Torasik Rayoterapi Sonrası Gelişen Radyasyon Pnömoniti Hastalarında Prognostik ve Prediktif Faktörlerin Analizi: Retrospektif Tek Merkez Deneyimi
Year 2024,
Volume: 7 Issue: 2, 48 - 52, 11.10.2024
Jamshid Hamdard
,
Harun Muğlu
,
Erdem Sünger
,
Mehmet Haluk Yücel
,
Maral Martin Mıldanoğlu
,
Ebru Engin Delipoyraz
,
Ebru Karcı
,
Ozgur Acikgoz
,
Ömer Yazıcı
,
Dilek Ünal
,
Omer Fatih Olmez
,
Ahmet Bilici
,
Özcan Yıldız
Abstract
Amaç: Çalışmamızda, torasik bölgeye radyoterapi (TRT)/ kemoradyoterapi (KRT) +/- immünoterapi (İO) alan hastalarda gelişen radyasyon pnömoniti sürecini ve etki eden faktörlerin ortaya konulması amaçlanmıştır.
Yöntem: TRT alan hastaların verileri retrospektif olarak tarandı ve radyasyon pnömoniti gelişen 26 hastanın verileri analiz edildi.
Bulgular: Hastaların ortanca yaşı 54.5 iken çoğu erkekti. Hastaların çoğunluğunda primer tanı akciğer kanseri idi. Ondört hasta (%53.8) eş zamalı KRT alırken, 13 hasta (%50) IO ile eş zamanlı RT almıştı. Toplamda ise 17 hasta (%65.4) tedavi sürecinde IO almıştı. Median RT dozu 44 Gy idi. Hastalarda RT ile pnömonit gelişene kadar geçen süre ortanca 5.8 ay iken IO başlangıcından pnömonitis gelişene kadar geçen süre ortanca 6.2 aydı. 20 hastada (%76.9) grad 2, 3 hastada (%11.5) grad 3 ve 3 hastada (%11.5) grad 1 pnömonitis görülmüştü. En sık görülen tomografi bulguları konsolidasyon ve septal kalınlaşma ve distorsiyon ile 5 hastada retikülonodüler görünüm ve 3 hastada buzlu cam görünümü şeklindeydi. Ortanca steroid kullanımı 1.95 ay idi . 14 hastada (%53.8) steroid dozu 1 mg/kg dozuna kadar çıkılmıştı. Ortanca 22.5 aylık takip süresinde, ortanca PFS 28.8 ay ve ortanca OS 54.1 aydı. Hiçbir hastada RT pnömonitine bağlı ölüm gözlenmedi. Grad 2-3 RT pnömoniti gelişimine etki eden faktörlerin analizi yapıldığında, her hangi bir predikte edici anlamlı faktör gösterilemedi. Sonuç: Çalışmamızda KRT+İO alan hastalarda RT pnömoniti İO almayanlara kıyasla daha fazla görülmedi. Fakat hasta sayısı az olduğu için daha fazla hasta sayıları ile geniş kapsamlı karşılaştırmalı çalışmalara ihtiyaç bulunmaktadır. RT pnömoniti zamanında akla getirilmediğinde ciddi mortal olabilen fakat erken farkedilerek, doğru tedavi edildiğinde yönetilebilir bir klinik antitedir.
References
- Respiratory system. In: Clinical Radiation Pathology, Rubin P, Casseratt GW (Eds), WB Saunders, Philadelphia 1968. p.423
- McDonald S, Rubin P, Phillips TL, Marks LB. Injury to the lung from cancer therapy: clinical syndromes, measurable endpoints, and potential scoring systems. Int J Radiat Oncol Biol Phys. 1995 Mar 30;31(5):1187-203.
- Gross NJ. Pulmonary effects of radiation therapy. Ann Intern Med. 1977 Jan;86(1):81-92.
- Abratt RP, Morgan GW, Silvestri G, Willcox P. Pulmonary complications of radiation therapy. Clin Chest Med. 2004 Mar;25(1):167-77.
- Epperly MW, Guo H, Gretton JE, Greenberger JS. Bone marrow origin of myofibroblasts in irradiation pulmonary fibrosis. Am J Respir Cell Mol Biol. 2003 Aug;29(2):213-24.
- Theise ND, Henegariu O, Grove J, Jagirdar J, Kao PN, Crawford JM, Badve S, Saxena R, Krause DS. Radiation pneumonitis in mice: a severe injury model for pneumocyte engraftment from bone marrow. Exp Hematol. 2002 Nov;30(11):1333-8.
