Abnormal pulmonary function tests predict the development of radiation-induced pneumonitis in advanced non-small cell lung Cancer

L Torre-Bouscoulet,J A Beck-Magaña,F Maldonado,O Arrieta,F J Lozano-Ruiz,D Martínez-Briseño,L Gochicoa-Rangel,M Arroyo-Hernández,C García-Sancho,R Fernández-Plata,A Guzmán-Barragán,M Blake-Cerda,E Vergara,W R Muñoz-Montaño

doi:10.1186/s12931-018-0775-2

Abstract

BackgroundRadiation pneumonitis (RP) is a frequent complication of concurrent chemoradiotherapy (CCRT) and is associated with severe symptoms that decrease quality of life and might result in pulmonary fibrosis or death. The aim of this study is to identify whether pulmonary function test (PFT) abnormalities may predict RP in non-small cell lung cancer (NSCLC) patients.MethodsA prospective multi-institutional study was conducted with locally advanced and oligometastatic NSCLC patients. All participants were evaluated at baseline, end of CCRT, week 6, 12, 24, and 48 post-CCRT. They completed forced spirometry with a bronchodilator, body plethysmography, impulse oscillometry, carbon monoxide diffusing capacity (DLCO), molar mass of CO2, six-minute walk test and exhaled fraction of nitric oxide (FeNO). Radiation pneumonitis was assessed with RTOG and CTCAE. The protocol was registered in www.clinicaltrials.gov (NCT01580579), registered April 19, 2012.ResultsFifty-two patients were enrolled; 37 completed one-year follow-up. RP ≥ Grade 2 was present in 11/37 (29%) for RTOG and 15/37 (40%) for CTCAE. Factors associated with RP were age over 60 years and hypofractionated dose. PFT abnormalities at baseline that correlated with the development of RP included lower forced expiratory volume in one second after bronchodilator (p = 0.02), DLCO (p = 0.02) and FeNO (p = 0.04). All PFT results decreased after CCRT and did not return to basal values at follow-up.ConclusionsFEV1, DLCO and FeNO prior to CCRT predict the development of RP in NSCLC. This study suggests that all patients under CCRT should be assessed by PFT to identify high-risk patients for close follow-up and early treatment.

Highlights

Radiation pneumonitis (RP) is a frequent complication of concurrent chemoradiotherapy (CCRT) and is associated with severe symptoms that decrease quality of life and might result in pulmonary fibrosis or death
Concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced nonsmall cell lung cancer (NSCLC) [3], but the advantage in survival seen with CCRT is contrasted with an increase in toxicity [4, 5]
We describe the performance of spirometry with a bronchodilator, body plethysmography, impulse oscillometry, carbon monoxide diffusion capacity (DLCO), molar mass of carbon dioxide (CO2), six-minute walk test and exhaled fraction of nitric oxide (FeNO)

Summary

Introduction

Radiation pneumonitis (RP) is a frequent complication of concurrent chemoradiotherapy (CCRT) and is associated with severe symptoms that decrease quality of life and might result in pulmonary fibrosis or death. The aim of this study is to identify whether pulmonary function test (PFT) abnormalities may predict RP in nonsmall cell lung cancer (NSCLC) patients. Non-small cell lung cancer (NSCLC) represents approximately 75% of the histological types of lung cancer. Concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced NSCLC [3], but the advantage in survival seen with CCRT is contrasted with an increase in toxicity [4, 5]. Patients with oligometastatic disease can receive local control with CCRT, which might improve outcome [7,8,9,10,11]

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