Evaluation of Factors Affecting Development of Radiation Pneumonitis after Radiotherapy in Patients with Lung Cancer

Öz

Abstract: In this single-institution prospective study, we aimed to evaluate factors affecting the development of radiation pneumonitis (RP) in patients with lung cancer following 3D conformal radiotherapy (3D-CRT) with normal dose-volume histograms (DVH) limits. This study included 41 patients with lung cancer who received definitive 3D-CRT between February 2012 and July 2013. Thirty (73.2%) of these patients underwent concurrent chemotherapy, while eight (19.5%) underwent adjuvant radiotherapy (RT). The median RT dose was 60 (range: 30-64) Gy. The relationships between RP evolution and various treatment-related factors, including DVH parameters, levels of pretreatment diffusing capacity of carbon monoxide (D_LCO), serum procalcitonin, CRP, and TGF-β1 were analyzed. Within the follow-up period (median: 8 months, range: 6-24 months), RP occurred in 15 (36.6%) patients (grade I in 11 patients and grade II in 4 patients) and only 2 patients received steroid therapy (methylprednisolone 1 mg/kg/day). Univariate analysis revealed that lymph node involvement status, D_LCO, and pretreatment serum procalcitonin levels were significantly associated with RP incidence (p=0.018, 0.045, and 0.001, respectively). However, multivariate analysis of the same factors indicated that only pretreatment serum procalcitonin level was significantly associated with RP incidence (p=0.027). In conclusion, our current data indicate that pretreatment serum procalcitonin level can be used to predict RP in patients with lung cancer who are treated with 3D-CRT with normal DVH limits.

Anahtar Kelimeler

• lung cancer,3 dimensional conformal radiotherapy (3D-CRT),procalcitonin

Radyoterapi Uygulanan Akciğer Kanseri Tanılı Vakalarda Radyasyon Pnömonisi Gelişimini Etkileyen Faktörler

Öz

Öz: Bu tek merkezli prospektif çalışmada 3 boyutlu konformal radyoterapi (3BKRT) ile tedavi edilen ve normal doz-volüm histogramına (DVH) sahip akciğer kanseri tanılı hastalarda radyasyon pnömonisi (RP) gelişimini etkileyen faktörleri değerlendirmeyi amaçlandı. Çalışmaya Şubat 2012-Temmuz 2013 tarihleri arasında küratif 3BKRT uygulanan 41 akciğer kanseri tanılı hasta dahil edildi. Otuz (%73,2) hastaya eş zamanlı kemoterapi verildi. Sekiz (%19,5) hastaya adjuvant radyoterapi (RT) uygulandı. Medyan RT dozu 60 (30-64) Gy idi. Tedavi sonrası RP gelişimi ile DVH parametreleri, tedavi öncesi karbon monoksit difüzyon kapasitesi (DLCO), serum prokalsitonin, CRP ve TGF-β1 seviyeleri gibi hastaya özgü faktörler arasındaki ilişki analiz edildi. Medyan 8 (6-24) aylık takip süresi içerisinde 15 (%36,6) hastada RP gelişti (11 hastada grade I, 4 hastada grade II) ve sadece 2 hastaya steroid (1 mg/kg/gün metilprednizolon) tedavisi uygulandı. Tek değişkenli analizde lenf nodu tutulumu, DLCO ve tedavi öncesi serum prokalsitonin düzeyinin RP gelişimi üzerine etkisi gösterildi (sırasıyla, p=0.018, 0,045, 0.001). Çok değişkenli analizde sadece tedavi öncesi serum prokalsitonin düzeyi ile istatistiksel anlamlı ilişki mevcut idi (p=0.027). Sonuç olarak tedavi öncesi serum prokalsitonin düzeyi 3BKRT ile tedavi edilen ve normal DVH değerlerine sahip akciğer kanseri tanılı hastalarda RP gelişimini tahmin etmede faydalı olabilir. 

Anahtar Kelimeler

• 3 boyutlu konformal radyoterapi (3BKRT),akciğer kanseri,prokalsitonin,radyasyon pnömonisi

Kaynakça

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