung V20 had a higher predictive risk of RP, whereas the overall risk was substantially higher for three-dimensional conformal radiotherapy (3DCRT) than intensity-modulated radiotherapy. On multivariate analysis, independent predictive factors for RP were smoking history (P = 0.035), radiotherapy modality (P < 0.001), PTV (P = 0.039), and lung V20 (P < 0.001), which were incorporated into the nomogram. The areas under the receiver operating characteristic curve of the nomogram in the primary and validation cohorts were 0.772 and 0.900, respectively, which were superior to each predictor alone. CONCLUSIONS Non-smoking status, 3DCRT, lung V20 (> 27.5%), and PTV (≥ 713.0 cc) were significantly associated with a higher risk of RP. A nomogram was built with satisfactory prediction ability.
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Affiliation(s)
- Kaiqi Lan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Cheng Xu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Shiliang Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Jinhan Zhu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Yadi Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China.,Department of Imaging Diagnosis and Interventional Center, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Li Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Suping Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China. .,Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China.
| | - Mian Xi
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China. .,Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China.
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Kawahara D, Imano N, Nishioka R, Ogawa K, Kimura T, Nakashima T, Iwamoto H, Fujitaka K, Hattori N, Nagata Y. Prediction of radiation pneumonitis after definitive radiotherapy for locally advanced non-small cell lung cancer using multi-region radiomics analysis. Sci Rep 2021; 11:16232. [PMID: 34376721 PMCID: PMC8355298 DOI: 10.1038/s41598-021-95643-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/19/2021] [Indexed: 12/22/2022] Open
Abstract
To predict grade ≥ 2 radiation pneumonitis (RP) in patients with locally advanced non-small cell lung cancer (NSCLC) using multi-region radiomics analysis. Data from 77 patients with NSCLC who underwent definitive radiotherapy between 2008 and 2018 were analyzed. Radiomic feature extraction from the whole lung (whole-lung radiomics analysis) and imaging- and dosimetric-based segmentation (multi-region radiomics analysis) were performed. Patients with RP grade ≥ 2 or < 2 were classified. Predictors were selected with least absolute shrinkage and selection operator logistic regression and the model was built with neural network classifiers. A total of 49,383 radiomics features per patient image were extracted from the radiotherapy planning computed tomography. We identified 4 features and 13 radiomics features in the whole-lung and multi-region radiomics analysis for classification, respectively. The accuracy and area under the curve (AUC) without the synthetic minority over-sampling technique (SMOTE) were 60.8%, and 0.62 for whole-lung and 80.1%, and 0.84 for multi-region radiomics analysis. These were improved 1.7% for whole-lung and 2.1% for multi-region radiomics analysis with the SMOTE. The developed multi-region radiomics analysis can help predict grade ≥ 2 RP. The radiomics features in the median- and high-dose regions, and the local intensity roughness and variation were important factors in predicting grade ≥ 2 RP.
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Affiliation(s)
- Daisuke Kawahara
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, 1-3-2 Kagamiyama, Higashihiroshima, Hiroshima, 734-8551, Japan.
| | - Nobuki Imano
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, 1-3-2 Kagamiyama, Higashihiroshima, Hiroshima, 734-8551, Japan
| | - Riku Nishioka
- Medical and Dental Sciences Course, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kouta Ogawa
- School of Medicine, Hiroshima University, Hiroshima, Japan
| | - Tomoki Kimura
- Division of Radiation Oncology Kochi Medical School, Department of Radiology, Kochi University, Kochi, Japan
| | - Taku Nakashima
- Department Molecular and Internal Medicine, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Iwamoto
- Department Molecular and Internal Medicine, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazunori Fujitaka
- Department Molecular and Internal Medicine, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Noboru Hattori
- Department 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, 1-3-2 Kagamiyama, Higashihiroshima, Hiroshima, 734-8551, Japan.,Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan
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16
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Rahi MS, Parekh J, Pednekar P, Parmar G, Abraham S, Nasir S, Subramaniyam R, Jeyashanmugaraja GP, Gunasekaran K. Radiation-Induced Lung Injury-Current Perspectives and Management. Clin Pract 2021; 11:410-429. [PMID: 34287252 PMCID: PMC8293129 DOI: 10.3390/clinpract11030056] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy plays an important role in the treatment of localized primary malignancies involving the chest wall or intrathoracic malignancies. Secondary effects of radiotherapy on the lung result in radiation-induced lung disease. The phases of lung injury from radiation range from acute pneumonitis to chronic pulmonary fibrosis. Radiation pneumonitis is a clinical diagnosis based on the history of radiation, imaging findings, and the presence of classic symptoms after exclusion of infection, pulmonary embolism, heart failure, drug-induced pneumonitis, and progression of the primary tumor. Computed tomography (CT) is the preferred imaging modality as it provides a better picture of parenchymal changes. Lung biopsy is rarely required for the diagnosis. Treatment is necessary only for symptomatic patients. Mild symptoms can be treated with inhaled steroids while subacute to moderate symptoms with impaired lung function require oral corticosteroids. Patients who do not tolerate or are refractory to steroids can be considered for treatment with immunosuppressive agents such as azathioprine and cyclosporine. Improvements in radiation technique, as well as early diagnosis and appropriate treatment with high-dose steroids, will lead to lower rates of pneumonitis and an overall good prognosis.
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Affiliation(s)
- Mandeep Singh Rahi
- Division of Pulmonary Diseases and Critical Care, Yale-New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA;
| | - Jay Parekh
- Department of Internal Medicine, Yale-New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA; (J.P.); (P.P.); (S.A.); (G.P.J.)
| | - Prachi Pednekar
- Department of Internal Medicine, Yale-New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA; (J.P.); (P.P.); (S.A.); (G.P.J.)
| | - Gaurav Parmar
- Department of Radiology, Yale-New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA;
| | - Soniya Abraham
- Department of Internal Medicine, Yale-New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA; (J.P.); (P.P.); (S.A.); (G.P.J.)
| | - Samar Nasir
- Department of Internal Medicine, University at Buffalo, 462 Grider Street, Buffalo, NY 14215, USA;
| | - Rajamurugan Subramaniyam
- Department of Pulmonary Critical Care Medicine, St. Louis University, 3635 Vista Ave, St. Louis, MO 63110, USA;
| | - Gini Priyadharshini Jeyashanmugaraja
- Department of Internal Medicine, Yale-New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA; (J.P.); (P.P.); (S.A.); (G.P.J.)
| | - Kulothungan Gunasekaran
- Division of Pulmonary Diseases and Critical Care, Yale-New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA;
- Correspondence: ; Tel.: +1-203-384-5009
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Hoeller U, Borgmann K, Oertel M, Haverkamp U, Budach V, Eich HT. Late Sequelae of Radiotherapy. Dtsch Arztebl Int 2021; 118:205-211. [PMID: 34024324 DOI: 10.3238/arztebl.m2021.0024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 03/25/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Approximately half of all patients with tumors need radiotherapy. Long-term survivors may suffer from late sequelae of the treatment. The existing radiotherapeutic techniques are being refined so that radiation can be applied more precisely, with the goal of limiting the radiation exposure of normal tissue and reducing late sequelae. METHODS This review is based on the findings of a selective search in PubMed for publications on late sequelae of conventional percutaneous radiotherapy, January 2000 to May 2020. Late sequelae affecting the central nervous system, lungs, and heart and the development of second tumors are presented, and radiobiological mechanisms and the relevant technical and conceptual considerations are discussed. RESULTS The current standard of treatment involves the use of linear accelerators, intensity-modulated radiotherapy (IMRT), image-guided and respiratory-gated radiotherapy, and the integration of positron emission tomography combined with computed tomography (PET-CT) in radiation treatment planning. Cardiotoxicity has been reduced with regard to the risk of coronary heart disease after radiotherapy for Hodgkin's lymphoma (hazard ratio [HR] 0.44 [0.23; 0.85]). It was also found that the rate of radiation- induced pneumonitis dropped from 7.9% with conformal treatment to 3.5% with IMRT in a phase III lung cancer trial. It is hoped that neurocognitive functional impairment will be reduced by hippocampal avoidance in modern treatment planning: an initial phase III trial yielded a hazard ratio of 0.74 [0.58; 0.94]. It is estimated that 8% of second solid tumors in adults are induced by radiotherapy (3 additional tumors per 1000 patients at 10 years). CONCLUSION Special challenges for research in this field arise from the long latency of radiation sequelae and the need for largescale, well-documented patient collectives in order to discern dose-effect relationships, and take account of cofactors, when the overall number of events is small. It is hoped that further technical and conceptual advances will be made in the areas of adaptive radiotherapy, proton and heavy-ion therapy, and personalized therapy.
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18
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Li N, Luo P, Li C, Hong Y, Zhang M, Chen Z. Analysis of related factors of radiation pneumonia caused by precise radiotherapy of esophageal cancer based on random forest algorithm. Math Biosci Eng 2021; 18:4477-4490. [PMID: 34198449 DOI: 10.3934/mbe.2021227] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The precise radiotherapy of esophageal cancer may cause different degrees of radiation damage for lung tissues and cause radioactive pneumonia. However, the occurrence of radioactive pneumonia is related to many factors. To further clarify the correlation between the occurrence of radioactive pneumonia and related factors, a random forest model was used to build a risk prediction model for patients with esophageal cancer undergoing radiotherapy. In this study, we retrospectively reviewed 118 patients with esophageal cancer confirmed by pathology in our hospital. The health characteristics and related parameters of all patients were analyzed, and the predictive effect of radiation pneumonia was discussed using the random forest algorithm. After treatment, 71 patients developed radioactive pneumonia (60.17%). In univariate analyses, age, planning target volume length, Karnofsky performance score (KPS), pulmonary emphysema, with or without chemotherapy, and the ratio of planning target volume to planning gross tumor volume (PTV/PGTV) in mediastinum were significantly associated with radioactive pneumonia (P < 0.05 for each comparison). Multivariate analysis revealed that with or without pulmonary emphysema (OR = 7.491, P = 0.001), PTV/PGTV (OR = 0.205, P = 0.007), and KPS (OR = 0.251, P = 0.011) were independent predictors for radiation pneumonia. The results concluded that the analysis of radiation pneumonia-related factors based on the random forest algorithm could build a mathematical prediction model for the easily obtained data. This algorithm also could effectively analyze the risk factors of radiation pneumonia and formulate the appropriate treatment plan for esophageal cancer.
