Factors affecting post-treatment radiation-induced lung disease in patients receiving stereotactic body radiotherapy to lung

Abstract

The aim of the study is to investigate factors that may cause radiation-induced lung disease (RILD) in patients undergoing stereotactic body radiotherapy (SBRT) for lung tumors. Medical records of patients treated between May 2018 and June 2019 with SBRT were retrospectively evaluated. All patients should have a diagnosis of either primary non-small cell lung cancer (NSCLC) or less than three metastases to lung from another primary. The median treatment dose was 50 Gy in 4–5 fractions. Tumor response and RILD were evaluated in thoracic computer tomography (CT) using RECIST criteria. 82 patients with 97 lung lesions were treated. The median age was 68 years (IQR = 62–76). With a median follow-up of 7.2 months (3–18 months), three patients had grade 3 radiation pneumonitis (RP). RILD was observed in 52% of cases. Patients who had RILD had a higher risk of symptomatic RP (p = 0.007). In multivariate analyses older age, previous lung radiotherapy history, and median planning treatment volume (PTV) D95 value of ≥ 48 Gy were associated with RILD. Local recurrence (LR) was observed in 5.1% of cases. There was no difference in overall survival and LR with the presence of RILD. Older age, previous lung radiotherapy history, and median PTV D95 value of ≥ 48 Gy seems to be associated with post-SBRT RILD.

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References

  1. Aoki T, Nagata Y, Negoro Y, Takayama K, Mizowaki T, Kokubo M, Oya N, Mitsumori M, Hiraoka M (2004) Evaluation of lung injury after three-dimensional conformal stereotactic radiation therapy for solitary lung tumors: CT appearance. Radiology 230(1):101–108. https://doi.org/10.1148/radiol.2301021226

    Article  Google Scholar 

  2. Aoki S, Yamashita H, Haga A, Nawa K, Imae T, Takahashi W, Abe O, Nakagawa K (2018) Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: a clinical comparison with the flattening filter technique. Oncol Lett 15(3):3928–3936. https://doi.org/10.3892/ol.2018.7809

    Article  Google Scholar 

  3. Bradley J (2007) Radiographic response and clinical toxicity following SBRT for stage I lung cancer. J Thorac Oncol 2(7 Suppl 3):S118-124. https://doi.org/10.1097/JTO.0b013e318074e50c

    Article  Google Scholar 

  4. Cashmore J (2008) The characterization of unflattened photon beams from a 6 MV linear accelerator. Phys Med Biol 53(7):1933–1946. https://doi.org/10.1088/0031-9155/53/7/009

    Article  Google Scholar 

  5. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45(2):228–247. https://doi.org/10.1016/j.ejca.2008.10.026

    Article  Google Scholar 

  6. Giuranno L, Ient J, De Ruysscher D, Vooijs MA (2019) Radiation-induced lung injury (RILI). Front Oncol 9:877–877. https://doi.org/10.3389/fonc.2019.00877

    Article  Google Scholar 

  7. Hanania AN, Mainwaring W, Ghebre YT, Hanania NA, Ludwig M (2019) Radiation-induced lung injury: assessment and management. Chest 156(1):150–162. https://doi.org/10.1016/j.chest.2019.03.033

    Article  Google Scholar 

  8. Hurmuz P, Cengiz M, Ozyigit G, Akkas EA, Yuce D, Yilmaz MT, Yildiz D, Zorlu F, Akyol F (2020) Stereotactic body radiotherapy in patients with early-stage non-small cell lung cancer: does beam-on time matter? Jpn J Clin Oncol 50(10):1182–1187. https://doi.org/10.1093/jjco/hyaa093

    Article  Google Scholar 

  9. Linda A, Trovo M, Bradley JD (2011) Radiation injury of the lung after stereotactic body radiation therapy (SBRT) for lung cancer: a timeline and pattern of CT changes. Eur J Radiol 79(1):147–154. https://doi.org/10.1016/j.ejrad.2009.10.029

    ADS  Article  Google Scholar 

  10. Liu H, Zhang X, Vinogradskiy YY, Swisher SG, Komaki R, Chang JY (2012) Predicting radiation pneumonitis after stereotactic ablative radiation therapy in patients previously treated with conventional thoracic radiation therapy. Int J Radiat Oncol Biol Phys 84(4):1017–1023. https://doi.org/10.1016/j.ijrobp.2012.02.020

