Factors predicting radiation pneumonitis in lung cancer patients: A retrospective study

Tiziana Rancati, Giovanni Luca Ceresoli, Giovanna Gagliardi, Stefano Schipani, Giovanni Mauro Cattaneo

Research output: Contribution to journalArticle

207 Citations (Scopus)

Abstract

Purpose: To evaluate clinical and lung dose-volume histogram based factors as predictors of radiation pneumonitis (RP) in lung cancer patients (PTs) treated with thoracic irradiation. Methods and materials: Records of all lung cancer PTs irradiated at our Institution between 1994 and 2000 were retrospectively reviewed. Eighty-four PTs with small or non-small-cell lung cancer, irradiated at >40 Gy, with full 3D dosimetry data and a follow-up time of >6 months from start of treatment, were analysed for RP. Pneumonitis was scored on the basis of SWOG toxicity criteria and was considered a complication when grade≥II. The following clinical parameters were considered: gender, age, surgery, chemotherapy agents, presence of chronic obstructive pulmonary disease (COPD), performance status. Dosimetric factors including prescribed dose (D iso), presence of final conformal boost, mean lung dose (D mean), % of lung receiving ≥20, 25, 30, 35, 40, and 45 Gy (respectively V 20→V 45), and normal tissue complication probability (NTCP) values were analysed. DVHs data and NTCP values were collected for both lungs considered as a paired organ. Median and quartile values were taken as cut-off for statistical analysis. Factors that influenced RP were assessed by univariate (log-rank) and multivariate analyses (Cox hazard model). Results: There were 14 PTs (16.6%) who had ≥grade II pulmonary toxicity. In the entire population, the univariate analysis revealed that many dosimetric parameters (D iso, V 20, V 30, V 40, V 45) were significantly associated with RP. No significant correlation was found between the incidence of RP and D mean or NTCP values. Multivariate analysis revealed that the use of mitomycin (MMC) (P=0.005) and the presence of COPD (P=0.026) were the most important risk factor for RP. In the group without COPD (55 PTs, seven RP) a few dosimetric factors (D mean, V 20, V 45) and NTCP values (all models) were associated with RP in the univariate analysis (P≤0.06). According to the multivariate analysis, the use of MMC was independently associated with RP (P=0.007), while D mean approached statistical significance (P=0.082). Conclusions: In this study the use of mitomycin or the presence of COPD is associated with a higher risk of RP. In the entire population NTCP values were not significantly correlated with the incidence of RP. Mean lung dose shows a clear trend toward statistical significance in the patient group without COPD.

Original languageEnglish
Pages (from-to)275-283
Number of pages9
JournalRadiotherapy and Oncology
Volume67
Issue number3
DOIs
Publication statusPublished - Jun 1 2003

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Radiation Pneumonitis
Lung Neoplasms
Retrospective Studies
Chronic Obstructive Pulmonary Disease
Lung
Mitomycin
Multivariate Analysis
Proportional Hazards Models
Incidence
Non-Small Cell Lung Carcinoma
Population
Pneumonia
Thorax

Keywords

  • Chronic obstructive pulmonary disease
  • Dose-volume histogram
  • Lung cancer
  • Mitomycin
  • Normal tissue complication probability
  • Radiation pneumonitis

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Urology

Cite this

Rancati, T., Ceresoli, G. L., Gagliardi, G., Schipani, S., & Cattaneo, G. M. (2003). Factors predicting radiation pneumonitis in lung cancer patients: A retrospective study. Radiotherapy and Oncology, 67(3), 275-283. https://doi.org/10.1016/S0167-8140(03)00119-1

Factors predicting radiation pneumonitis in lung cancer patients : A retrospective study. / Rancati, Tiziana; Ceresoli, Giovanni Luca; Gagliardi, Giovanna; Schipani, Stefano; Cattaneo, Giovanni Mauro.

In: Radiotherapy and Oncology, Vol. 67, No. 3, 01.06.2003, p. 275-283.

Research output: Contribution to journalArticle

Rancati, T, Ceresoli, GL, Gagliardi, G, Schipani, S & Cattaneo, GM 2003, 'Factors predicting radiation pneumonitis in lung cancer patients: A retrospective study', Radiotherapy and Oncology, vol. 67, no. 3, pp. 275-283. https://doi.org/10.1016/S0167-8140(03)00119-1
Rancati, Tiziana ; Ceresoli, Giovanni Luca ; Gagliardi, Giovanna ; Schipani, Stefano ; Cattaneo, Giovanni Mauro. / Factors predicting radiation pneumonitis in lung cancer patients : A retrospective study. In: Radiotherapy and Oncology. 2003 ; Vol. 67, No. 3. pp. 275-283.
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AU - Ceresoli, Giovanni Luca

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AU - Cattaneo, Giovanni Mauro

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N2 - Purpose: To evaluate clinical and lung dose-volume histogram based factors as predictors of radiation pneumonitis (RP) in lung cancer patients (PTs) treated with thoracic irradiation. Methods and materials: Records of all lung cancer PTs irradiated at our Institution between 1994 and 2000 were retrospectively reviewed. Eighty-four PTs with small or non-small-cell lung cancer, irradiated at >40 Gy, with full 3D dosimetry data and a follow-up time of >6 months from start of treatment, were analysed for RP. Pneumonitis was scored on the basis of SWOG toxicity criteria and was considered a complication when grade≥II. The following clinical parameters were considered: gender, age, surgery, chemotherapy agents, presence of chronic obstructive pulmonary disease (COPD), performance status. Dosimetric factors including prescribed dose (D iso), presence of final conformal boost, mean lung dose (D mean), % of lung receiving ≥20, 25, 30, 35, 40, and 45 Gy (respectively V 20→V 45), and normal tissue complication probability (NTCP) values were analysed. DVHs data and NTCP values were collected for both lungs considered as a paired organ. Median and quartile values were taken as cut-off for statistical analysis. Factors that influenced RP were assessed by univariate (log-rank) and multivariate analyses (Cox hazard model). Results: There were 14 PTs (16.6%) who had ≥grade II pulmonary toxicity. In the entire population, the univariate analysis revealed that many dosimetric parameters (D iso, V 20, V 30, V 40, V 45) were significantly associated with RP. No significant correlation was found between the incidence of RP and D mean or NTCP values. Multivariate analysis revealed that the use of mitomycin (MMC) (P=0.005) and the presence of COPD (P=0.026) were the most important risk factor for RP. In the group without COPD (55 PTs, seven RP) a few dosimetric factors (D mean, V 20, V 45) and NTCP values (all models) were associated with RP in the univariate analysis (P≤0.06). According to the multivariate analysis, the use of MMC was independently associated with RP (P=0.007), while D mean approached statistical significance (P=0.082). Conclusions: In this study the use of mitomycin or the presence of COPD is associated with a higher risk of RP. In the entire population NTCP values were not significantly correlated with the incidence of RP. Mean lung dose shows a clear trend toward statistical significance in the patient group without COPD.

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KW - Chronic obstructive pulmonary disease

KW - Dose-volume histogram

KW - Lung cancer

KW - Mitomycin

KW - Normal tissue complication probability

KW - Radiation pneumonitis

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