|Table of Contents|

A preliminary study of the correlation between parameters of pulmonary function and lung dosimetry and the occurrence of radiation pneumonitis

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2024 20
Page:
3965-3971
Research Field:
Publishing date:

Info

Title:
A preliminary study of the correlation between parameters of pulmonary function and lung dosimetry and the occurrence of radiation pneumonitis
Author(s):
WANG Ru; BAI Han; LI Qianyan; KONG Yinwu; LEI Linping; YU Jinhui; ZOU Yulin; CHANG Li
Department of Radiation Oncology,the Third Affiliated Hospital of Kunming Medical University,Yunnan Tumor Hospital,Yunnan Kunming 650118,China.
Keywords:
pulmonary function; dosimetric parameters; radiation pneumonitis; correlation
PACS:
R730.231
DOI:
10.3969/j.issn.1672-4992.2024.20.027
Abstract:
Objective:To investigate the correlation between pre-radiotherapy parameters of pulmonary function and lung dosimetry and the occurrence of radiation pneumonitis (RP).Methods:The data of 85 patients with lung cancer who underwent volumetric modulated arc therapy at our hospital from 2020 to 2023 and who had undergone pulmonary function tests within six months prior to radiotherapy were retrospectively analyzed,with the clinically observed endpoint of RP.The relationship between patients' clinical data,pulmonary function parameters,and lung dosimetry parameters and the occurrence of RP was analyzed using univariate and multivariate analysis methods.Results:In the group of 85 patients,39 developed grade ≥2 RP,with an incidence rate of 45.8%.Univariate analysis showed that smoking status and pre-radiotherapy lung disease were significantly correlated with the occurrence of grade ≥2 RP (P＜0.05).The lung function of patients before radiotherapy was not significantly correlated with the occurrence of grade ≥2 RP (P＞0.05).The V20 (WLV20),V30 (WLV30),V40 (WLV40),and the mean lung dose (MLD) in whole lung,V5 (ILV5) and V20 (ILV20) in the ipsilateral lung,V20 (CLV20) in the contralateral lung,and tumor PTV size were all significantly correlated with the occurrence of grade ≥2 RP (P＜0.05).Multivariate analysis showed that pre-radiotherapy lung disease,MLD,and ILV5 were independent risk factors for the occurrence of grade≥2 RP (P＜0.05).Conclusion:Pre-radiotherapy lung function is not an important predictor of the occurrence of RP in patients.Lung disease,MLD in whole lung,and ILV5 are independent risk factors for preventing the occurrence of grade 2 or higher RP in lung cancer patients treated with volumetric modulated arc therapy.

References:

