Interstitial Lung Change in Pre-radiation Therapy Computed Tomography Is a Risk Factor for Severe Radiation Pneumonitis.
- Author:
Yun Hee LEE
1
;
Yeon Sil KIM
;
Sang Nam LEE
;
Hyo Chun LEE
;
Se Jin OH
;
Seoung Joon KIM
;
Young Kyoon KIM
;
Dae Hee HAN
;
Ie Ryung YOO
;
Jin Hyung KANG
;
Suk Hee HONG
Author Information
- Publication Type:Original Article
- Keywords: Radiation pneumonitis; Interstitial lung diseases; Lung neoplasms; Radiotherapy
- MeSH: Chemoradiotherapy; Follow-Up Studies; Humans; Incidence; Lung Diseases, Interstitial; Lung Neoplasms; Lung*; Medical Records; Radiation Pneumonitis*; Radiotherapy; Risk Factors*; Tomography, X-Ray Computed
- From:Cancer Research and Treatment 2015;47(4):676-686
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: We examined clinical and dosimetric factors as predictors of symptomatic radiation pneumonitis (RP) in lung cancer patients and evaluated the relationship between interstitial lung changes in the pre-radiotherapy (RT) computed tomography (CT) and symptomatic RP. MATERIALS AND METHODS: Medical records and dose volume histogram data of 60 lung cancer patients from August 2005 to July 2006 were analyzed. All patients were treated with three dimensional (3D) conformal RT of median 56.9 Gy. We assessed the association of symptomatic RP with clinical and dosimetric factors. RESULTS: With a median follow-up of 15.5 months (range, 6.1 to 40.9 months), Radiation Therapy Oncology Group grade > or = 2 RP was observed in 14 patients (23.3%). Five patients (8.3%) died from RP. The interstitial changes in the pre-RT chest CT, mean lung dose (MLD), and V30 significantly predicted RP in multivariable analysis (p=0.009, p < 0.001, and p < 0.001, respectively). MLD, V20, V30, and normal tissue complication probability normal tissue complication probability (NTCP) were associated with the RP grade but less so for grade 5 RP. The risk of RP grade > or = 2, > or = 3, or > or = 4 was higher in the patients with interstitial lung change (grade 2, 15.6% to 46.7%, p=0.03; grade 3, 4.4% to 40%, p=0.002; grade 4, 4.4% to 33.3%, p=0.008). Four of the grade 5 RP patients had diffuse interstitial change in pre-RT CT and received chemoradiotherapy. CONCLUSION: Our study identified diffuse interstitial disease as a significant clinical risk for RP, particularly fatal RP. We showed the usefulness of MLD, V20, V30, and NTCP in predicting the incidence and severity of RP.
