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Predictive factors for radiation-induced pulmonary toxicity after three-dimensional conformal chemoradiation in locally advanced non-small-cell lung cancer

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Abstract

Background and Purpose

Radiation pneumonitis (RP) is a restricting complication of non-small-cell lung cancer irradiation. Three-dimensional conformal radiotherapy (3D-CRT) represents an advance because exposure of normal tissues is minimised. This study tries to identify prognostic factors associated with severe RP.

Materials and Methods

Eighty patients with stage IIIA (20%) and IIIB (80%) NSCLC treated with cisplatin-based induction chemotherapy followed by concurrent chemotherapy and hyperfractionated 3D-CRT (median dose: 72.4 Gy, range: 54.1–85.9) were retrospectively evaluated. Acute and late RP were scored using RTOG glossary. Potential predictive factors evaluated included clinical, therapeutic and dosimetric factors. The lungs were defined as a whole organ. Univariate and multivariate analyses were performed.

Results

Early and late RP grade ≥3 were observed in two patients (2%) and 10 patients (12%), respectively. Five patients (6%) died of pulmonary toxicity, 3 of whom had pre-existing chronic obstructive pulmonary disease (COPD). Median time to occurrence of late RP was 4.5 months (range: 3–8). Multivariate analysis showed that COPD (OR=10.1, p=0.01) and NTCPkwa >30% (OR=10.5, p=0.007) were independently associated with late grade ≥3 RP. Incidence of RP ≥3 grade for patients with COPD and/or NTCPkwa >30% was 25% vs. 4% for patients without COPD and NTCPkwa <30% (p=0.01). Risk of severe RP was higher for patients with COPD and/or NTCPkwa >30% (OR=7.3; CI 95% = 1.4−37.3, p=0.016).

Conclusions

COPD and NTCP are predictive of severe RP. Careful medical evaluation and meticulous treatment planning are of paramount importance to decrease the incidence of severe RP.

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Authors and Affiliations

  1. Department of Radiation Oncology, Clínica Universitaria University of Navarra, Pio XII, 36, ES-31008, Pamplona, Navarra, Spain

    M. Moreno, J. Aristu, L. I. Ramos, L. Arbea, J. M. López-Picazo, M. Cambeiro & R. Martínez-Monge

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  1. M. Moreno
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  2. J. Aristu
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  3. L. I. Ramos
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Correspondence to M. Moreno.

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Moreno, M., Aristu, J., Ramos, L.I. et al. Predictive factors for radiation-induced pulmonary toxicity after three-dimensional conformal chemoradiation in locally advanced non-small-cell lung cancer. Clin Transl Oncol 9, 596–602 (2007). https://doi.org/10.1007/s12094-007-0109-1

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