Abstract
Due to the profound difference in radiosensitivity of patients and various side effects caused by this phenomenon, a radiosensitivity marker is needed. Prediction by a marker may help personalise the treatment. In this study, we tested chromosomal aberrations (CA) of in vitro irradiated blood as predictor of pulmonary function decrease of nonsmall cell lung cancer (NSCLC) patients and also compared it with the CAs in the blood of irradiated patients. Peripheral blood samples were taken from 45 lung cancer patients before stereotactic radiotherapy (SBRT) and immediately after the last fraction and 3, 6, 9, 12, 15, 18, 21, and 24 months later. Respiratory function measurements were performed at the same time. Diffusing capacity of lung for carbon monoxide (DLCO), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1s), and FEV1s/FVC (FEV1%) were monitored. Metaphase preparations of lymphocytes were made with standard procedures, and chromosome aberrations were analysed. In our cohort, the 36-month local relapse-free survival was 97.4%, and the distant metastasis-free survival was 71.5% at 36 months. There was no change in the mean of the pulmonary function tests (PFTs) after the therapy. However, there was a considerable variability between the patients. Therefore, we subtracted the baseline and normalised the PFT values. There were significant decreases at 12–24 months in relative FEV1s and relative FEV1%. The tendentious decrease of the PFTs could be predicted by the in vitro chromosome aberration data. We also found connections between the in vitro and in vivo CA values (i.e., dicentrics plus rings after 3 Gy irradiation predicts dicentric-plus-ring value directly after the radiotherapy/V54 Gy (p = 0.001 24.2%)).We found that—after further validation—chromosome aberrations resulted from in vitro irradiation before radiotherapy can be a predictive marker of pulmonary function decrease after lung irradiation.
Highlights
Radiotherapy is a crucial modality for treating lung cancer, which still leads the morbidity and mortality statistics worldwide
We found that—after further validation—chromosome aberrations resulted from in vitro irradiation before radiotherapy can be a predictive marker of pulmonary function decrease after lung irradiation
stereotactic body radiotherapy (SBRT) seems to be well tolerated at population level in the medically inoperable patient group, but the diffusing capacity of the lung carbon monoxide (DLCO) or forced vital capacity (FVC) results are controversial [8,9,10]
Summary
Radiotherapy is a crucial modality for treating lung cancer, which still leads the morbidity and mortality statistics worldwide. Stereotactic body radiotherapy (SBRT) has an emerging role in the treatment of patients with medically inoperable tumours. The cause might be that the average lung function values after SBRT of the whole patient group may not change, but the individuals may exhibit significant increases or decreases. For example, found that 10% of the patients experienced at least 14.8% decline in FEV1%, while another 10% experienced an increase of at least 12.7% [11]. To judge the risk of pulmonary fibrosis, the baseline clinical and treatment planning data, such as tumour volume, stage, and isodose volumes may not be enough [13]
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