Chemoradiotherapy for limited-stage small-cell lung cancer and interstitial lung abnormalities

Haruyasu Murakami,Tateaki Naito,Hideyuki Harada,Hirotsugu Kenmotsu,Masahiro Endo,Nobuaki Mamesaya,Akira Ono,Haruki Kobayashi,Yasuhiro Gon,Kazushige Wakuda,Toshiaki Takahashi,Shota Omori

doi:10.1186/s13014-021-01780-y

Haruyasu Murakami, Tateaki Naito + Show 10 more

Open Access

https://doi.org/10.1186/s13014-021-01780-y

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Journal: Radiation Oncology	Publication Date: Mar 17, 2021
Citations: 7	License type: open-access

Affiliation: Shizuoka Cancer Center, Nihon University

Abstract

BackgroundPatients with lung cancer and interstitial lung disease treated with radiotherapy are at risk of developing radiation pneumonitis. However, the association between interstitial lung abnormalities (ILAs) and radiation pneumonitis in patients with limited-stage small-cell lung cancer (LS-SCLC) remains unclear. Furthermore, the prognosis is uncertain for patients with SCLC and ILAs treated with chemoradiotherapy. We investigated the impact of ILAs on radiation pneumonitis and assessed the prognosis of patients with LS-SCLC and ILAs treated with chemoradiotherapy.MethodsWe retrospectively reviewed the medical records of 149 patients with LS-SCLC who received first-line treatment between January 2009 and December 2016.ResultsIn the univariate analysis, the patients with ILAs showed a higher incidence rate of radiation pneumonitis compared with those without ILAs (64% vs. 10%, P < 0.001). Multivariate analysis confirmed that ILAs were significantly associated with the incidence of radiation pneumonitis. In the univariate analysis, patients with ILAs showed poorer overall survival than those without ILAs (median, 18.9 vs. 67.9 months, P = 0.0338). Multivariate analysis showed that ILAs were a significant independent negative prognostic factor. However, the 2-year and 5-year survival rates for the patients with ILAs treated with chemoradiotherapy were 36% and 26%, respectively, and 8% and 0%, respectively, for those treated with chemotherapy alone.ConclusionsILAs were found to be a predictive factor for radiation pneumonitis in patients with LS-SCLC treated with chemoradiotherapy. Patients with LS-SCLC and ILAs who were treated with chemoradiotherapy had both the possibility of long-term survival and risk of radiation pneumonitis.

Highlights

Patients with lung cancer and interstitial lung disease treated with radiotherapy are at risk of developing radiation pneumonitis
Patient characteristics During the defined study period, a total of 149 patients diagnosed with limited-stage small-cell lung cancer (LS-Small-cell lung cancer (SCLC)) underwent first-line treatment, including CRT (n = 107), surgery (n = 10), chemotherapy alone (n = 31), and radiotherapy alone (n = 1) (Fig. 1a)
The Interstitial lung abnormality (ILA) accounted for 5% of the area of a lung zone in seven (64%) cases and 10% of the area of a lung zone in the remaining four cases (36%)

Summary

Introduction

Patients with lung cancer and interstitial lung disease treated with radiotherapy are at risk of developing radiation pneumonitis. The association between interstitial lung abnormalities (ILAs) and radiation pneumonitis in patients with limited-stage small-cell lung cancer (LS-SCLC) remains unclear. Kobayashi et al Radiat Oncol (2021) 16:52 changes have been detected in patients with emphysema and in lung cancer-screening populations [5, 6] These slight changes have been classified as interstitial lung abnormalities (ILAs), defined as non-dependent abnormalities affecting more than 5% of any lung zone [7, 8]. The prognosis for patients with SCLC and ILAs treated with CCRT is uncertain because the slight radiological findings of ILAs are often missed. This study investigated the association between ILAs and RP in patients with LS-SCLC and ILAs treated with CCRT at our institution and evaluated their prognosis

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Conclusion