- Carver JR, Shapiro CL, Ng A, Jacobs L, Schwartz C, Virgo KS, Hagerty KL, Somerfield MR, Vaughn DJ; ASCO Cancer Survivorship Expert Panel. American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol. 2007 Sep 1;25(25):3991-4008.
- Cella L, Liuzzi R, D'Avino V, Conson M, Di Biase A, Picardi M, Pugliese N, Solla R, Salvatore M, Pacelli R. Pulmonary damage in Hodgkin's lymphoma patients treated with sequential chemo- radiotherapy: Predictors of radiation-induced lung injury. Acta Oncol. 2014 May;53(5):613-9.
- Bergonie J, Teissier J. Rapport sur l’action des rayons X sur la tuberculose. [Reports on the action of X rays on tuberculosis]. Arch Electr Med 1898; 6:334.
- Jain V, Berman AT. Radiation pneumonitis: old problem, new tricks. Cancers (Basel) 2018; 10:222.
- Bledsoe TJ, Nath SK, Decker RH. Radiation pneumonitis. Clin Chest Med 2017; 38:201–208.
- Keffer S, Guy CL, Weiss E. Fatal radiation pneumonitis: literature review and case series. Adv Radiat Oncol 2019; 5:238– 249.
- Lierova A, Jelicova M, Nemcova M, et al. Cytokines and radiation-induced pulmonary injuries. J Radiat Res 2018; 59:709–753.
- Hanania AN, Mainwaring W, Ghebre YT, et al. Radiation- induced lung injury: assessment and management. Chest 2019; 156:150–162.
- Giuranno L, Ient J, De Ruysscher D, Vooijs MA. Radiation- induced lung injury (RILI). Front Oncol 2019; 9:877.
- Ullah T, Patel H, Pena GM, Shah R, Fein AM. A contemporary review of radiation pneumonitis. Curr Opin Pulm Med. 2020 Jul;26(4):321-325.
- Rovirosa A, Valduvieco I. Radiation pneumonitis. Clin Pulm Med 2010; 17:218–222.
- Antonia SJ, Villegas A, Daniel D, et al. Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. N Engl J Med. 2017;377(20):1919-1929.
- Zhou Q, Chen M, Jiang O, et al. Sugemalimab versus placebo after concurrent or sequential chemoradiotherapy in patients with locally advanced, unresectable, stage III non-small-cell lung cancer in China (GEMSTONE-301): interim results of a randomised, double-blind, multicentre, phase 3 trial. Lancet Oncol. 2022;23(2):209-219.
- Jung HA, Noh JM, Sun JM, et al. Real world data of durvalumab consolidation after chemoradiotherapy in stage III non-small-cell lung cancer. Lung Cancer. 2020;146:23-29.
- Zhou Z, Song X, Wu A, Liu H, Wu H, Wu Q, Liu Y, Li Y, Cai Y, Liang S. Pulmonary emphysema is a risk factor for radiation pneumonitis in NSCLC patients with squamous cell carcinoma after thoracic radiation therapy. Sci Rep. 2017 Jun 5;7(1):2748.
- Han C, Qiu J, Bai L, Liu T, Chen J, Wang H, Dang J. Pneumonitis Risk After Chemoradiotherapy With and Without Immunotherapy in Patients With Locally Advanced Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys. 2024 Feb 13:S0360-3016(24)00298-0.
- Smesseim I, Mets OM, Daniels JMA, Bahce I, Senan S. Diagnosis and management of pneumonitis following chemoradiotherapy and immunotherapy in stage III non-small cell lung cancer. Radiother Oncol. 2024 May;194:110147.
Year 2024,
Volume: 7 Issue: 2, 48 - 52, 11.10.2024
Jamshid Hamdard
,
Harun Muğlu
,
Erdem Sünger
,
Mehmet Haluk Yücel
,
Maral Martin Mıldanoğlu
,
Ebru Engin Delipoyraz
,
Ebru Karcı
,
Ozgur Acikgoz
,
Ömer Yazıcı
,
Dilek Ünal
,
Omer Fatih Olmez
,
Ahmet Bilici
,
Özcan Yıldız
References
- Respiratory system. In: Clinical Radiation Pathology, Rubin P, Casseratt GW (Eds), WB Saunders, Philadelphia 1968. p.423
- McDonald S, Rubin P, Phillips TL, Marks LB. Injury to the lung from cancer therapy: clinical syndromes, measurable endpoints, and potential scoring systems. Int J Radiat Oncol Biol Phys. 1995 Mar 30;31(5):1187-203.
