Abstract
ObjectiveRadiation pneumonitis (RP) is a dose-limiting toxicity that affects the treatment of lung cancer. Data on factors predictive of developing symptomatic RP after stereotactic body radiation therapy (SBRT) are limited. We reviewed data to identify pretreatment factors predictive of the development of symptomatic RP in patients’ lung cancer treated with SBRT.MethodsData were collected on 296 patients treated with SBRT for lung cancer. Factors available at time of consultation were analyzed for the development of symptomatic RP, defined as CTCAE v. 4.0 ≥ Grade 2. The factors analyzed included patient demographic, tumor-specific, and pretreatment pulmonary function data. Univariate and multivariate analyses were performed to assess for predictive factors.ResultsMedian follow-up was 22 months. The rate of symptomatic RP was 16%. Univariate analysis showed an increased rate of symptomatic RP with treatments to the right lung (22% vs. 9%, p = 0.007), driven primarily by an increased rate of symptomatic RP when treating the right lower lobe (RLL) vs. other lobes (31 vs. 13%, p = 0.03). Patients with a history of prior lung directed therapy were also more likely to develop symptomatic RP (12% vs. 24%, p = 0.008). These statistical differences were retained on multivariate analysis.ConclusionSBRT to the right lung, especially the RLL, and to patients with a history of prior lung-directed therapy increases the risk of developing symptomatic RP after SBRT. Further studies on ways to predict and prevent symptomatic RP are needed.
Highlights
Lung cancer is the leading cause of cancer death in the United States with an estimated 234,030 new cases of lung cancer and 154,050 deaths from lung cancer in 2018 [1]
Univariate analysis showed an increased rate of symptomatic radiation pneumonitis (RP) with treatments to the right lung (22% vs. 9%, p = 0.007), driven primarily by an increased rate of symptomatic RP when treating the right lower lobe (RLL) vs. other lobes (31 vs. 13%, p = 0.03)
The aim of this study is to evaluate patient-specific, pretreatment factors available at time of consultation that influence the rate of RP in patients treated with stereotactic body radiation therapy (SBRT) for primary or secondary lung cancer
Summary
Lung cancer is the leading cause of cancer death in the United States with an estimated 234,030 new cases of lung cancer and 154,050 deaths from lung cancer in 2018 [1]. Radiation therapy has a well-established role in treating patients with locally advanced lung cancer. Recent studies, using more modern radiation techniques with high dose per fraction treatment radiation therapy via stereotactic body radiation therapy (SBRT) have shown excellent local control with low rates of clinically relevant RP [4,5,6]. This has led to use of SBRT in treating patients with early stage lung cancer that have been deemed medically inoperable or in those who decline definitive surgery. Studies are assessing the role of SBRT in treating medically operable patients [7, 8]
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