[an error occurred while processing this directive] | [an error occurred while processing this directive]
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.
Corresponding Authors:
Wang Ping, Email:wangping@tjmuch.com
Cite this article:
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.
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.
[1] Kong FM, Ten-Haken R, Eisbruch A, et al. Non-small cell lung cancer therapy-related pulmonary toxicity:an update on radiation pneumonitis and fibrosis[J]. Semin Oncol,2005,32:42-54. [2] Mehta V. Radiation pneumonitis and pulmonary fibrosis in non-small-cell lung cancer:pulmonary function, prediction, and prevention[J].Int J Radiat Oncol Biol Phys,2005,63:5-24. [3] Consensus M. American Thoracic Society American Thoracic Society/European Respiratory Society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias[J]. Crit Care Med,2002,165:277-304. [4] Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society:glossary of terms for thoracic imaging[J]. Radiology,2008,246:697-722. [5] Kim M, Lee J, Ha B, et al. Factors predicting radiationpneumonitis in locally advanced non-small cell lung cancer[J]. Radiat Oncol J,2011,29:181-190. [6] 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,2012,14:943-952. [7] Palma D, Senan S, Tsujino K, et al. Predicting radiation pneumonitis after chemoradiation therapy for lung cancer:an international individual patient data meta-analysis[J]. Int J Radiat Oncol Biol Phys,2013,85:444-450. [8] Vogelius IR, Bentzen SM. A literature-based meta-analysis of clinical risk factors for development of radiation induced pneumonitis[J]. Acta Oncol,2012,51:975-983. [9] Wang D, Sun J, Zhu J, et al. Functional dosimetric metrics for predicting radiation-induced lung injury in non-small cell lung cancer patients treated with chemoradiotherapy[J/OL].Radiat Oncol,2012,7:69[2014-02-10].http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3434088/. [10] Minami-Shimmyo Y, Ohe Y, Yamamoto S, et al. Risk Factors for Treatment-Related Death Associated with chemotherapy and thoracic radiotherapy for lung cancer[J]. J Thorac Oncol,2012,7:177-182. [11] Kobayashi H, Uno T, Isobe K, et al. Radiation pneumonitis following twice-daily radiotherapywith concurrent carboplatin and paclitaxel in patients with stage Ⅲ non-small-cell lung cancer[J]. Jpn J Clin Oncol,2010,40:464-469. [12] 王军,庞青松,王平等.紫杉醇卡铂周方案同步化疗联合三维适形放射治疗局部晚期非小细胞肺癌的临床研究[J]. 中华肿瘤杂志,2007,29:769-772. [13] Wang L, Correa CR, Zhao L, et al. The effect of radiation dose and chemotherapy on overall survival in 237 patients with Stage Ⅲ non-small-cell lung cancer[J]. Int J Radiat Oncol Biol Phys,2009,73:1383-1390. [14] Gulati M. Diagnostic assessment of patients with interstitial lung disease[J]. Prim Care Respir J,2011,20:120-127. [15] 马大庆.问质性肺疾病的高分辨CT表现[J].中华全科医师杂志,2011,11:372-374. [16] 夏艺,管宇,范丽,等.慢性阻塞性肺疾病患者不同HRCT表现型的临床及CT容积量化的分析[J].实用放射学杂志,2013,29:1067-1070. [17] Mendoza CS, Washko GR, Ross JC, et al. Emphysema quantification in a multi-scanner HRCT cohort using local intensity distributions[C]//IEEE. Proc IEEE Int Symp Biomed Imaging. Kyoto:IEEE,2012:474-477. [18] Yamashita H, Kobayashi-Shibata S, Terahara A, et al. Prescreening based on the presence of CT-scan abnormalities and biomarkers (KL-6 and SP-D) may reduce severe radiation pneumonitis after stereotactic radiotherapy[J/OL]. Radiat Oncol,2010,5:32[2014-02-10]. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876174/. [19] Kimura T, Togami T, Takashima H, et al. Radiation pneumonitis in patients with lung and mediastinal tumours:a retrospective study of risk factors focused on pulmonary emphysema[J]. Br J Radiol,2012,85:135-141.
2014, Vol. 23 
