Pulmonary damage in Hodgkin's lymphoma patients treated with sequential chemo-radiotherapy: Predictors of radiation-induced lung injury

Laura Cella, Raffaele Liuzzi, Vittoria D'Avino, Manuel Conson, Angela Di Biase, Marco Picardi, Novella Pugliese, Raffaele Solla, Marco Salvatore, Roberto Pacelli

Research output: Contribution to journalArticle

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Abstract

Background. Our aim was to define predictors of late radiation-induced lung injury (RILI) in Hodgkin's lymphoma (HL) survivors treated with bleomycin-containing chemotherapy and radiotherapy. Material and methods. Eighty consecutive patients treated with chemotherapy and subsequent supradiaphragmatic radiation therapy for HL were retrospectively reviewed for symptoms and/or radiological signs of RILI. Median patient age was 26 years (range 14-55). Left, right, and total lung dosimetric parameters along with clinical, disease, and treatment-related characteristics were analyzed. Multivariate logistic regression analyses were performed. A receiver operator characteristic (ROC) curve analysis was performed to find possible cutoff values dividing patients into high-And low-risk groups. Results. Seven of 80 (9%) patients had lung disease at baseline. Four of 80 (5%) had toxicity after chemotherapy and before the beginning of radiotherapy. These patients were excluded from further evaluation. At a median time of 10 months (range 9-18), 9/69 patients (13%) developed lung radiological changes on computed tomography (CT) after treatment. Four of nine patients were diagnosed RTOG grade ≥ 2. On multivariate analyses, left-lung V30 (p = 0.004, OR = 1.108 95% CI 1.033-1.189) and total-lung V30 (p = 0.009, OR = 1.146 95% CI 1.035-1.270) resulted to be predictors of lung CT changes with a cutoff value of 16% and 15%, respectively. When only symptomatic RILI was considered a left-lung V30 cutoff value of 32% was estimated. Conclusion. Bleomycin and RT may cause lung injury in a small, but significant fraction of HL patients. Left-lung V30 predicts the risk of developing asymptomatic or symptomatic RILI after sequential chemo-radiotherapy.

Original languageEnglish
Pages (from-to)613-619
Number of pages7
JournalActa Oncologica
Volume53
Issue number5
DOIs
Publication statusPublished - 2014

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Lung Injury
Hodgkin Disease
Radiotherapy
Radiation
Lung
Bleomycin
Drug Therapy
Tomography
Lung Diseases
Survivors
Multivariate Analysis
Logistic Models
Regression Analysis
Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Hematology
  • Medicine(all)

Cite this

Pulmonary damage in Hodgkin's lymphoma patients treated with sequential chemo-radiotherapy : Predictors of radiation-induced lung injury. / Cella, Laura; Liuzzi, Raffaele; D'Avino, Vittoria; Conson, Manuel; Di Biase, Angela; Picardi, Marco; Pugliese, Novella; Solla, Raffaele; Salvatore, Marco; Pacelli, Roberto.

In: Acta Oncologica, Vol. 53, No. 5, 2014, p. 613-619.

Research output: Contribution to journalArticle

Cella, L, Liuzzi, R, D'Avino, V, Conson, M, Di Biase, A, Picardi, M, Pugliese, N, Solla, R, Salvatore, M & Pacelli, R 2014, 'Pulmonary damage in Hodgkin's lymphoma patients treated with sequential chemo-radiotherapy: Predictors of radiation-induced lung injury', Acta Oncologica, vol. 53, no. 5, pp. 613-619. https://doi.org/10.3109/0284186X.2013.850739
Cella, Laura ; Liuzzi, Raffaele ; D'Avino, Vittoria ; Conson, Manuel ; Di Biase, Angela ; Picardi, Marco ; Pugliese, Novella ; Solla, Raffaele ; Salvatore, Marco ; Pacelli, Roberto. / Pulmonary damage in Hodgkin's lymphoma patients treated with sequential chemo-radiotherapy : Predictors of radiation-induced lung injury. In: Acta Oncologica. 2014 ; Vol. 53, No. 5. pp. 613-619.
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abstract = "Background. Our aim was to define predictors of late radiation-induced lung injury (RILI) in Hodgkin's lymphoma (HL) survivors treated with bleomycin-containing chemotherapy and radiotherapy. Material and methods. Eighty consecutive patients treated with chemotherapy and subsequent supradiaphragmatic radiation therapy for HL were retrospectively reviewed for symptoms and/or radiological signs of RILI. Median patient age was 26 years (range 14-55). Left, right, and total lung dosimetric parameters along with clinical, disease, and treatment-related characteristics were analyzed. Multivariate logistic regression analyses were performed. A receiver operator characteristic (ROC) curve analysis was performed to find possible cutoff values dividing patients into high-And low-risk groups. Results. Seven of 80 (9{\%}) patients had lung disease at baseline. Four of 80 (5{\%}) had toxicity after chemotherapy and before the beginning of radiotherapy. These patients were excluded from further evaluation. At a median time of 10 months (range 9-18), 9/69 patients (13{\%}) developed lung radiological changes on computed tomography (CT) after treatment. Four of nine patients were diagnosed RTOG grade ≥ 2. On multivariate analyses, left-lung V30 (p = 0.004, OR = 1.108 95{\%} CI 1.033-1.189) and total-lung V30 (p = 0.009, OR = 1.146 95{\%} CI 1.035-1.270) resulted to be predictors of lung CT changes with a cutoff value of 16{\%} and 15{\%}, respectively. When only symptomatic RILI was considered a left-lung V30 cutoff value of 32{\%} was estimated. Conclusion. Bleomycin and RT may cause lung injury in a small, but significant fraction of HL patients. Left-lung V30 predicts the risk of developing asymptomatic or symptomatic RILI after sequential chemo-radiotherapy.",
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T1 - Pulmonary damage in Hodgkin's lymphoma patients treated with sequential chemo-radiotherapy