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Affiliation(s)
- Na Li
- Department of Oncology Center, Second Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Peng Luo
- The First Department of Oncology, Cancer Hospital, Chinese Academy of Sciences, Hefei, Anhui 230031, China
| | - Chunyang Li
- Radiotherapy Center, Second Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Yanyan Hong
- Department of Oncology Center, Second Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Mingjun Zhang
- Department of Oncology Center, Second Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Zhendong Chen
- Department of Oncology Center, Second Hospital of Anhui Medical University, Hefei, Anhui 230601, China
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Yang LT, Zhou L, Chen L, Liang SX, Huang JQ, Zhu XD. Establishment and Verification of a Prediction Model for Symptomatic Radiation Pneumonitis in Patients with Esophageal Cancer Receiving Radiotherapy. Med Sci Monit 2021; 27:e930515. [PMID: 33953150 PMCID: PMC8112075 DOI: 10.12659/msm.930515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study aimed to determine the value of the significant index in predicting symptomatic radiation pneumonitis (RP) in esophageal cancer patients, establish a nomogram prediction model, and verify the model. MATERIAL AND METHODS The patients enrolled were divided into 2 groups: a model group and a validation group. According to the logistic regression analysis, the independent predictors for symptomatic RP were obtained, and the nomogram prediction model was established according to these independent predictors. The consistency index (C-index) and calibration curve were used to evaluate the accuracy of the model, and the prediction ability of the model was verified in the validation group. Recursive partitioning analysis (RPA) was used for the risk stratification analysis. RESULTS The ratio of change regarding the pre-albumin at the end of treatment (P=0.001), platelet-to-lymphocyte ratio during treatment (P=0.027), and neutrophil-to-lymphocyte ratio at the end of treatment (P=0.001) were the independent predictors for symptomatic RP. The C-index of the nomogram model was 0.811. According to the risk stratification of RPA, the whole group was divided into 3 groups: a low-risk group, a medium-risk group, and a high-risk group. The incidence of symptomatic RP was 0%, 16.9%, and 57.6%, respectively. The receiver operating characteristic curve also revealed that the nomogram model has good accuracy in the validation group. CONCLUSIONS The developed nomogram and corresponding risk classification system have superior prediction ability for symptomatic RP and can predict the occurrence of RP in the early stage.
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Affiliation(s)
- Liu-Ting Yang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China (mainland)
| | - Lei Zhou
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China (mainland)
| | - Long Chen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China (mainland)
| | - Shi-Xiong Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China (mainland)
| | - Jiang-Qiong Huang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China (mainland)
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China (mainland).,Department of Oncology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
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20
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Xu Y, Huang Y, Chen Y, Cao K, Liu Z, Wan Z, Liao Z, Li B, Cui J, Yang Y, Xu X, Cai J, Gao F. Grape Seed Proanthocyanidins play the roles of radioprotection on Normal Lung and radiosensitization on Lung Cancer via differential regulation of the MAPK Signaling Pathway. J Cancer 2021; 12:2844-2854. [PMID: 33854585 PMCID: PMC8040900 DOI: 10.7150/jca.49987] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 02/03/2021] [Indexed: 01/08/2023] Open
Abstract
Radiation-induced lung injury (RILI) is a common serious complication and dose-limiting factor caused by radiotherapy for lung cancer. This study was to investigate radioprotective effects of grape seed proanthocyanidins (GSP) on normal lung as well as radiosensitizing effects on lung cancer. In vitro, we demonstrated radioprotective effects of GSP on normal alveolar epithelial cells (MLE-12 and BEAS/2B) and radiosensitizing effects on lung cancer cells (LLC and A549). In vivo, we confirmed these two-way effects in tumor-bearing mice. The results showed that GSP inhibited tumor growth, and played a synergistic killing effect with radiotherapy on lung cancer. Meanwhile, GSP reduced radiation damage to normal lung tissues. The two-way effects related to the differential regulation of the MAPK signaling pathway by GSP on normal lung and lung cancer. Moreover, GSP regulated secretion of cytokines IL-6 and IFN-γ and expression of p53 and Ki67 on normal lung and lung cancer. Our findings suggest that GSP is expected to be an ideal radioprotective drug for lung cancer patients who are treated with radiotherapy.
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Affiliation(s)
- Yang Xu
- Department of Radiation Medicine, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, China, 200433.,Department of Radiology, Xizang Military General Hospital, 66 Niangre North Road, Lhasa City, Tibet, China, 850000
| | - Yijuan Huang
- Department of Radiation Medicine, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, China, 200433.,Department of Radiology, First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing, Zhejiang, 314000
| | - Yuanyuan Chen
- Department of Radiation Medicine, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, China, 200433
| | - Kun Cao
- Department of Radiation Medicine, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, China, 200433
| | - Zhe Liu
- Department of Radiation Medicine, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, China, 200433
| | - Zhijie Wan
- Department of Radiation Medicine, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, China, 200433
| | - Zebin Liao
- Department of Radiation Medicine, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, China, 200433
| | - Bailong Li
- Department of Radiation Medicine, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, China, 200433
| | - Jianguo Cui
- Department of Radiation Medicine, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, China, 200433
| | - Yanyong Yang
- Department of Radiation Medicine, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, China, 200433
| | - Xiaohua Xu
- Department of Nuclear Radiation, Tongji University Affiliated Shanghai Pulmonary Hospital, 507 Zhengmin Road, Shanghai, China, 200433
| | - Jianming Cai
- Department of Radiation Medicine, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, China, 200433
| | - Fu Gao
- Department of Radiation Medicine, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, China, 200433
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Arroyo-Hernández M, Maldonado F, Lozano-Ruiz F, Muñoz-Montaño W, Nuñez-Baez M, Arrieta O. Radiation-induced lung injury: current evidence. BMC Pulm Med 2021; 21:9. [PMID: 33407290 PMCID: PMC7788688 DOI: 10.1186/s12890-020-01376-4] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/14/2020] [Indexed: 02/07/2023] Open
Abstract
Chemo-radiotherapy and systemic therapies have proven satisfactory outcomes as standard treatments for various thoracic malignancies; however, adverse pulmonary effects, like pneumonitis, can be life-threatening. Pneumonitis is caused by direct cytotoxic effect, oxidative stress, and immune-mediated injury. Radiotherapy Induced Lung Injury (RILI) encompasses two phases: an early phase known as Radiation Pneumonitis (RP), characterized by acute lung tissue inflammation as a result of exposure to radiation; and a late phase called Radiation Fibrosis (RF), a clinical syndrome that results from chronic pulmonary tissue damage. Currently, diagnoses are made by exclusion using clinical assessment and radiological findings. Pulmonary function tests have constituted a significant step in evaluating lung function status during radiotherapy and useful predictive tools to avoid complications or limit toxicity. Systemic corticosteroids are widely used to treat pneumonitis complications, but its use must be standardized, and consider in the prophylaxis setting given the fatal outcome of this adverse event. This review aims to discuss the clinicopathological features of pneumonitis and provide practical clinical recommendations for prevention, diagnosis, and management.
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Affiliation(s)
- Marisol Arroyo-Hernández
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México
| | - Federico Maldonado
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México
| | - Francisco Lozano-Ruiz
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México
| | - Wendy Muñoz-Montaño
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México
| | - Mónica Nuñez-Baez
- Departamento de Radioncología, Hospital Universitario HM Sanchinarro, Caracas, Venezuela
| | - Oscar Arrieta
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México.
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Sardaro A, McDonald F, Bardoscia L, Lavrenkov K, Singh S, Ashley S, Traish D, Ferrari C, Meattini I, Asabella AN, Brada M. Dyspnea in Patients Receiving Radical Radiotherapy for Non-Small Cell Lung Cancer: A Prospective Study. Front Oncol 2020; 10:594590. [PMID: 33425746 PMCID: PMC7787051 DOI: 10.3389/fonc.2020.594590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/18/2020] [Indexed: 12/19/2022] Open
Abstract
Background and Purpose Dyspnea is an important symptomatic endpoint for assessment of radiation-induced lung injury (RILI) following radical radiotherapy in locally advanced disease, which remains the mainstay of treatment at the time of significant advances in therapy including combination treatments with immunotherapy and chemotherapy and the use of local ablative radiotherapy techniques. We investigated the relationship between dose-volume parameters and subjective changes in dyspnea as a measure of RILI and the relationship to spirometry. Material and Methods Eighty patients receiving radical radiotherapy for non-small cell lung cancer were prospectively assessed for dyspnea using two patient-completed tools: EORTC QLQ-LC13 dyspnea quality of life assessment and dyspnea visual analogue scale (VAS). Global quality of life, spirometry and radiation pneumonitis grade were also assessed. Comparisons were made with lung dose-volume parameters. Results The median survival of the cohort was 26 months. In the evaluable group of 59 patients there were positive correlations between lung dose-volume parameters and a change in dyspnea quality of life scale at 3 months (V30 p=0.017; V40 p=0.026; V50 p=0.049; mean lung dose p=0.05), and a change in dyspnea VAS at 6 months (V30 p=0.05; V40 p=0.026; V50 p=0.028) after radiotherapy. Lung dose-volume parameters predicted a 10% increase in dyspnea quality of life score at 3 months (V40; p=0.041, V50; p=0.037) and dyspnea VAS score at 6 months (V40; p=0.027) post-treatment. Conclusions Worsening of dyspnea is an important symptom of RILI. We demonstrate a relationship between lung dose-volume parameters and a 10% worsening of subjective dyspnea scores. Our findings support the use of subjective dyspnea tools in future studies on radiation-induced lung toxicity, particularly at doses below conventional lung radiation tolerance limits.
