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KMID : 0859320080260010035
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Journal of the Korean Society for Therapeutic Radiology and Oncology
2008 Volume.26 No. 1 p.35 ~ p.44
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Incidence and Prognostic Factors of Radiation Pneumonitis
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Kim Myung-Se
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Abstract
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Purpose: To evaluate the incidence and prognostic factors of treatment-related pneumonitis in non-small-cell lung cancer (NSCLC) patients treated with intensity modulated radiation therapy (IMRT).
Materials and Methods: One-hundred-five patients with NSCLC treated with IMRT between 1 August 2004 and 30 November 2006 were analyzed retrospectively. The mean age of patients was 62.9 years, and squamous carcinomas were confirmed in 81 patients (77%). Sixty-six patients (62.9%) were classified as stage III, and 59 patients had lesions in the right lung. Twenty-seven patients were treated with a dose of 3,060 cGy preoperatively, and 10 patients were given a dose of 5,040 cGy postoperatively. Sixty-eight patients received a dose of 7,020 cGy for curative intent. Sixty-eight patients were treated with the use of the CORVUS planning system and 37 patients were treated with the use of the ECLIPSE planning system.
Results: Of 105 patients, 21 patients (20%) had abnormal radiological findings, but only seven patients (6.7%) required treatment for radiation pneumonitis. Six of the seven patients had other serious lesions, including a bronchioesophageal fistula (one patient), recurrence in the treatment field (two patients), brain metastasis (one patient) and lung-to-lung metastasis (two patients); all of these patients died within 19 months after radiation treatment. Sixteen patients (23.5%) that received planning with the CORVUS system had abnormal lung findings. Five patients (13.5%) had abnormal lung findings with the use of the ECLIPSE planning system. Other prognostic factors such as perioperative radiation therapy, a volume over 10% of the V20 volume in the right lung, were also statistically significant.
Conclusion: This retrospective analysis suggests that IMRT could be a beneficial treatment modality for the
reduction of radiation pneumonitis in NSCLC patients. However, the higher incidence of abnormal radiological findings in perioperative patients treated with relatively lower doses (3,060∼5,040 cGy) suggest the need for judicious treatment planning in preoperative or postoperative treatment.
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KEYWORD
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Intensitymodulatedradiationtherapy(IMRT), Non-small-celllungcancer(NSCLC), Radiationpneumonitis, Incidencerate, Prognosticfactors
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