- Gross NJ. Pulmonary effects of radiation therapy. Ann Intern Med. 1977 Jan;86(1):81-92.
- Abratt RP, Morgan GW, Silvestri G, Willcox P. Pulmonary complications of radiation therapy. Clin Chest Med. 2004 Mar;25(1):167-77.
- Epperly MW, Guo H, Gretton JE, Greenberger JS. Bone marrow origin of myofibroblasts in irradiation pulmonary fibrosis. Am J Respir Cell Mol Biol. 2003 Aug;29(2):213-24.
- Theise ND, Henegariu O, Grove J, Jagirdar J, Kao PN, Crawford JM, Badve S, Saxena R, Krause DS. Radiation pneumonitis in mice: a severe injury model for pneumocyte engraftment from bone marrow. Exp Hematol. 2002 Nov;30(11):1333-8.
- Carver JR, Shapiro CL, Ng A, Jacobs L, Schwartz C, Virgo KS, Hagerty KL, Somerfield MR, Vaughn DJ; ASCO Cancer Survivorship Expert Panel. American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol. 2007 Sep 1;25(25):3991-4008.
- Cella L, Liuzzi R, D'Avino V, Conson M, Di Biase A, Picardi M, Pugliese N, Solla R, Salvatore M, Pacelli R. Pulmonary damage in Hodgkin's lymphoma patients treated with sequential chemo- radiotherapy: Predictors of radiation-induced lung injury. Acta Oncol. 2014 May;53(5):613-9.
- Bergonie J, Teissier J. Rapport sur l’action des rayons X sur la tuberculose. [Reports on the action of X rays on tuberculosis]. Arch Electr Med 1898; 6:334.
- Jain V, Berman AT. Radiation pneumonitis: old problem, new tricks. Cancers (Basel) 2018; 10:222.
- Bledsoe TJ, Nath SK, Decker RH. Radiation pneumonitis. Clin Chest Med 2017; 38:201–208.
- Keffer S, Guy CL, Weiss E. Fatal radiation pneumonitis: literature review and case series. Adv Radiat Oncol 2019; 5:238– 249.
- Lierova A, Jelicova M, Nemcova M, et al. Cytokines and radiation-induced pulmonary injuries. J Radiat Res 2018; 59:709–753.
- Hanania AN, Mainwaring W, Ghebre YT, et al. Radiation- induced lung injury: assessment and management. Chest 2019; 156:150–162.
- Giuranno L, Ient J, De Ruysscher D, Vooijs MA. Radiation- induced lung injury (RILI). Front Oncol 2019; 9:877.
- Ullah T, Patel H, Pena GM, Shah R, Fein AM. A contemporary review of radiation pneumonitis. Curr Opin Pulm Med. 2020 Jul;26(4):321-325.
- Rovirosa A, Valduvieco I. Radiation pneumonitis. Clin Pulm Med 2010; 17:218–222.
- Antonia SJ, Villegas A, Daniel D, et al. Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. N Engl J Med. 2017;377(20):1919-1929.
- Zhou Q, Chen M, Jiang O, et al. Sugemalimab versus placebo after concurrent or sequential chemoradiotherapy in patients with locally advanced, unresectable, stage III non-small-cell lung cancer in China (GEMSTONE-301): interim results of a randomised, double-blind, multicentre, phase 3 trial. Lancet Oncol. 2022;23(2):209-219.
- Jung HA, Noh JM, Sun JM, et al. Real world data of durvalumab consolidation after chemoradiotherapy in stage III non-small-cell lung cancer. Lung Cancer. 2020;146:23-29.
- Zhou Z, Song X, Wu A, Liu H, Wu H, Wu Q, Liu Y, Li Y, Cai Y, Liang S. Pulmonary emphysema is a risk factor for radiation pneumonitis in NSCLC patients with squamous cell carcinoma after thoracic radiation therapy. Sci Rep. 2017 Jun 5;7(1):2748.
- Han C, Qiu J, Bai L, Liu T, Chen J, Wang H, Dang J. Pneumonitis Risk After Chemoradiotherapy With and Without Immunotherapy in Patients With Locally Advanced Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys. 2024 Feb 13:S0360-3016(24)00298-0.
- Smesseim I, Mets OM, Daniels JMA, Bahce I, Senan S. Diagnosis and management of pneumonitis following chemoradiotherapy and immunotherapy in stage III non-small cell lung cancer. Radiother Oncol. 2024 May;194:110147.