Abstract
BackgroundThe relationship between lung dose-volume histogram (DVH) parameters and radiation pneumonitis (RP) associated with induction concurrent chemoradiotherapy (CCRT) followed by surgery in patients with non-small cell lung cancer (NSCLC) is unclear, particularly when concerning irradiation of the whole lung prior to resection. We performed this study to identify factors associated with grade ≥ 2 RP in such patients.MethodsPatients who received induction CCRT (chemotherapy: cisplatin and docetaxel; radiotherapy: 46 Gy/23 fractions) between May 2003 and May 2017 were reviewed. The mean lung dose (MLD) and the percentage of the lung volume that received ≥5 Gy (V5) and ≥ 20 Gy (V20) were calculated. Factors associated with the development of grade ≥ 2 RP were analyzed.ResultsOne hundred and eight patients were included in this study, 34 (31.5%) of whom experienced grade ≥ 2 RP. A V20 ≥ 21%, an MLD ≥10 Gy, and a lower lobe tumor location were significant predictors of grade ≥ 2 RP on univariate analysis (p = 0.007, 0.002, and 0.004, respectively). Moreover, an MLD ≥10 Gy and lower lobe location were significant predictors of grade ≥ 2 RP on multivariate analysis (p = 0.026 and 0.0043, respectively). The cumulative incidence rates of grade ≥ 2 RP at 6 months were 15.7 and 45.6% in patients with MLDs < 10 Gy and ≥ 10 Gy, respectively, and were 23.5 and 55.6% in patients with upper/middle lobe- vs. lower lobe-located tumors, respectively.ConclusionsMLD and lower lobe location were predictors of grade ≥ 2 RP in patients who received induction CCRT. It is necessary to reduce the MLD to the greatest extent possible to prevent the occurrence of this adverse event.
Highlights
The relationship between lung dose-volume histogram (DVH) parameters and radiation pneumonitis (RP) associated with induction concurrent chemoradiotherapy (CCRT) followed by surgery in patients with nonsmall cell lung cancer (NSCLC) is unclear, when concerning irradiation of the whole lung prior to resection
Toyooka et al demonstrated that the 3- and 5-year overall survival rates of patients who received induction CCRT were significantly higher than those of patients who received induction chemotherapy [4]
We investigated the relationship between whole-lung DVH parameters and the development of grade ≥ 2 RP in patients receiving induction CCRT for NSCLC
Summary
The relationship between lung dose-volume histogram (DVH) parameters and radiation pneumonitis (RP) associated with induction concurrent chemoradiotherapy (CCRT) followed by surgery in patients with nonsmall cell lung cancer (NSCLC) is unclear, when concerning irradiation of the whole lung prior to resection. Definitive concurrent chemoradiotherapy (CCRT) is considered a standard therapy for patients with locally advanced stage III non-small-cell lung cancer (NSCLC); the concurrent administration of docetaxel and cisplatin has shown promising results [1]. Meta-analyses of individual participant data regarding preoperative chemotherapy have shown improved survival for patients with stage IB–IIIA NSCLC [3]. The phase III INT 0139 randomized controlled trial that compared induction CCRT plus subsequent lobectomy to definitive CCRT without surgery in patients with stage III NSCLC found that the overall survival was poorer in the latter group than in the former [5]
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