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Affiliation(s)
- Angela Sardaro
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Interdisciplinary Department of Medicine, Nuclear Medicine Unit and Section of Radiology and Radiation Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Fiona McDonald
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Academic Radiotherapy Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Lilia Bardoscia
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Konstantin Lavrenkov
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Department of Oncology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shalini Singh
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Department of Radiotherapy, Lucknow, India
| | - Sue Ashley
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Daphne Traish
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Cristina Ferrari
- Interdisciplinary Department of Medicine, Nuclear Medicine Unit and Section of Radiology and Radiation Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Icro Meattini
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Department of Biomedical, Experimental, and Clinical Sciences, University of Florence, Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Artor Niccoli Asabella
- Interdisciplinary Department of Medicine, Nuclear Medicine Unit and Section of Radiology and Radiation Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Michael Brada
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Academic Radiotherapy Unit, The Institute of Cancer Research, Sutton, United Kingdom.,Department of Radiation Oncology, University of Liverpool and Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
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24
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Du F, Tang N, Cui Y, Wang W, Zhang Y, Li Z, Li J. A Novel Nomogram Model Based on Cone-Beam CT Radiomics Analysis Technology for Predicting Radiation Pneumonitis in Esophageal Cancer Patients Undergoing Radiotherapy. Front Oncol 2020; 10:596013. [PMID: 33392091 PMCID: PMC7774595 DOI: 10.3389/fonc.2020.596013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/04/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose We quantitatively analyzed the characteristics of cone-beam computed tomography (CBCT) radiomics in different periods during radiotherapy (RT) and then built a novel nomogram model integrating clinical features and dosimetric parameters for predicting radiation pneumonitis (RP) in patients with esophageal squamous cell carcinoma (ESCC). Methods At our institute, a retrospective study was conducted on 96 ESCC patients for whom we had complete clinical feature and dosimetric parameter data. CBCT images of each patient in three different periods of RT were obtained, the images were segmented using both lungs as the region of interest (ROI), and 851 image features were extracted. The least absolute shrinkage selection operator (LASSO) was applied to identify candidate radiomics features, and logistic regression analyses were applied to construct the rad-score. The optimal period for the rad-score, clinical features, and dosimetric parameters were selected to construct the nomogram model and then the receiver operating characteristic (ROC) curve was used to evaluate the prediction capacity of the model. Calibration curves and decision curves were used to demonstrate the discriminatory and clinical benefit ratios, respectively. Results The relative volume of total lung treated with ≥5 Gy (V5), mean lung dose (MLD), and tumor stage were independent predictors of RP and were finally incorporated into the nomogram. When the three time periods were modeled, the first period was better than the others. In the primary cohort, the area under the ROC curve (AUC) was 0.700 (95% confidence interval (CI) 0.568–0.832), and in the independent validation cohort, the AUC was 0.765 (95% CI 0.588–0.941). In the nomogram model that integrates clinical features and dosimetric parameters, the AUC in the primary cohort was 0.836 (95% CI 0.700–0.918), and the AUC in the validation cohort was 0.905 (95% CI 0.799–1.000). The nomogram model exhibits excellent performance. Calibration curves indicate a favorable consistency between the nomogram prediction and the actual outcomes. The decision curve exhibits satisfactory clinical utility. Conclusion The radiomics model based on early lung CBCT is a potentially valuable tool for predicting RP. V5, MLD, and tumor stage have certain predictive effects for RP. The developed nomogram model has a better prediction ability than any of the other predictors and can be used as a quantitative model to predict RP.
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Affiliation(s)
- Feng Du
- Department of Radiation Oncology, School of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Radiation Oncology, Zibo Municipal Hospital, Zibo, China
| | - Ning Tang
- Department of Radiation Oncology, School of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuzhong Cui
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhenxiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Harris WB, Zou W, Cheng C, Jain V, Teo BK, Dong L, Feigenberg SJ, Berman AT, Levin WP, Cengel KA, O'Reilly SE. Higher Dose Volumes May Be Better for Evaluating Radiation Pneumonitis in Lung Proton Therapy Patients Compared With Traditional Photon-Based Dose Constraints. Adv Radiat Oncol 2020; 5:943-50. [PMID: 33083657 DOI: 10.1016/j.adro.2020.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/14/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose The dosimetric parameters used clinically to reduce the likelihood of radiation pneumonitis (RP) for lung cancer radiation therapy have traditionally been V20Gy ≤ 30% to 35% and mean lung dose ≤ 20 to 23 Gy; however, these parameters are derived based on studies from photon therapy. The purpose of this study is to evaluate whether such dosimetric predictors for RP are applicable for locally advanced non-small cell lung cancer (LA-NSCLC) patients treated with proton therapy. Methods and Materials In the study, 160 (78 photon, 82 proton) patients with LA-NSCLC treated with chemoradiotherapy between 2011 and 2016 were retrospectively identified. Forty (20 photon, 20 proton) patients exhibited grade ≥2 RP after therapy. Dose volume histograms for the uninvolved lung were extracted for each patient. The percent lung volumes receiving above various dose levels were obtained in addition to V20Gy and Dmean. These dosimetric parameters and patient characteristics were evaluated with univariate and multivariate logistic regression tests. Receiver operating characteristic curves were generated to obtain the optimal dosimetric constraints through analyzing RP and non-RP sensitivity and specificity values. Results The multivariate analysis showed V40Gy and Dmean to be statistically significant for proton and photon patients, respectively. V35Gy to V50Gy were strongly correlated to V40Gy for proton patients. Based on the receiver operating characteristic curves, V35Gy to V50Gy had the highest area under the curve compared with other dose levels for proton patients. A potential dosimetric constraint for RP predictor in proton patients is V40Gy ≤ 23%. Conclusions In addition to V20Gy and Dmean, the lung volume receiving higher doses, such as V40Gy, may be used as an additional indicator for RP in LA-NSCLC patients treated with proton therapy.
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Käsmann L, Dietrich A, Staab-Weijnitz CA, Manapov F, Behr J, Rimner A, Jeremic B, Senan S, De Ruysscher D, Lauber K, Belka C. Radiation-induced lung toxicity - cellular and molecular mechanisms of pathogenesis, management, and literature review. Radiat Oncol 2020; 15:214. [PMID: 32912295 PMCID: PMC7488099 DOI: 10.1186/s13014-020-01654-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/20/2020] [Indexed: 12/17/2022] Open
Abstract
Lung, breast, and esophageal cancer represent three common malignancies with high incidence and mortality worldwide. The management of these tumors critically relies on radiotherapy as a major part of multi-modality care, and treatment-related toxicities, such as radiation-induced pneumonitis and/or lung fibrosis, are important dose limiting factors with direct impact on patient outcomes and quality of life. In this review, we summarize the current understanding of radiation-induced pneumonitis and pulmonary fibrosis, present predictive factors as well as recent diagnostic and therapeutic advances. Novel candidates for molecularly targeted approaches to prevent and/or treat radiation-induced pneumonitis and pulmonary fibrosis are discussed.
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Affiliation(s)
- Lukas Käsmann
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- German Center for Lung Research (DZL), partner site Munich, Munich, Germany.
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany.
| | - Alexander Dietrich
- Walther Straub Institute of Pharmacology and Toxicology, Member of the German Center for Lung Research (DZL), Medical Faculty, LMU-Munich, Munich, Germany
| | - Claudia A Staab-Weijnitz
- German Center for Lung Research (DZL), partner site Munich, Munich, Germany
- Institute of Lung Biology and Disease, Helmholtz Zentrum München, Munich, Germany
| | - Farkhad Manapov
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Center for Lung Research (DZL), partner site Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - Jürgen Behr
- German Center for Lung Research (DZL), partner site Munich, Munich, Germany
- Department of Internal Medicine V, LMU Munich, Munich, Germany
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Kirsten Lauber
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Center for Lung Research (DZL), partner site Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
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von Reibnitz D, Yorke ED, Oh JH, Apte AP, Yang J, Pham H, Thor M, Wu AJ, Fleisher M, Gelb E, Deasy JO, Rimner A. Predictive Modeling of Thoracic Radiotherapy Toxicity and the Potential Role of Serum Alpha-2-Macroglobulin. Front Oncol 2020; 10:1395. [PMID: 32850450 PMCID: PMC7423838 DOI: 10.3389/fonc.2020.01395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/02/2020] [Indexed: 12/25/2022] Open
Abstract
Background: To investigate the impact of alpha-2-macroglobulin (A2M), a suspected intrinsic radioprotectant, on radiation pneumonitis and esophagitis using multifactorial predictive models. Materials and Methods: Baseline A2M levels were obtained for 258 patients prior to thoracic radiotherapy (RT). Dose-volume characteristics were extracted from treatment plans. Spearman's correlation (Rs) test was used to correlate clinical and dosimetric variables with toxicities. Toxicity prediction models were built using least absolute shrinkage and selection operator (LASSO) logistic regression on 1,000 bootstrapped datasets. Results: Grade ≥2 esophagitis and pneumonitis developed in 61 (23.6%) and 36 (14.0%) patients, respectively. The median A2M level was 191 mg/dL (range: 94-511). Never/former/current smoker status was 47 (18.2%)/179 (69.4%)/32 (12.4%). We found a significant negative univariate correlation between baseline A2M levels and esophagitis (Rs = -0.18/p = 0.003) and between A2M and smoking status (Rs = 0.13/p = 0.04). Further significant parameters for grade ≥2 esophagitis included age (Rs = -0.32/p < 0.0001), chemotherapy use (Rs = 0.56/p < 0.0001), dose per fraction (Rs = -0.57/p < 0.0001), total dose (Rs = 0.35/p < 0.0001), and several other dosimetric variables with Rs > 0.5 (p < 0.0001). The only significant non-dosimetric parameter for grade ≥2 pneumonitis was sex (Rs = -0.32/p = 0.037) with higher risk for women. For pneumonitis D15 (lung) (Rs = 0.19/p = 0.006) and D45 (heart) (Rs = 0.16/p = 0.016) had the highest correlation. LASSO models applied on the validation data were statistically significant and resulted in areas under the receiver operating characteristic curve of 0.84 (esophagitis) and 0.78 (pneumonitis). Multivariate predictive models did not require A2M to reach maximum predictive power. Conclusion: This is the first study showing a likely association of higher baseline A2M values with lower risk of radiation esophagitis and with smoking status. However, the baseline A2M level was not a significant risk factor for radiation pneumonitis.
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Affiliation(s)
- Donata von Reibnitz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ellen D Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Aditya P Apte
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jie Yang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Hai Pham
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Maria Thor
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Martin Fleisher
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Emily Gelb
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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28
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Green A, Vasquez Osorio E, Aznar MC, McWilliam A, van Herk M. Image Based Data Mining Using Per-voxel Cox Regression. Front Oncol 2020; 10:1178. [PMID: 32793486 PMCID: PMC7386130 DOI: 10.3389/fonc.2020.01178] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/10/2020] [Indexed: 11/13/2022] Open
Abstract
Image Based Data Mining (IBDM) is a novel analysis technique allowing the interrogation of large amounts of routine radiotherapy data. Using this technique, unexpected correlations have been identified between dose close to the prostate and biochemical relapse, and between dose to the base of the heart and survival in lung cancer. However, most analyses to date have considered only dose when identifying a region of interest, with confounding variables accounted for post-hoc, most often using a multivariate Cox regression. In this work, we introduce a novel method to account for confounding variables directly in the analysis, by performing a Cox regression in every voxel of the dose distribution, and apply it in the analysis of a large cohort of lung cancer patients. Our method produces three-dimensional maps of hazard for clinical variables, accounting for dose at each spatial location in the patient. Results confirm that a region of interest exists in the base of the heart where those patients with poor performance status (PS), PS > 1, have a stronger adverse reaction to incidental dose, but that the effect changes when considering other clinical variables, with patient age becoming dominant. Analyses such as this will help shape future clinical trials in which hypotheses generated by the analysis will be tested.
