Relationship of pulmonary abnormalities on high-resolution CT before radiotherapy with radiation pneumonitis after three-dimensional radiotherapy in patients with lung cancer
Wang Qi*, Dai Dong, Zhao Jinkun, Xiao Jianyu, Sun Yao, Zhao Lujun, Yuan Zhiyong, Wang Ping
*Department of Radiation Oncology,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
Abstract：Objective To investigate the relationship of pulmonary abnormalities on high-resolution CT (HRCT) before radiotherapy with radiation pneumonitis (RP) after three-dimensional radiotherapy (3DRT) in patients with lung cancer. Methods A retrospective analysis was performed on the HRCT images (before radiotherapy) and clinical data of 262 patients with lung cancer who received 3DRT from January 2009 to April 2011. HRCT showed reticular opacities, honeycomb patterns, ground-glass attenuation, and pulmonary emphysema (PE). Clinical data included general conditions (age, sex, KPS score, history of smoking, chronic obstructive pulmonary disease (COPD), interstitial lung disease, and forced expired volume in one second (FEV1)/forced vital capacity (FCV)), disease factors (tumor location, histology, and stage), and radiotherapy factors (total dose, minimum lethal dose (MLD), lung V20, surgery, and concurrent chemotherapy). Univariate and multivariate analyses (logistic regression) were used to identify predictive factors for RP. Results On pre-treatment HRCT, 129 patients had reticular opacities, mild in 56 patients, moderate in 49 patients, and severe in 24 patients;37 patients had honeycomb patterns;22 patients had ground-glass attenuation. A total of 154 patients had PE;grade 1 PE was found in 71 patients, grade 2 PE in 55 patients, grade 3 PE in 20 patients, and grade 4 PE in 8 patients. Fifty-eight patients developed RP;among them, 39 patients had grade 1—2 RP, and 19 patients had grade 3—5 RP. In RP patients, 34 had reticular opacities, 38 had PE, 6 had honeycomb patterns, and 2 had ground-glass attenuation, according to the pre-treatment HRCT. Univariate analysis showed that COPD, FEV1/FCV, V20, MLD, chemotherapy, and PE and reticular opacities on HRCT were associated with RP. Multivariate analysis showed that the predictive factors for grade ≥3 RP were concurrent and induction chemotherapy, severe reticular opacities, and grade 3 PE. Conclusions Pulmonary abnormalities on HRCT before radiotherapy could help to predict the incidence of RP after thoracic radiotherapy in patients with lung cancer.
Wang Qi*,Dai Dong,Zhao Jinkun et al. Relationship of pulmonary abnormalities on high-resolution CT before radiotherapy with radiation pneumonitis after three-dimensional radiotherapy in patients with lung cancer[J]. Chinese Journal of Radiation Oncology, 2014, 23(4): 297-301.
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