Risk factors and dosimetric limitations for acute radiation pneumonitis after gemcitabine induction chemotherapy for non-small cell lung cancer
Cui Xiaoying1, Sheng Liming2, Du Xianghui2
1The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China; 2Department of Thoracic Radiotherapy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital),Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences,Hangzhou 310022, China
Abstract：Objective To summarize the incidence of acute radiation pneumonitis (ARP) after gemcitabine induction chemotherapy for non-small cell lung cancer (NSCLC) and identify the high risk factors and dosimetric limitations of ARP after gemcitabine induction chemotherapy. Methods We retrospectively analyzed 191 NSCLC cases who were received gemcitabine induction chemotherapy and chest radiotherapy in radiotherapy department of Zhejiang Cancer Hospital between January 2010 and December 2010.Base line data, treatment information and the incidence of ARP after treatment were collected. The risk factors of ARP were analyzed with univariate and multivariate Logistic regression method. Results A total of 49 patients developed ≥ grade Ⅱ ARP, accounting for 25.7% of all cases. Univariate analysis indicated that the probability of ARP in patients who received the cumulative dose of gemcitabine ≥ 9.0g was 3.45 times higher than that in those treated at a dose of < 9.0g (P=0.015). Radiation dose ≥ 50Gy was significantly correlated with the occurrence of ARP (P=0.008). The risk of ARP was increased by 7.69 times if the time interval between radiotherapy and chemotherapy was within 10 weeks (P=0.047). Among the dosimetric parameters, V5Gy, V20Gy, V30Gy and mean lung dose (MLD) of bilateral lungs were 45%, 22%, 16%, and 1200 cGy respectively. All of them could effectively predict the occurrence of ARP (all P≤0.001). Multivariate analysis indicated that only radiotherapy dose (P=0.044) and V5Gy(P=0.02) were the independent predictors of ARP. Conclusions For NSCLC patients who receive gemcitabine induction chemotherapy, the cumulative dose of gemcitabine, the interval time between chemotherapy and radiotherapy and the radiation dose are associated with the occurrence of ARP.We should strictly limit the total lung dosimetric parameters, such as V5Gy, V20Gy, V30Gy and MLD to reduce the incidence of ARP.
Cui Xiaoying,Sheng Liming,Du Xianghui. Risk factors and dosimetric limitations for acute radiation pneumonitis after gemcitabine induction chemotherapy for non-small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(7): 519-522.
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