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Affiliation(s)
- Andrew Green
- The University of Manchester, Radiotherapy Related Research, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Eliana Vasquez Osorio
- The University of Manchester, Radiotherapy Related Research, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Marianne C. Aznar
- The University of Manchester, Radiotherapy Related Research, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Alan McWilliam
- The University of Manchester, Radiotherapy Related Research, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Marcel van Herk
- The University of Manchester, Radiotherapy Related Research, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Stervik L, Pettersson N, Scherman J, Behrens CF, Ceberg C, Engelholm S, Gunnarsson K, Hallqvist A, Nyman J, Persson GF, Pøhl M, Wahlstedt I, Vogelius IR, Bäck A. Analysis of early respiratory-related mortality after radiation therapy of non-small-cell lung cancer: feasibility of automatic data extraction for dose-response studies. Acta Oncol 2020; 59:628-635. [PMID: 32202189 DOI: 10.1080/0284186x.2020.1739331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose: To examine the feasibility of automatic data extraction from clinical radiation therapy (RT) databases at four hospitals to investigate the impact of mean lung dose (MLD) and age on the risk of early respiratory-related death and early overall death for patients treated with RT for non-small-cell lung cancer (NSCLC).Material and methods: We included adult patients with NSCLC receiving curatively intended RT between 2002 and 2017 at four hospitals. A script was developed to automatically extract RT-related data. The cause of death for patients deceased within 180 days of the start of RT was retrospectively assessed. Using logistic regression, the risks of respiratory-related death and of overall death within 90 and 180 days were investigated using MLD and age as variables.Results: Altogether, 1785 patients were included in the analysis of early overall mortality and 1655 of early respiratory-related mortality. The respiratory-related mortalities within 90 and 180 days were 0.9% (15/1655) and 3.6% (60/1655). The overall mortalities within 90 and 180 days were 2.5% (45/1785) and 10.6% (190/1785). Higher MLD and older age were associated with an increased risk of respiratory-related death within 180 days and overall death within 90 and 180 days (all p<.05). For example, the risk of respiratory-related death within 180 days and their 95% confidence interval for patients aged 65 and 75 years with MLDs of 20 Gy was according to our logistic model 3.8% (2.6-5.0%) and 7.7% (5.5-10%), respectively.Conclusions: Automatic data extraction was successfully used to pool data from four hospitals. MLD and age were associated with the risk of respiratory-related death within 180 days of the start of RT and with overall death within 90 and 180 days. A model quantifying the risk of respiratory-related death within 180 days was formulated.
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Affiliation(s)
- Louise Stervik
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Niclas Pettersson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonas Scherman
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Claus F. Behrens
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Crister Ceberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Silke Engelholm
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Kerstin Gunnarsson
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Hallqvist
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Nyman
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gitte F. Persson
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Pøhl
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Isak Wahlstedt
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ivan R. Vogelius
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna Bäck
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
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30
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Yang J, Veeraraghavan H, van Elmpt W, Dekker A, Gooding M, Sharp G. CT images with expert manual contours of thoracic cancer for benchmarking auto-segmentation accuracy. Med Phys 2020; 47:3250-3255. [PMID: 32128809 DOI: 10.1002/mp.14107] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/17/2020] [Accepted: 02/22/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Automatic segmentation offers many benefits for radiotherapy treatment planning; however, the lack of publicly available benchmark datasets limits the clinical use of automatic segmentation. In this work, we present a well-curated computed tomography (CT) dataset of high-quality manually drawn contours from patients with thoracic cancer that can be used to evaluate the accuracy of thoracic normal tissue auto-segmentation systems. ACQUISITION AND VALIDATION METHODS Computed tomography scans of 60 patients undergoing treatment simulation for thoracic radiotherapy were acquired from three institutions: MD Anderson Cancer Center, Memorial Sloan Kettering Cancer Center, and the MAASTRO clinic. Each institution provided CT scans from 20 patients, including mean intensity projection four-dimensional CT (4D CT), exhale phase (4D CT), or free-breathing CT scans depending on their clinical practice. All CT scans covered the entire thoracic region with a 50-cm field of view and slice spacing of 1, 2.5, or 3 mm. Manual contours of left/right lungs, esophagus, heart, and spinal cord were retrieved from the clinical treatment plans. These contours were checked for quality and edited if necessary to ensure adherence to RTOG 1106 contouring guidelines. DATA FORMAT AND USAGE NOTES The CT images and RTSTRUCT files are available in DICOM format. The regions of interest were named according to the nomenclature recommended by American Association of Physicists in Medicine Task Group 263 as Lung_L, Lung_R, Esophagus, Heart, and SpinalCord. This dataset is available on The Cancer Imaging Archive (funded by the National Cancer Institute) under Lung CT Segmentation Challenge 2017 (http://doi.org/10.7937/K9/TCIA.2017.3r3fvz08). POTENTIAL APPLICATIONS This dataset provides CT scans with well-delineated manually drawn contours from patients with thoracic cancer that can be used to evaluate auto-segmentation systems. Additional anatomies could be supplied in the future to enhance the existing library of contours.
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Affiliation(s)
- Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Harini Veeraraghavan
- Department of Medical Physics, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Greg Sharp
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
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31
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Zhao Q, Liu M, Wang Z, Huang W, Allen Li X, Zhou T, Zhang J, Zhang Z, Wang Q, Yu S, Han D, Sun H, Li H, Lin H, Li B. High dose radiation therapy based on normal tissue constraints with concurrent chemotherapy achieves promising survival of patients with unresectable stage III non-small cell lung cancer. Radiother Oncol 2019; 145:7-12. [PMID: 31869678 DOI: 10.1016/j.radonc.2019.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to investigate the potential of individual isotoxic dose escalation based on normal tissue constraints (NTC), hypothesizing that high dose radiation therapy would be superior to standard-dose in concurrent chemoradiotherapy for unresectable stage III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Individually prescribed radiation doses were calculated based on NTC. Patients with total tumour radiation doses ≥66 Gy were assigned to the high dose (HD, ≥66 Gy) group, and all other patients were assigned to the standard-dose (SD, <66 Gy) group. Each patient was retrospectively assigned an Eighth edition of American Joint Committee on Cancer disease stage based on the imaging data of initial diagnosis to avoid over- and under-staging. Intensity modulated radiation therapy plans were optimized to minimize the volumes of organs at risk exposed to radiation. The primary endpoint was overall survival. RESULTS From March 2006 to September 2012, 140 patients were enrolled and assigned to two groups: 71 patients into the HD group and 69 patients into the SD group. The median survival time (MST) was significantly higher in the HD group (33.5 months) than in the SD group (21 months), (p < 0.0001). Overall 5-year survival rates were significantly higher in the HD group than in the SD group (37.8% vs 16.7%). Median progression-free survival was 19 months in the HD group and 11 months in the SD group (p < 0.0001). No difference in severe (grade 3-5) toxic effects was noted between the two groups. CONCLUSIONS The significant positive association observed between prescribed dose and survival suggests that individualized isotoxic dose-escalated radiation based on NTC might improve survival in this cohort of stage III NSCLC Chinese patients.
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Affiliation(s)
- Qian Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ming Liu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China
| | - Zhongtang Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, USA
| | - Tao Zhou
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jian Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zicheng Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qiang Wang
- Department of Radiation Oncology, People's Hospital of Linzi District, Zibo, China
| | - Shuzeng Yu
- Department of Radiation Oncology, LiaoCheng People's Hospital, Liaocheng, China
| | - Dan Han
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Hongfu Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Hongsheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Haiqun Lin
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Frist Medical University and Shandong Academy of Medical Sciences, Jinan, China.
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32
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Zhou Y, Yan T, Zhou X, Cao P, Luo C, Zhou L, Xu Y, Liu Y, Xue J, Wang J, Wang Y, Lu Y, Liang B, Gong Y. Acute severe radiation pneumonitis among non-small cell lung cancer (NSCLC) patients with moderate pulmonary dysfunction receiving definitive concurrent chemoradiotherapy: Impact of pre-treatment pulmonary function parameters. Strahlenther Onkol 2019; 196:505-514. [PMID: 31828393 DOI: 10.1007/s00066-019-01552-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/14/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Severe acute radiation pneumonitis (SARP) is a life-threatening complication of thoracic radiotherapy. Pre-treatment pulmonary function (PF) may influence its incidence. We have previously reported on the incidence of SARP among patients with moderate pulmonary dysfunction who received definitive concurrent chemoradiotherapy (dCCRT) for non-small cell lung cancer (NSCLC). METHODS The clinical outcomes, dose-volume histograms (DVH), and PF parameters of 122 patients (forced expiratory volume in 1 s [FEV1%]: 60-69%) receiving dCCRT between 2013 and 2019 were recorded. SARP was defined as grade ≥3 RP occurring during or within 3 months after CCRT. Logistic regression, receiver operating characteristics curves (ROC), and hazard ratio (HR) analyses were performed to evaluate the predictive value of each factor for SARP. RESULTS Univariate and multivariate analysis indicated that the ratio of carbon monoxide diffusing capacity (DLCO%; odds ratio [OR]: 0.934, 95% confidence interval [CI] 0.896-0.974, p = 0.001) and mean lung dose (MLD; OR: 1.002, 95% CI 1.001-1.003, p = 0.002) were independent predictors of SARP. The ROC AUC of combined DLCO%/MLD was 0.775 (95% confidence interval [CI]: 0.688-0.861, p = 0.001), with a sensitivity and specificity of 0.871 and 0.637, respectively; this was superior to DLCO% (0.656) or MLD (0.667) alone. Compared to the MLD-low/DLCO%-high group, the MLD-high/DLCO%-low group had the highest risk for SARP, with an HR of 9.346 (95% CI: 2.133-40.941, p = 0.003). CONCLUSION The DLCO% and MLD may predict the risk for SARP among patients with pre-treatment moderate pulmonary dysfunction who receive dCCRT for NSCLC. Prospective studies are needed to validate our findings.