    Article  Google Scholar 

  11. Matsuo Y, Nagata Y, Mizowaki T, Takayama K, Sakamoto T, Sakamoto M, Norihisa Y, Hiraoka M (2007) Evaluation of mass-like consolidation after stereotactic body radiation therapy for lung tumors. Int J Clin Oncol 12(5):356–362. https://doi.org/10.1007/s10147-007-0691-9

    Article  Google Scholar 

  12. Mickey RM, Greenland S (1989) The impact of confounder selection criteria on effect estimation. Am J Epidemiol 129(1):125–137. https://doi.org/10.1093/oxfordjournals.aje.a115101

    Article  Google Scholar 

  13. Navarria P, Ascolese AM, Mancosu P, Alongi F, Clerici E, Tozzi A, Iftode C, Reggiori G, Tomatis S, Infante M, Alloisio M, Testori A, Fogliata A, Cozzi L, Morenghi E, Scorsetti M (2013) Volumetric modulated arc therapy with flattening filter free (FFF) beams for stereotactic body radiation therapy (SBRT) in patients with medically inoperable early stage non small cell lung cancer (NSCLC). Radiother Oncol 107(3):414–418. https://doi.org/10.1016/j.radonc.2013.04.016

    Article  Google Scholar 

  14. Pastis NJ Jr, Greer TJ, Tanner NT, Wahlquist AE, Gordon LL, Sharma AK, Koch NC, Silvestri GA (2014) Assessing the usefulness of 18F-fluorodeoxyglucose PET-CT scan after stereotactic body radiotherapy for early-stage non-small cell lung cancer. Chest 146(2):406–411. https://doi.org/10.1378/chest.13-2281

    Article  Google Scholar 

  15. Prayer F, Röhrich S, Pan J, Hofmanninger J, Langs G, Prosch H (2020) Artificial intelligence in lung imaging. Radiologe 60(1):42–47. https://doi.org/10.1007/s00117-019-00611-2

    Article  Google Scholar 

  16. Prendergast BM, Fiveash JB, Popple RA, Clark GM, Thomas EM, Minnich DJ, Jacob R, Spencer SA, Bonner JA, Dobelbower MC (2013) Flattening filter-free linac improves treatment delivery efficiency in stereotactic body radiation therapy. J Appl Clin Med Phys 14(3):4126. https://doi.org/10.1120/jacmp.v14i3.4126

    Article  Google Scholar 

  17. Takeda A, Kunieda E, Fujii H, Yokosuka N, Aoki Y, Oooka Y, Oku Y, Ohashi T, Sanuki N, Mizuno T, Ozawa Y (2013) Evaluation for local failure by 18F-FDG PET/CT in comparison with CT findings after stereotactic body radiotherapy (SBRT) for localized non-small-cell lung cancer. Lung Cancer 79(3):248–253. https://doi.org/10.1016/j.lungcan.2012.11.008

    Article  Google Scholar 

  18. Vassiliev ON, Titt U, Pönisch F, Kry SF, Mohan R, Gillin MT (2006) Dosimetric properties of photon beams from a flattening filter free clinical accelerator. Phys Med Biol 51(7):1907–1917. https://doi.org/10.1088/0031-9155/51/7/019

    Article  Google Scholar 

  19. Zhu X, Li X, Gu H, Yu W, Fu X (2019) Radiation-induced lung injury patterns and the misdiagnosis after SBRT of lung cancer. Eur J Radiol 121:108708. https://doi.org/10.1016/j.ejrad.2019.108708

    Article  Google Scholar 

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Correspondence to Pervin Hurmuz.

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Hurmuz, P., Cengiz, M., Esen, C.S.B. et al. Factors affecting post-treatment radiation-induced lung disease in patients receiving stereotactic body radiotherapy to lung. Radiat Environ Biophys (2020). https://doi.org/10.1007/s00411-020-00878-3

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Keywords

  • SBRT
  • SABR
  • Lung
  • Radiation-induced lung disease
  • Radiotherapy