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KMID : 1038620110290030181
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Radiation Oncology Journal
2011 Volume.29 No. 3 p.181 ~ p.190
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Factors predicting radiation pneumonitis in locally advanced non-small cell lung cancer
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Kim Myung-Soo
Lee Ji-Hae
Ha Bo-Ram
Lee Re-Na
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Abstract
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Purpose: Thoracic radiotherapy is a major treatment modality of stage III non-small cell lung cancer. The normal lung tissue is sensitive to radiation and radiation pneumonitis is the most important dose-limiting complication of thoracic radiation therapy. This study was performed to identify the clinical and dosimetric parameters related to the risk of radiation pneumonitis after defi nitive radiotherapy in stage III non-small cell cancer patients.
Materials and Methods : The medical records were reviewed for 49 patients who completed defi nitive radiation therapy for locally advanced non-small cell lung cancer from August 2000 to February 2010. Radiation therapy was delivered with the daily dose of 1.8 Gy to 2.0 Gy and the total radiation dose ranged from 50.0 Gy to 70.2 Gy (median, 61.2 Gy). Elective nodal irradiation was delivered at a dose of 45.0 Gy to 50.0 Gy. Seven patients (14.3%) were treated with radiation therapy alone and forty two patients (85.7%) were treated with chemotherapy either sequentially or concurrently.
Results: Twenty-fi ve cases (51.0%) out of 49 cases experienced radiation pneumonitis. According to the radiation pneumonitis grade, 10 (20.4%) were grade 1, 9 (18.4%) were grade 2, 4 (8.2%) were grade 3, and 2 (4.1%) were grade 4. In the univariate analyses, no clinical factors including age, sex, performance status, smoking history, underlying lung disease, tumor location, total radiation dose and chemotherapy were associated with grade ≥2 radiation pneumonitis. In the subgroup analysis of the chemotherapy group, concurrent rather than sequential chemotherapy was signifi cantly related to grade ≥2 radiation pneumonitis comparing sequential chemotherapy. In the univariate analysis with dosimetric factors, mean lung dose (MLD), V20, V30, V40, MLDipsi, V20ipsi, V30ipsi, and V40ipsi were associated with grade ≥2 radiation pneumonitis. In addition, multivariate analysis showed that MLD and V30 were independent predicting factors for grade ≥2 radiation pneumonitis.
Conclusion: Concurrent chemotherapy, MLD and V30 were statistically signifi cant predictors of grade ≥2 radiation pneumonitis in patients with stage III non-small cell lung cancer undergoing defi nitive radiotherapy. The cutoff values for MLD and V30 were 16 Gy and 18%, respectively.
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KEYWORD
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Non-small cell lung cancer, Radiation therapy, Radiation pneumonitis, Dosimetric factor
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