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Affiliation(s)
- Ying Zhou
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Tiansheng Yan
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Xiaojuan Zhou
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Peng Cao
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Chunli Luo
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Lin Zhou
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yong Xu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yongmei Liu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Jianxin Xue
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Jin Wang
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yongsheng Wang
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - You Lu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Binmiao Liang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Youling Gong
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China. .,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.
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Xiao L, Yang G, Chen J, Yang Y, Meng X, Wang X, Wu Q, Huo Z, Yu Q, Yu J, Kong FMS, Yuan S. Comparison of predictive powers of functional and anatomic dosimetric parameters for radiation-induced lung toxicity in locally advanced non-small cell lung cancer. Radiother Oncol 2019; 129:242-248. [PMID: 30471708 DOI: 10.1016/j.radonc.2018.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/01/2018] [Accepted: 09/10/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the predictive value of the perfusion (Q) single-photon emission computed tomography (SPECT)-weighted dose-function histogram (DFH) obtained mid-treatment (mid-Tx) with radiotherapy (RT) for radiation-induced lung toxicity (RILT) in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS The study population consisted of NSCLC patients who were undergoing RT treatment and enrolled in prospective imaging studies. Q-SPECT was performed prior to and during RT (at ∼40-45 Gy). A baseline dose-volume histogram (DVH) and mid-Tx DVH based on simulation CT as well as a baseline DFH and mid-Tx DFH based on Q-SPECT were calculated. Only patients with stage III NSCLC and visible functional lung (FL) changes on the mid-Tx scan were eligible for this enriched analysis. RILT was graded according to a reported scale. RESULTS Forty-two stage III NSCLC patients met the criteria for inclusion. The accumulative incidence of grade ≥2 RILT was 31% in this high-risk population. Significant differences in functional metrics such as functional lung volume FV5-FV20 at increments of 5 Gy and functional MLD (FMLD) were observed between patients with and without grade ≥2 RILT (p < 0.05). Similar results were also obtained for anatomical metrics from V5-V20 and MLD (p < 0.05). The areas under the receiver operating characteristic curves (AUCs) ranged from 0.724to 0.812 for baseline DVH parameters, from 0.745 to 0.830 for mid-Tx DVH parameters, from 0.764 to 0.878 for baseline DFH parameters, and from 0.767 to 0.891 for mid-Tx DFH parameters. Further principal components analysis showed that the AUCs were 0.814/0.817 and 0.790/0.857 for baseline/mid-Tx DVH and baseline/mid-Tx DFH, respectively. CONCLUSIONS Mid-Tx DFH parameters based on Q-SPECT were significantly elevated in patients with grade ≥2 RILT in this study population. Among the metrics compared, mid-Tx DFH seemed to have better predictive accuracy, but this difference did not reach statistical difference.
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Affiliation(s)
- Linlin Xiao
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China; Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guoren Yang
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Jinhu Chen
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Yuchen Yang
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Xue Meng
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Xiaohui Wang
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Qingwei Wu
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Zongwei Huo
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Qingxi Yu
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Jinming Yu
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China; Shandong Academy of Medical Sciences, Jinan, China
| | - Feng-Ming Spring Kong
- Department of Radiation Oncology, Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, USA.
| | - Shuanghu Yuan
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China; Shandong Academy of Medical Sciences, Jinan, China.
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Abstract
Radiation pneumonitis (RP) and radiation fibrosis (RF) are two dose-limiting toxicities of radiotherapy (RT), especially for lung, and esophageal cancer. It occurs in 5-20% of patients and limits the maximum dose that can be delivered, reducing tumor control probability (TCP) and may lead to dyspnea, lung fibrosis, and impaired quality of life. Both physical and biological factors determine the normal tissue complication probability (NTCP) by Radiotherapy. A better understanding of the pathophysiological sequence of radiation-induced lung injury (RILI) and the intrinsic, environmental and treatment-related factors may aid in the prevention, and better management of radiation-induced lung damage. In this review, we summarize our current understanding of the pathological and molecular consequences of lung exposure to ionizing radiation, and pharmaceutical interventions that may be beneficial in the prevention or curtailment of RILI, and therefore enable a more durable therapeutic tumor response.
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Affiliation(s)
- Lorena Giuranno
- Department of Radiotherapy, GROW School for Oncology Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jonathan Ient
- Department of Radiotherapy, GROW School for Oncology Maastricht University Medical Centre, Maastricht, Netherlands
| | - Dirk De Ruysscher
- Department of Radiotherapy, GROW School for Oncology Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marc A Vooijs
- Department of Radiotherapy, GROW School for Oncology Maastricht University Medical Centre, Maastricht, Netherlands
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Selek U, Sezen D, Bolukbasi Y. Lung Cancer. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Menoux I, Le Fèvre C, Noël G, Antoni D. [Radiation-induced lung toxicity predictors after stereotactic radiation therapy for non-small cell lung carcinoma stage I]. Cancer Radiother 2018; 22:826-838. [PMID: 30337050 DOI: 10.1016/j.canrad.2017.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/08/2017] [Accepted: 12/22/2017] [Indexed: 12/19/2022]
Abstract
In case of refusal or contraindication for surgical management of a stage I non-small cell lung carcinoma, the validated alternative therapy is stereotactic irradiation. This technique reaches an equivalent tumour control rate than surgery and significantly higher than conventional radiotherapy. One of the dreaded complications is radiation induced lung toxicity (radiation pneumonitis and lung fibrosis), especially when it is symptomatic, occurring in about 10 % of cases. This article is a literature review of this complication's predictive factors.
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Affiliation(s)
- I Menoux
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67065 Strasbourg cedex, France.
| | - C Le Fèvre
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67065 Strasbourg cedex, France
| | - G Noël
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67065 Strasbourg cedex, France; EA 3430, laboratoire de radiobiologie, université de Strasbourg, fédération de médecine translationnelle de Strasbourg (FMTS), 67065 Strasbourg, France
| | - D Antoni
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67065 Strasbourg cedex, France; EA 3430, laboratoire de radiobiologie, université de Strasbourg, fédération de médecine translationnelle de Strasbourg (FMTS), 67065 Strasbourg, France
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Tucker SL, Xu T, Paganetti H, Deist T, Verma V, Choi N, Mohan R, Liao Z. Validation of Effective Dose as a Better Predictor of Radiation Pneumonitis Risk Than Mean Lung Dose: Secondary Analysis of a Randomized Trial. Int J Radiat Oncol Biol Phys 2019; 103:403-10. [PMID: 30291994 DOI: 10.1016/j.ijrobp.2018.09.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/29/2018] [Accepted: 09/25/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To confirm the superiority of effective dose (Deff) over mean lung dose (MLD) for predicting risk of radiation pneumonitis (RP), using data from patients on a randomized trial of intensity modulated radiation therapy (IMRT) versus passively scattered proton therapy (PSPT). METHODS AND MATERIALS The prescribed target dose for the 203 evaluated patients was 66 to 74 Gy (relative biological effectiveness) in 33 to 37 fractions with concurrent carboplatin/paclitaxel. Time to grade ≥2 RP was computed from the start of radiation therapy, with disease recurrence or death considered censoring events. Generalized Lyman models of censored time to RP were constructed with MLD or Deff as the dosimetric parameter. Smoking status (current, former, never) was also analyzed. RESULTS Of the 203 patients, 46 experienced grade ≥2 RP (crude incidence 23%) at a median 3.7 months (range, 0.6-12.6 months). The volume parameter estimated for the Deff model was n = 0.5, confirming estimates from earlier studies. Compared with MLD (in which n = 1), the dosimetric parameter Deff, computed using n = 0.5, resulted in a better fit of the Lyman model to the clinical data (P = .010). Using Deff, the model describes RP risk for IMRT and PSPT data combined because no further improvement was found from separate fits (P = .558). Based on Deff, predicted RP risk per patient ranged from 24 percentage points lower to 19 percentage points higher than predictions based on MLD. For patients with similar MLD, Deff predicted higher risk, on average, for PSPT over IMRT. Current smokers had a lower risk of RP compared with former smokers and nonsmokers (P = .021). CONCLUSIONS We used data from a randomized trial to validate our previous finding that Deff with n = 0.5 (corresponding to root mean squared dose) is a better predictor of RP than is MLD. Differences between Deff and MLD indicate that delivering higher doses to smaller lung volumes (vs lower doses to larger volumes) increases RP risk. We further corroborated that current smoking is associated with decreased RP risk.
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Krafft SP, Rao A, Stingo F, Briere TM, Court LE, Liao Z, Martel MK. The utility of quantitative CT radiomics features for improved prediction of radiation pneumonitis. Med Phys 2018; 45:5317-5324. [PMID: 30133809 DOI: 10.1002/mp.13150] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/05/2018] [Accepted: 07/23/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The purpose of this study was to explore gains in predictive model performance for radiation pneumonitis (RP) using pretreatment CT radiomics features extracted from the normal lung volume. METHODS A total of 192 patients treated for nonsmall cell lung cancer with definitive radiotherapy were considered in the current study. In addition to clinical and dosimetric data, CT radiomics features were extracted from the total lung volume defined using the treatment planning scan. A total of 6851 features (15 clinical, 298 total lung and heart dosimetric, and 6538 image features) were gathered and considered candidate predictors for modeling of RP grade ≥3. Models were built with the least absolute shrinkage and selection operator (LASSO) logistic regression and applied to the set of candidate predictors with 50 iterations of tenfold nested cross-validation. RESULTS In the current cohort, 30 of 192 patients (15.6%) presented with RP grade ≥3. Average cross-validated AUC (CV-AUC) using only the clinical and dosimetric parameters was 0.51. CV-AUC was 0.68 when total lung CT radiomics features were added. Analysis with the entire set of available predictors revealed seven different image features selected in at least 40% of the model fits. CONCLUSIONS We have successfully incorporated CT radiomics features into a framework for building predictive RP models via LASSO logistic regression. Addition of normal lung image features produced superior model performance relative to traditional dosimetric and clinical predictors of RP, suggesting that pretreatment CT radiomics features should be considered in the context of RP prediction.