［1］ 汪盛,王彩莲.放射性肺炎临床相关预测因素的研究进展［J］.中华放射肿瘤学杂志,2021,30(03):305-310. WANG S,WANG CL.Research progress on clinically relevant predictors of radiation pneumonitis［J］.Chinese Journal of Radiation Oncology,2021,30(03):305-310.
［2］许亚萍,刘辉,赵兰，等.放射相关性肺炎中国专家诊治共识［J］.中华肿瘤防治杂志,2022,29(14):1015-1022. XU YP,LIU H,ZHAO L,et al.Chinese expert consensus on the diagnosis and treatment of radiation-associated pneumonia［J］.Chinese Journal of Cancer Prevention and Treat,2022,29(14):1015-1022.
［3］ ARROYO-HERNANDEZ M,MALDONADO F,LOZANO-RUIZ F,et al.Radiation-induced lung injury:current evidence［J］.BMC Pulm Med,2021,21(1):1-12.
［4］ TORRE-BOUSCOUIETT L,ARROYO-HERNANDEZ M,MARTINEZ-BRISENO D,et al.Longitudinal evaluation of lung function in patients with advanced non-small cell lung cancer treated with concurrent chemoradiation therapy［J］.Int J Radiat Oncol,2018,101(4):910-918.
［5］ WANG J,CAO J,YUAN S,et al.Poor baseline pulmonary function may not increase the risk of radiation-induced lung toxicity［J］.Int J Radiat Oncol Biol Phys,2013,85(3):798-804.
［6］ LEE TH,KANG BH,KIM HJ,et al.Predictors of post-chemoradiotherapy pulmonary complication in locally advanced non-small cell lung cancer［J］.Cancer Res Treat,2023,55(3):865-874.
［7］ SCHRODER C,ENGENHART CABILLIC R,VORWERK H,et al.Changes in pulmonary function and influencing factors after high-dose intrathoracic radio(chemo)therapy［J］.Strahlenther Onkol,2016,193(2):125-131.
［8］ ASO S,NAVARRO MARTIN A,CASTILLO R,et al.Severity of radiation pneumonitis,from clinical,dosimetric and biological features:a pilot study［J］.Radiat Oncol,2020,15(1):1-10.
［9］ MORGAN-FLETCHER SL.Prescribing,recording and reporting photon beam therapy (supplement to ICRU report 50),ICRU report 62［J］.Brit J Radiol,2001,74(879):294.
［10］ HODAPP N.The ICRU report 83:prescribing,recording and reporting photon-beam intensity-modulated radiation therapy (IMRT)［J］.Strahlenther Onkol,2012,188(1):97-99.
［11］ ETTINGER DS,WOOD DE,AGGARWAL C,et al.NCCN guidelines insights:non-small cell lung cancer,version 1.2020［J］.Natl Compr Canc Netw,2019,17(12):1464-1472.
［12］ BENSENANE R,HELFRE S,CAO K,et al.Optimizing lung cancer radiation therapy:A systematic review of multifactorial risk assessment for radiation-induced lung toxicity［J］.Cancer Treat Rev,2024,124:102684.
［13］ 高玉华,杨育梁,唐楠,等.深部热疗对放射性肺炎预防作用的临床研究［J］.现代肿瘤医学，2018,26(01):46-48. GAO Yuhua,YANG Yuliang,TANG Nan,et al.Clinical research of deep heat therapy in the prevention of radioactive pneumonia［J］.Modern Oncology,2018,26(01):46-48.
［14］ 乔红梅,郑安婕,宁鹏,等.放射性肺炎相关细胞因子预测因素的研究进展［J］.现代肿瘤医学， 2020,28(15):2730-2734. QIAO Hongmei,ZHENG Anjie,NING Peng,et al.Advances in predicting factors of cytokines related to radiation pneumonitis［J］.Modern Oncology,2020,28(15):2730-2734.
［15］ 张燕燕,欧阳举.肺癌放疗后放射性肺炎相关预测因素研究进展［J］.现代肿瘤医学，2017,25(07):1167-1170. ZHANG Yanyan,OUYANG Ju.Advancement in the studies on dose-related predictive parameters of radiation pneumonitis after radiotherapy for lung cancer patients［J］.Modern Oncology,2017,25(07):1167-1170.
［16］ YOM SS,LIAO Z,LIU HH,et al.Initial evaluation of treatment-related pneumonitis in advanced-stage non-small-cell lung cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy［J］.Int J Radiat Oncol Biol Phys,2007,68(1):94-102.
［17］ HU J,HAN G,LEI Y,et al.Dosimetric comparison of three radiotherapy techniques in irradiation of left-sided breast cancer patients after radical mastectomy［J］.BioMed Res Int,2020,2020:1-10.
［18］ TATSUNO S,DOI H,OKADA W,et al.Risk factors for radiation pneumonitis after rotating gantry intensity-modulated radiation therapy for lung cancer［J］.Sci Rep,2022,12(1):590-600.
［19］ ZHANG XJ,SUN JG,SUN J,et al.Prediction of radiation pneumonitis in lung cancer patients:a systematic review［J］.J Cancer Res Clin Oncol,2012,138:2103-2116.
［20］ SAYNAK M,HIGGINSON DS,MORRIS DE,et al.Current status of postoperative radiation for non-small-cell lung cancer［J］.Semin Radiat Onco,2010,20(3):192-200.
［21］ UEYAMA T,ARIMURA T,TAKUMI K,et al.Risk factors for radiation pneumonitis after stereotactic radiation therapy for lung tumours:clinical usefulness of the planning target volume to total lung volume ratio［J］.Brit J Radiol,2018,91(1086):453-461.
［22］ KONG FM,HAYMAN JA,GRIFFITH KA,et al.Final toxicity results of a radiation-dose escalation study in patients with non-small-cell lung cancer (NSCLC):predictors for radiation pneumonitis and fibrosis［J］.Int J Radiat Oncol,2006,65(4):1075-1086.
［23］ VOGELIUS IR,BENTZEN SM.A literature-based meta-analysis of clinical risk factors for development of radiation induced pneumonitis［J］.Acat Oncol,2012,51(8):975-983.
［24］ LI X,HUANG C,XIE X,et al.The impact of smoking status on the progression-free survival of non-small cell lung cancer patients receiving molecularly target therapy or immunotherapy versus chemotherapy:A meta-analysis［J］.J Clin Pharm Ther,2021,46(2):256-266.