T2 - Predictors of radiation-induced lung injury

AU - Cella, Laura

AU - Liuzzi, Raffaele

AU - D'Avino, Vittoria

AU - Conson, Manuel

AU - Di Biase, Angela

AU - Picardi, Marco

AU - Pugliese, Novella

AU - Solla, Raffaele

AU - Salvatore, Marco

AU - Pacelli, Roberto

PY - 2014

Y1 - 2014

N2 - Background. Our aim was to define predictors of late radiation-induced lung injury (RILI) in Hodgkin's lymphoma (HL) survivors treated with bleomycin-containing chemotherapy and radiotherapy. Material and methods. Eighty consecutive patients treated with chemotherapy and subsequent supradiaphragmatic radiation therapy for HL were retrospectively reviewed for symptoms and/or radiological signs of RILI. Median patient age was 26 years (range 14-55). Left, right, and total lung dosimetric parameters along with clinical, disease, and treatment-related characteristics were analyzed. Multivariate logistic regression analyses were performed. A receiver operator characteristic (ROC) curve analysis was performed to find possible cutoff values dividing patients into high-And low-risk groups. Results. Seven of 80 (9%) patients had lung disease at baseline. Four of 80 (5%) had toxicity after chemotherapy and before the beginning of radiotherapy. These patients were excluded from further evaluation. At a median time of 10 months (range 9-18), 9/69 patients (13%) developed lung radiological changes on computed tomography (CT) after treatment. Four of nine patients were diagnosed RTOG grade ≥ 2. On multivariate analyses, left-lung V30 (p = 0.004, OR = 1.108 95% CI 1.033-1.189) and total-lung V30 (p = 0.009, OR = 1.146 95% CI 1.035-1.270) resulted to be predictors of lung CT changes with a cutoff value of 16% and 15%, respectively. When only symptomatic RILI was considered a left-lung V30 cutoff value of 32% was estimated. Conclusion. Bleomycin and RT may cause lung injury in a small, but significant fraction of HL patients. Left-lung V30 predicts the risk of developing asymptomatic or symptomatic RILI after sequential chemo-radiotherapy.

AB - Background. Our aim was to define predictors of late radiation-induced lung injury (RILI) in Hodgkin's lymphoma (HL) survivors treated with bleomycin-containing chemotherapy and radiotherapy. Material and methods. Eighty consecutive patients treated with chemotherapy and subsequent supradiaphragmatic radiation therapy for HL were retrospectively reviewed for symptoms and/or radiological signs of RILI. Median patient age was 26 years (range 14-55). Left, right, and total lung dosimetric parameters along with clinical, disease, and treatment-related characteristics were analyzed. Multivariate logistic regression analyses were performed. A receiver operator characteristic (ROC) curve analysis was performed to find possible cutoff values dividing patients into high-And low-risk groups. Results. Seven of 80 (9%) patients had lung disease at baseline. Four of 80 (5%) had toxicity after chemotherapy and before the beginning of radiotherapy. These patients were excluded from further evaluation. At a median time of 10 months (range 9-18), 9/69 patients (13%) developed lung radiological changes on computed tomography (CT) after treatment. Four of nine patients were diagnosed RTOG grade ≥ 2. On multivariate analyses, left-lung V30 (p = 0.004, OR = 1.108 95% CI 1.033-1.189) and total-lung V30 (p = 0.009, OR = 1.146 95% CI 1.035-1.270) resulted to be predictors of lung CT changes with a cutoff value of 16% and 15%, respectively. When only symptomatic RILI was considered a left-lung V30 cutoff value of 32% was estimated. Conclusion. Bleomycin and RT may cause lung injury in a small, but significant fraction of HL patients. Left-lung V30 predicts the risk of developing asymptomatic or symptomatic RILI after sequential chemo-radiotherapy.

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