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Affiliation(s)
- Shane P Krafft
- Department of Radiation Physics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.,The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
| | - Arvind Rao
- Department of Bioinformatics and Computational Biology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Francesco Stingo
- Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Tina Marie Briere
- Department of Radiation Physics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Mary K Martel
- Department of Radiation Physics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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Kim YJ, Kim SS, Song SY, Choi EK. Feasibility of stereotactic radiotherapy for lung lesions and conventional radiotherapy for nodal areas in primary lung malignancies. Radiat Oncol 2018; 13:127. [PMID: 29996863 DOI: 10.1186/s13014-018-1071-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/02/2018] [Indexed: 12/25/2022] Open
Abstract
Background Combined stereotactic body radiotherapy (SBRT) for lung lesions and conventional radiotherapy (CRT) for nodal areas may be more effective than CRT alone in patients with locally advanced lung cancer. Methods This study included 21 patients with small primary lung tumors distant from the regional nodal areas. The SBRT dose was 40–60 Gy in 4 fractions. CRT doses were 66 Gy in 30 fractions for non-small cell lung cancer and 52.5 Gy in 25 fractions for small cell lung cancer. Results The median follow-up duration was 12 months, and the median survival was 13 months. The 1 year overall survival, local recurrence-free survival, and distant metastasis-free survival rates were 60.5, 84.8, and 62.1%, respectively. Two patients experienced in-field local recurrence combined with out-field regional recurrence and/or distant failure. The major recurrence pattern was distant failure (crude incidence, 43%). Three patients aged ≥79 years experienced grade ≥ 3 acute radiation pneumonitis, and one also had idiopathic interstitial pneumonia. Conclusion The combination of SBRT for the lung lesion and CRT for the nodal region seems to be effective and safe for lung malignancies. However, patients older in age and/or with underlying pulmonary disease require stricter lung dose constraints.
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Christophides D, Appelt AL, Gusnanto A, Lilley J, Sebag-Montefiore D. Method for Automatic Selection of Parameters in Normal Tissue Complication Probability Modeling. Int J Radiat Oncol Biol Phys 2018; 101:704-712. [PMID: 29681482 DOI: 10.1016/j.ijrobp.2018.02.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/08/2018] [Accepted: 02/26/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To present a fully automatic method to generate multiparameter normal tissue complication probability (NTCP) models and compare its results with those of a published model, using the same patient cohort. METHODS AND MATERIALS Data were analyzed from 345 rectal cancer patients treated with external radiation therapy to predict the risk of patients developing grade 1 or ≥2 cystitis. In total, 23 clinical factors were included in the analysis as candidate predictors of cystitis. Principal component analysis was used to decompose the bladder dose-volume histogram into 8 principal components, explaining more than 95% of the variance. The data set of clinical factors and principal components was divided into training (70%) and test (30%) data sets, with the training data set used by the algorithm to compute an NTCP model. The first step of the algorithm was to obtain a bootstrap sample, followed by multicollinearity reduction using the variance inflation factor and genetic algorithm optimization to determine an ordinal logistic regression model that minimizes the Bayesian information criterion. The process was repeated 100 times, and the model with the minimum Bayesian information criterion was recorded on each iteration. The most frequent model was selected as the final "automatically generated model" (AGM). The published model and AGM were fitted on the training data sets, and the risk of cystitis was calculated. RESULTS The 2 models had no significant differences in predictive performance, both for the training and test data sets (P value > .05) and found similar clinical and dosimetric factors as predictors. Both models exhibited good explanatory performance on the training data set (P values > .44), which was reduced on the test data sets (P values < .05). CONCLUSIONS The predictive value of the AGM is equivalent to that of the expert-derived published model. It demonstrates potential in saving time, tackling problems with a large number of parameters, and standardizing variable selection in NTCP modeling.
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Affiliation(s)
- Damianos Christophides
- Leeds Cancer Centre, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom.
| | - Ane L Appelt
- Leeds Cancer Centre, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom; Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark
| | - Arief Gusnanto
- Department of Statistics, University of Leeds, Leeds, United Kingdom
| | - John Lilley
- Leeds Cancer Centre, St. James's University Hospital, Leeds, United Kingdom
| | - David Sebag-Montefiore
- Leeds Cancer Centre, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
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Li F, Zhou Z, Wu A, Cai Y, Wu H, Chen M, Liang S. Preexisting radiological interstitial lung abnormalities are a risk factor for severe radiation pneumonitis in patients with small-cell lung cancer after thoracic radiation therapy. Radiat Oncol 2018; 13:82. [PMID: 29716649 PMCID: PMC5930768 DOI: 10.1186/s13014-018-1030-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/16/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Previous studies reported that patients with preexisting radiological interstitial lung abnormalities (ILAs) were more susceptible to developing radiation pneumonitis (RP) after thoracic radiation therapy (TRT). The present study aimed to evaluate the incidence and predictors of RP after TRT in patients with small-cell lung cancer (SCLC) with or without preexisting radiological ILAs. METHODS A total of 95 consecutive patients with SCLC between January 2015 and December 2015, who were treated with thoracic intensity-modulated radiation therapy at Shanghai Pulmonary Hospital,Tongji University School of Medicine, were analyzed. The diagnosis of ILAs was reviewed by two experienced thoracic radiologists based on the pretreatment high-resolution computed tomography imaging, such as honeycombing, subpleural reticular opacities, ground-glass opacity, and traction bronchiectasis. Univariate and multivariate analyses were used to assess the correlation of clinical factors, preexisting radiological ILAs, and dose-volume histogram-based dosimetric parameters with RP. RESULTS Fifteen (15.8%) patients had preexisting radiological ILAs. The incidence of ≥ grade 2 and 3 RP at 1 year was 27.1% and 12.7% in the entire cohort, respectively. Preexisting radiological ILAs were associated with an increased risk of ≥grade 2 RP (50.0% in ILAs + vs 23.3% in ILAs-, P = 0.017) and ≥ grade 3 RP (35.8% in ILAs + vs 8.9% in ILAs-, P = 0.005) at 1 year. Preexisting radiological ILAs and smoking history (≥40 pack-years of smoking) were significant predictors of ≥grade 3 RP in multivariate analysis (P = 0.023 and 0.012, respectively). CONCLUSIONS Preexisting radiological ILAs and smoking history (≥40 pack-years of smoking) are associated with an increased risk of ≥grade 3 RP after TRT in patients with SCLC.
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Affiliation(s)
- Fangjuan Li
- The Second Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Department of Radiation Oncology, Shanghai Pulmonary Hospital,Tongji University School of Medicine, Zhengmin Road, Yangpu District, Shanghai, 200433, People's Republic of China
| | - Ziyang Zhou
- Department of the Second Oncology, the First People's Hospital of Qinzhou, Qinzhou, People's Republic of China
| | - Ailu Wu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital,Tongji University School of Medicine, Zhengmin Road, Yangpu District, Shanghai, 200433, People's Republic of China
| | - Yong Cai
- Department of Radiation Oncology, Shanghai Pulmonary Hospital,Tongji University School of Medicine, Zhengmin Road, Yangpu District, Shanghai, 200433, People's Republic of China
| | - Hongyu Wu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital,Tongji University School of Medicine, Zhengmin Road, Yangpu District, Shanghai, 200433, People's Republic of China
| | - Ming Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, East Banshan Road, Gongshu District, Hangzhou, People's Republic of China. .,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, 310022, People's Republic of China.
| | - Shixiong Liang
- Department of Radiation Oncology, Shanghai Pulmonary Hospital,Tongji University School of Medicine, Zhengmin Road, Yangpu District, Shanghai, 200433, People's Republic of China.
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Zhang P, Yan H, Wang S, Kai J, Pi G, Peng Y, Liu X, Sun J. Post-radiotherapy maintenance treatment with fluticasone propionate and salmeterol for lung cancer patients with grade III radiation pneumonitis: A case report. Medicine (Baltimore) 2018; 97:e10681. [PMID: 29794744 PMCID: PMC6392590 DOI: 10.1097/md.0000000000010681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE This combination of fluticasone propionate (FP) and the long-acting β2-agonist salmeterol (Salm) can control the symptoms of asthma and COPD better than FP or Salm on their own and better than the combination of inhaled corticosteroids plus montelukast. FP/Salm has been shown to control symptoms of asthma and COPD better than a double dose of inhaled steroids. The patient in our report had a history of COPD, and suffered relapse of RP when given only steroids. It is possible that COPD history helps explain this patient's more difficult treatment course. Therefore, this combination may be more effective than inhaled steroids for patients with a history of COPD. PATIENT CONCERS This patient suffered adverse reactions triggered by methylprednisolone: weight gain, hyperglycaemia and sleep disturbance after more than two months of intravenous and oral prednisolone. These reactions disappeared when we switched the patients to FP/Salm maintenance therapy. DIAGNOSES The patient underwent upper right lobectomy in September 2011. Immunohistochemistry indicated low squamous cell differentiation, and he was diagnosed with stage IIB disease (T2N1M0) according to the Union for International Cancer Control (UICC) (7th edition).One month after repeat radiotherapy, the patient experienced fever (37.6°C), cough, chest distress and shortness of breath. We performed serologic tests, laboratory tests for procalcitonin and C-reactive protein, as well as sputum and blood cultures to rule out bacterial infection. Chest CT showed consolidation with air bronchogram in the hilum of the right lung and ground-glass densities in the right lower lobe and left upper lobe. These radiographic signs are typical of RP. Since the patient required oxygen, he was diagnosed with grade III RP. INTERVENTIONS After the patinet was diagnosed with grade III RP. The patient was immediately prescribed oxygen, anti-infectives for prophylaxis, treatments to facilitate expectoration and prevent asthma, and most importantly, intravenous methylprednisone at an initial dose of 60 per day. And we cut the steroid dose in half every one week when the patient's symptoms improved obviously, and the patchy shadow on the chest radiograph sharply reduced. Then we give him FP (500 mg)/Salm (50 mg) twice daily for two months. Then the dose was halved for an additional two months. OUTCOMES The patient showed no signs of tumor or RP relapse by the last follow-up in March 2018. LESSONS This maintenance therapy of FP/Salm for patient with grade III RP may help avoid relapse when steroid therapy is tapered, particularly for patients with a history of COPD. It may also reduce risk of steroid-associated adverse effects. Based on the results observed with our patient, we intend to design a prospective trial to assess the efficacy of FP/Salm when used as preventive treatment for patients at high risk of RP, and when used as maintenance treatment for patients with grade III RP.