［25］ BERGMAN M,FOUNTOUKIDIS G,SMITH D,et al.Effect of smoking on treatment efficacy and toxicity in patients with cancer:A systematic review and meta-analysis［J］.Cancers (Basel),2022,14(17):4117-4130.
［26］ AMIN NP,MIFTN M,THORNTON D,et al.Effect of induction chemotherapy on estimated risk of radiation pneumonitis in bulky non-small cell lung cancer［J］.Med Dosim,2013,38(3):320-326.
［27］ WONG A,RILEY M,ZHAO S,et al.Association between pretreatment chest imaging and immune checkpoint inhibitor pneumonitis among patients with lung cancer［J］.J Natl Compr Canc Ne,2023,21(11):1164-1171.
［28］ LI F,ZHOU Z,WU A,et al.Preexisting radiological interstitial lung abnormalities are a risk factor for severe radiation pneumonitis in patients with small-cell lung cancer after thoracic radiation therapy［J］.Radiat Oncol,2018,13(1):82.
［29］ LI F,LIU H,WU H,et al.Risk factors for radiation pneumonitis in lung cancer patients with subclinical interstitial lung disease after thoracic radiation therapy［J］.Radiat Oncol,2021,16(1):70-81.
［30］ JEONG WG,KIM YH,AHN SJ,et al.Effect of interstitial lung abnormality on concurrent chemoradiotherapy-treated stage Ⅲ non-small cell lung cancer patients［J］.Anticancer Res,2023,43(4):1797-1807.
［31］ KASYMJANOVA G,JAGOE RT,PEPE C,et al.Does the presence of emphysema increase the risk of radiation pneumonitis in lung cancer patients［J］.Curr Oncol,2018,25(6):e610-e614.
［32］ KONG FM,WANG S.Non-dosimetric risk factors for radiation-induced lung toxicity［J］.Semin Radiat Oncol,2014,25(2):100-109.
［33］ TORRE-BOUSCOUIET L,MUNOZ-MONTANO WR,MARTINES-BRISENO D,et al.Abnormal pulmonary function tests predict the development of radiation-induced pneumonitis in advanced non-small cell lung cancer［J］.Respir Res,2018,19(1):72-82.
［34］ ZHOU Y,YAN T,ZHOU X,et al.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［J］.Strahlenther Onkol,2019,196(6):505-514.
［35］ LINAM J,MADTES D,CHOW L,et al.The relationship between pulmonary function metrics and radiation-induced lung injury［J］.J Solid Tumors,2012,3(1):6-14.
［36］ WANG D,ZHU J,SUN J,et al.Functional and biologic metrics for predicting radiation pneumonitis in locally advanced non-small cell lung cancer patients treated with chemoradiotherapy［J］.Clin Transl Oncol,2012,14(12):943-952.
［37］ CHOI NC,KANAREK DJ.Toxicity of thoracic radiotherapy on pulmonary function in lung cancer［J］.Lung Cancer,1994,10(suppl_1):S219-S230.
［38］ FERRERO C,BADELLINO S,FILIPPI AR,et al.Pulmonary function and quality of life after VMAT-based stereotactic ablative radiotherapy for early stage inoperable NSCLC:a prospective study［J］.Lung Cancer,2015,89(3):350-356.
［39］ WANG W,MEN Y,WANG J,et al.Postoperative radiotherapy is effective in improving survival of patients with stage pⅢ-N2 non-small-cell lung cancer after pneumonectomy［J］.BMC Cancer,2019,19(1):478-486.
［40］ BERKOVIC P,GULYBAN A,DEFRAENE G,et al.Stereotactic robotic body radiotherapy for patients with oligo recurrent pulmonary metastases［J］.BMC Cancer,2020,20(1):402-411.
［41］ KATSUI K，OGATA T，WATNANBE K，et al.Dose-volume parameters predict radiation pneumonitis after induction chemoradiotherapy followed by surgery for non-small cell lung cancer a retrospective analysis［J］.BMC Cancer,2019,19(1):1144-1152.
［42］ CHO WK，OH D，KIM HK，et al.Dosimetric predictors for postoperative pulmonary complications in esophageal cancer following neoadjuvant chemoradiotherapy and surgery［J］.Radiother Oncol,2019,13(3):187-192.
［43］ ZHAO J,MA C,GAN G,et al.Analysis of clinical and physical dosimetric factors that determine the outcome of severe acute radiation pneumonitis in lung cancer patients［J］.Radiother Oncol,2023,18(1):143-153.
［44］ TSUJINO K,HIROTA S,ENDO M,et al.Predictive value of dose-volume histogram parameters for predicting radiation pneumonitis after concurrent chemoradiation for lung cancer［J］.Int J Radiat Oncol,2003,55(1):1105-1115.
［45］ CHUN SG,HU C,CHOY H,et al.Impact of intensity-modulated radiation therapy technique for locally advanced non-small-cell lung cancer:a secondary analysis of the NRG oncology RTOG 0617 randomized clinical trial［J］.J Clin Oncol,2016,35(1):56-62.
［46］ 王谨,庄婷婷,何智纯,等.非小细胞肺癌同期放化疗后重度急性放射性肺炎的预测因素［J］.中华放射肿瘤学杂志，2012,21(4):326-329. WANG J，ZHUANG TT，HE ZC,et al.Severe acute radiation pneumonitis after concurrent chemoradiotherapy in non-small cell lung cancer［J］.Chinese Journal of Radiation Oncology,2012,21(4):326-329.
［47］ RYCKMAN JM，BAINE M，CARMICHEAL J，et al.Correlation of dosimetric factors with the development of symptomatic radiation pneumonitis in stereotactic body radiotherapy［J］.Radiat Oncol,2020,15(1):33-51.

Memo

Memo:
云南省基础研究计划项目（编号：202101AY070001-162，202101AY070001-164）；云南省中青年学术和技术带头人后备人才项目（编号：202005AC160025）；云南省高层次卫生健康技术人才培养专项项目（编号：D-2019030）
Last Update: 1900-01-01