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Affiliation(s)
| | | | - Sheng Wang
- Department of Surgical Oncology, Hubei Cancer Hospital, the Affiliated Hubei cancer Hospital of Huazhong University of Science and Technology, Wuhan, China
| | - Jindan Kai
- Department of Surgical Oncology, Hubei Cancer Hospital, the Affiliated Hubei cancer Hospital of Huazhong University of Science and Technology, Wuhan, China
| | | | - Yi Peng
- Department of Radiation Oncology
| | | | - Junwei Sun
- Department of Surgical Oncology, Hubei Cancer Hospital, the Affiliated Hubei cancer Hospital of Huazhong University of Science and Technology, Wuhan, China
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Torre-Bouscoulet L, Muñoz-Montaño WR, Martínez-Briseño D, Lozano-Ruiz FJ, Fernández-Plata R, Beck-Magaña JA, García-Sancho C, Guzmán-Barragán A, Vergara E, Blake-Cerda M, Gochicoa-Rangel L, Maldonado F, Arroyo-Hernández M, Arrieta O. Abnormal pulmonary function tests predict the development of radiation-induced pneumonitis in advanced non-small cell lung Cancer. Respir Res 2018; 19:72. [PMID: 29690880 PMCID: PMC5937833 DOI: 10.1186/s12931-018-0775-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/10/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Radiation pneumonitis (RP) is a frequent complication of concurrent chemoradiotherapy (CCRT) and is associated with severe symptoms that decrease quality of life and might result in pulmonary fibrosis or death. The aim of this study is to identify whether pulmonary function test (PFT) abnormalities may predict RP in non-small cell lung cancer (NSCLC) patients. METHODS A prospective multi-institutional study was conducted with locally advanced and oligometastatic NSCLC patients. All participants were evaluated at baseline, end of CCRT, week 6, 12, 24, and 48 post-CCRT. They completed forced spirometry with a bronchodilator, body plethysmography, impulse oscillometry, carbon monoxide diffusing capacity (DLCO), molar mass of CO2, six-minute walk test and exhaled fraction of nitric oxide (FeNO). Radiation pneumonitis was assessed with RTOG and CTCAE. The protocol was registered in www.clinicaltrials.gov (NCT01580579), registered April 19, 2012. RESULTS Fifty-two patients were enrolled; 37 completed one-year follow-up. RP ≥ Grade 2 was present in 11/37 (29%) for RTOG and 15/37 (40%) for CTCAE. Factors associated with RP were age over 60 years and hypofractionated dose. PFT abnormalities at baseline that correlated with the development of RP included lower forced expiratory volume in one second after bronchodilator (p = 0.02), DLCO (p = 0.02) and FeNO (p = 0.04). All PFT results decreased after CCRT and did not return to basal values at follow-up. CONCLUSIONS FEV1, DLCO and FeNO prior to CCRT predict the development of RP in NSCLC. This study suggests that all patients under CCRT should be assessed by PFT to identify high-risk patients for close follow-up and early treatment.
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Affiliation(s)
- L Torre-Bouscoulet
- Subdirección de Investigación Clínica, INER, Calz. de Tlalpan 4502, Tlalpan, Sección XVI, C.P. 14080, Ciudad de México, México
- Departamento de Fisiología Respiratoria INER, México city, México
| | - W R Muñoz-Montaño
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCAN), Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080, Ciudad de México, CP, Mexico
| | - D Martínez-Briseño
- Departamento de Investigación en Epidemiología y Ciencias Sociales en Salud, Instituto Nacional de Enfermedades Respiratorias (INER), México city, Mexico
| | | | - R Fernández-Plata
- Departamento de Investigación en Epidemiología y Ciencias Sociales en Salud, Instituto Nacional de Enfermedades Respiratorias (INER), México city, Mexico
| | - J A Beck-Magaña
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCAN), Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080, Ciudad de México, CP, Mexico
| | - C García-Sancho
- Departamento de Investigación en Epidemiología y Ciencias Sociales en Salud, Instituto Nacional de Enfermedades Respiratorias (INER), México city, Mexico
| | - A Guzmán-Barragán
- Departamento de Investigación en Epidemiología y Ciencias Sociales en Salud, Instituto Nacional de Enfermedades Respiratorias (INER), México city, Mexico
| | - E Vergara
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCAN), Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080, Ciudad de México, CP, Mexico
| | - M Blake-Cerda
- Departamento de Radio-Oncología, INCAN, México city, Mexico
| | - L Gochicoa-Rangel
- Subdirección de Investigación Clínica, INER, Calz. de Tlalpan 4502, Tlalpan, Sección XVI, C.P. 14080, Ciudad de México, México
- Departamento de Fisiología Respiratoria INER, México city, México
| | - F Maldonado
- Departamento de Radio-Oncología, INCAN, México city, Mexico
| | - M Arroyo-Hernández
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCAN), Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080, Ciudad de México, CP, Mexico
| | - O Arrieta
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCAN), Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080, Ciudad de México, CP, Mexico.
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Ciudad de México, México.
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Vasiljevic D, Arnold C, Neuman D, Fink K, Popovscaia M, Kvitsaridze I, Nevinny-Stickel M, Glatzer M, Lukas P, Seppi T. Occurrence of pneumonitis following radiotherapy of breast cancer - A prospective study. Strahlenther Onkol 2018; 194:520-32. [PMID: 29450591 DOI: 10.1007/s00066-017-1257-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/22/2017] [Indexed: 01/17/2023]
Abstract
AIM of this study is to determine the temporal resolution of therapy-induced pneumonitis, and to assess promoting factors in adjuvant treated patients with unilateral mammacarcinoma. PATIENTS AND METHODS A total of 100 post-surgery patients were recruited. The cohort was treated by 2 field radiotherapy (2FRT; breast and chest wall, N = 75), 3 field radiotherapy (3FRT; + supraclavicular lymphatic region, N = 8), or with 4 field radiotherapy (4FRT; + parasternal lymphatic region, N = 17). Ninety-one patients received various systemic treatments prior to irradiation. Following an initial screening visit post-RT, two additional visits after 12 and 25 weeks were conducted including radiographic examination. In addition, general anamnesis and the co-medication were recorded. The endpoint was reached as soon as a pneumonitis was developed or at maximum of six months post-treatment. RESULTS A pneumonitis incidence of 13% was determined. Of 91 patients with prior systemic therapy, 11 patients developed pneumonitis. Smoking history and chronic obstructive pulmonary disease (COPD) appeared to be positive predictors, whereas past pneumonia clearly promoted pneumonitis. Further pneumonitis-promoting predictors are represented by the applied field extensions (2 field radiotherapy [2FRT] < 3 field radiotherapy [3FRT] < 4 field radiotherapy [4FRT]) and the type of combined initial systemic therapies. As a consequence, all of the three patients in the study cohort treated with 4FRT and initial chemotherapy combined with anti-hormone and antibody protocols developed pneumonitis. A combination of the hormone antagonists tamoxifen and goserelin might enhance the risk for pneumonitis. Remarkably, none of the 11 patients co-medicated with statins suffered from pneumonitis. CONCLUSIONS The rapidly increasing use of novel systemic therapy schedules combined with radiotherapy (RT) needs more prospective studies with larger cohorts. Our results indicate that contribution to pneumonitis occurrence of various (neo)adjuvant therapy approaches followed by RT is of minor relevance, whereas mean total lung doses of >10 Gy escalate the risk of lung tissue complications. The validity of potential inhibitors of therapy-induced pneumonitis as observed for statin co-medication should further be investigated in future trials.
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Jiang C, Han S, Chen W, Ying X, Wu H, Zhu Y, Shi G, Sun X, Xu Y. A retrospective study of shrinking field radiation therapy during chemoradiotherapy in stage III non-small cell lung cancer. Oncotarget 2018; 9:12443-12451. [PMID: 29552324 PMCID: PMC5844760 DOI: 10.18632/oncotarget.23849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 10/26/2017] [Indexed: 12/25/2022] Open
Abstract
Background and purpose: This retrospective study aimed to investigate the feasibility of shrinking field radiotherapy during chemoradiotherapy in non-small cell lung cancer (NSCLC). Patients and methods Ninety-seven patients with stage III NSCLC who achieved a good response to chemoradiation were analyzed. Computed tomography was performed after 40-50 Gy dose radiation to evaluate curative effect. Patients in the shrinking field group underwent resimulation CT scans and shrinking field radiotherapy. Acute symptomatic irradiation-induced pneumonia (ASIP), progression patterns and survival were assessed. Results Of the 97 patients who achieved response after a median total dose of 60 Gy, fifty patients received shrinking field radiotherapy. The incidence of acute symptomatic irradiation-induced pneumonia tended to be lower for the shrinking field group (18.0% vs. 23.4%, P = 0.51). The rate of disease progression was significantly higher in the non-shrinking than shrinking field group (95.7% vs. 66.0%, P < 0.001). Compared to the non-shrinking field group, the shrinking field group had similar overall survival (30.0 vs. 30.0 months, P = 0.58) but significantly better median progression-free survival (14.0 vs. 11.0 months, P = 0.006). Conclusions Shrinking field radiotherapy during chemoradiotherapy in stage III non-small cell lung cancer seems safe with acceptable toxicities and relapse, and potentially spares normal tissues and enables dose escalation. Prospective trials are warranted.
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Affiliation(s)
- Chenxue Jiang
- First Clinical Medical School, Wenzhou Medical University, Wenzhou, PR China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, PR China
| | - Shuiyun Han
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, PR China
| | - Wucheng Chen
- First Clinical Medical School, Wenzhou Medical University, Wenzhou, PR China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, PR China
| | - Xiaozhen Ying
- First Clinical Medical School, Wenzhou Medical University, Wenzhou, PR China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, PR China
| | - He Wu
- First Clinical Medical School, Wenzhou Medical University, Wenzhou, PR China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, PR China
| | - Yaoyao Zhu
- First Clinical Medical School, Wenzhou Medical University, Wenzhou, PR China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, PR China
| | - Guodong Shi
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, PR China
| | - Xiaojiang Sun
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, PR China
| | - Yaping Xu
- First Clinical Medical School, Wenzhou Medical University, Wenzhou, PR China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, PR China
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Liao Z, Lee JJ, Komaki R, Gomez DR, O'Reilly MS, Fossella FV, Blumenschein GR, Heymach JV, Vaporciyan AA, Swisher SG, Allen PK, Choi NC, DeLaney TF, Hahn SM, Cox JD, Lu CS, Mohan R. Bayesian Adaptive Randomization Trial of Passive Scattering Proton Therapy and Intensity-Modulated Photon Radiotherapy for Locally Advanced Non-Small-Cell Lung Cancer. J Clin Oncol 2018; 36:1813-1822. [PMID: 29293386 DOI: 10.1200/jco.2017.74.0720] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose This randomized trial compared outcomes of passive scattering proton therapy (PSPT) versus intensity-modulated (photon) radiotherapy (IMRT), both with concurrent chemotherapy, for inoperable non-small-cell lung cancer (NSCLC). We hypothesized that PSPT exposes less lung tissue to radiation than IMRT and thereby reduces toxicity without compromising tumor control. The primary end points were grade ≥ 3 radiation pneumonitis (RP) and local failure (LF). Patients and Methods Eligible patients had stage IIB to IIIB NSCLC (or stage IV NSCLC with a single brain metastasis or recurrent lung or mediastinal disease after surgery) who were candidates for concurrent chemoradiation therapy. Pairs of treatment plans for IMRT and PSPT were created for each patient. Patients were eligible for random assignment only if both plans satisfied the same prespecified dose-volume constraints for at-risk organs at the same tumor dose. Results Compared with IMRT (n = 92), PSPT (n = 57) exposed less lung tissue to doses of 5 to 10 Gy(RBE), which is the absorbed Gy dose multiplied by the relative biologic effectiveness (RBE) factor for protons; exposed more lung tissue to ≥ 20 Gy(RBE), but exposed less heart tissue at all dose levels between 5 and 80 Gy(RBE). The grade ≥ 3 RP rate for all patients was 8.1% (IMRT, 6.5%; PSPT, 10.5%); corresponding LF rates were 10.7% (all), 10.9% (IMRT), and 10.5% (PSPT). The posterior probability of IMRT being better than PSPT was 0.54. Exploratory analysis showed that the RP and LF rates at 12 months for patients enrolled before versus after the trial midpoint were 21.1% (before) versus 18.2% (after) for the IMRT group (P = .047) and 31.0% (before) versus 13.1% (after) for the PSPT group (P = .027). Conclusion PSPT did not improve dose-volume indices for lung but did for heart. No benefit was noted in RP or LF after PSPT. Improvements in both end points were observed over the course of the trial.
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Affiliation(s)
- Zhongxing Liao
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - J Jack Lee
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ritsuko Komaki
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Daniel R Gomez
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Michael S O'Reilly
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Frank V Fossella
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - George R Blumenschein
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - John V Heymach
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ara A Vaporciyan
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Stephen G Swisher
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Pamela K Allen
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Noah Chan Choi
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Thomas F DeLaney
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Stephen M Hahn
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - James D Cox
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Charles S Lu
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Radhe Mohan
- Zhongxing Liao, J. Jack Lee, Ritsuko Komaki, Daniel R. Gomez, Michael S. O'Reilly, Frank V. Fossella, George R. Blumenschein Jr, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Pamela K. Allen, Stephen M. Hahn, James D. Cox, Charles S. Lu, and Radhe Mohan, The University of Texas MD Anderson Cancer Center, Houston, TX; and Noah Chan Choi and Thomas F. DeLaney, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Ding X, Man X, Sun M, Xing J, Fan T, Gao M, Yan H, Li B. Which is the optimal threshold for defining functional lung in single-photon emission computed tomography lung perfusion imaging of lung cancer patients? Nucl Med Commun 2018; 39:103-9. [PMID: 29257008 DOI: 10.1097/MNM.0000000000000774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to investigate the optimal threshold for the functional lung (FL) definition of single-photon emission computed tomography (SPECT) lung perfusion imaging. PATIENTS AND METHODS Forty consecutive stage III non-small-cell lung cancer patients underwent SPECT lung perfusion scans and PET/CT scans for treatment planning, and the images were coregistered. Total lung and perfusion lung volumes corresponding to 10, 20, …, 60% of the maximum SPECT count were segmented automatically. The SPECT-weighted mean lung dose (SWMDx%) and the percentage of FL volume receiving more than 20 Gy (Fx%V20) of different thresholds were investigated using SPECT-weighted dose-volume histograms. Receiver-operator characteristic curves were used to identify SWMD and FV20 of different thresholds in predicting the incidence of radiation pneumonitis (RP). RESULTS Eleven (27.5%) patients developed RP (grades 1, 2, 3, and 4 were 10.0, 7.5, 7.5, and 2.5%, respectively) after treatment. The largest area under the receiver-operator characteristic curve was 0.881 for the ability of SWMD to predict RP with 20% as the threshold and 0.928 for the ability of FV20 with 20% as the threshold. CONCLUSION The SWMD20% and FV20 of FL using 20% of the maximum SPECT count as the threshold may be better predictors for the risk of RP.
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Zhou R, Xu T, Nguyen QN, Liu Y, Yang J, Komaki R, Gomez DR, Liao Z. Radiation Dose, Local Disease Progression, and Overall Survival in Patients With Inoperable Non-Small Cell Lung Cancer After Concurrent Chemoradiation Therapy. Int J Radiat Oncol Biol Phys 2017; 100:452-461. [PMID: 29174428 DOI: 10.1016/j.ijrobp.2017.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 09/20/2017] [Accepted: 10/02/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To identify predictors of local control and overall survival (OS) for patients with inoperable non-small cell lung cancer treated with concurrent chemoradiation therapy. METHODS AND MATERIALS We identified 491 patients with newly diagnosed stage IIIA-IIIB non-small cell lung cancer who had received 60 to 74 Gy (with concurrent chemotherapy) from January 2005 through December 2013 and grouped them by radiation dose received: 60 to 63 Gy, 64 to 66 Gy, 67 to 70 Gy, or 71 to 74 Gy. Local progression (LP) was that appearing within the high-dose volume (planning target volume plus 1-cm margin). Times to events were calculated from the completion of radiation therapy. Potential predictors of LP and OS were analyzed with a Cox regression model. RESULTS Rates of LP for all patients were 16.2% at 1 year, 26.2% at 2 years, 31.0% at 3 years, 32.9% at 4 years, and 32.9% at 5 years; corresponding OS rates were 85.3%, 61.2%, 44.5%, 37.0%, and 31.6%. Median OS time was 21 months (range, 2.9-99.9 months). In multivariate analysis, receipt of 67 to 70 Gy was associated with improved LP-free survival (LPFS) relative to 60 to 63 Gy (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.062-3.150, P=.030) or 64 to 66 Gy (HR 2.14, 95% CI 1.159-3.969, P=.015). Non-squamous histology (HR 0.23, 95% CI 0.114-0.478, P=.000), gross tumor volume (HR 1.00, 95% CI 1.000-1.003, P=.018) and induction chemotherapy (HR 1.86, 95% CI 1.239-2.778, P=.003) were independent predictors of LPFS. Local progression-free survival was the only independent predictor of OS (HR 2.71, 95% CI 1.331-5.512, P=.006). Incidence of grade ≥3 radiation pneumonitis was no different among dose groups (P=.307). CONCLUSIONS Squamous histology, large tumor volumes, and receipt of induction chemotherapy all predicted worse LPFS. Doses of 67 to 70 Gy were associated with improved LP-free survival after chemoradiotherapy. The link between LP and reduced OS suggests that more effective local control strategies are warranted.
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Affiliation(s)
- RongRong Zhou
- Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ting Xu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ying Liu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Ju Yang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; The Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University and Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel R Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Blais E, Pichon B, Mampuya A, Antoine M, Lagarde P, Kantor G, Breton-Callu C, Lefebvre C, Gerard M, Aamarcha A, Ozsahin M, Bourhis J, Maingon P, Troussier I, Pourel N. Doses aux organes à risque en radiothérapie conformationnelle et en radiothérapie stéréotaxique : les poumons. Cancer Radiother 2017; 21:584-596. [DOI: 10.1016/j.canrad.2017.07.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/21/2017] [Accepted: 07/23/2017] [Indexed: 12/25/2022]
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Diwanji TP, Mohindra P, Vyfhuis M, Snider JW, Kalavagunta C, Mossahebi S, Yu J, Feigenberg S, Badiyan SN. Advances in radiotherapy techniques and delivery for non-small cell lung cancer: benefits of intensity-modulated radiation therapy, proton therapy, and stereotactic body radiation therapy. Transl Lung Cancer Res 2017; 6:131-147. [PMID: 28529896 DOI: 10.21037/tlcr.2017.04.04] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The 21st century has seen several paradigm shifts in the treatment of non-small cell lung cancer (NSCLC) in early-stage inoperable disease, definitive locally advanced disease, and the postoperative setting. A key driver in improvement of local disease control has been the significant evolution of radiation therapy techniques in the last three decades, allowing for delivery of definitive radiation doses while limiting exposure of normal tissues. For patients with locally-advanced NSCLC, the advent of volumetric imaging techniques has allowed a shift from 2-dimensional approaches to 3-dimensional conformal radiation therapy (3DCRT). The next generation of 3DCRT, intensity-modulated radiation therapy and volumetric-modulated arc therapy (VMAT), have enabled even more conformal radiation delivery. Clinical evidence has shown that this can improve the quality of life for patients undergoing definitive management of lung cancer. In the early-stage setting, conventional fractionation led to poor outcomes. Evaluation of altered dose fractionation with the previously noted technology advances led to advent of stereotactic body radiation therapy (SBRT). This technique has dramatically improved local control and expanded treatment options for inoperable, early-stage patients. The recent development of proton therapy has opened new avenues for improving conformity and the therapeutic ratio. Evolution of newer proton therapy techniques, such as pencil-beam scanning (PBS), could improve tolerability and possibly allow reexamination of dose escalation. These new progresses, along with significant advances in systemic therapies, have improved survival for lung cancer patients across the spectrum of non-metastatic disease. They have also brought to light new challenges and avenues for further research and improvement.
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Affiliation(s)
- Tejan P Diwanji
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA
| | - Pranshu Mohindra
- University of Maryland School of Medicine, Baltimore, Maryland, 21201, USA
| | - Melissa Vyfhuis
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA
| | - James W Snider
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA
| | - Chaitanya Kalavagunta
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA
| | - Sina Mossahebi
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA
| | - Jen Yu
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA
| | - Steven Feigenberg
- University of Maryland School of Medicine, Baltimore, Maryland, 21201, USA
| | - Shahed N Badiyan
- University of Maryland School of Medicine, Baltimore, Maryland, 21201, USA
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