Abstract
Pulmonary emphysema (PE) has been demonstrated to have a high prevalence in patients with locally advanced non-small cell lung cancer (NSCLC). A total of 153 patients with locally advanced NSCLC were enrolled in this study to investigate the association between PE and radiation pneumonitis (RP) after definitive thoracic radiation therapy (TRT). The incidence of RP in Grade 2, 3 and 5 were 11.1%, 9.8% and 0.7%, respectively. Univariate analysis revealed that age, PE, forced vital capacity (FVC), arterial partial pressure of oxygen (PO2) and mean lung dose (MLD) were significantly associated with the risk of Grade ≥2 or Grade ≥3 RP in patients with squamous cell carcinoma (SCC, P < 0.05). Logistic analysis demonstrated that PE was an independent risk factor of RP in SCC (P < 0.05). Receiver operating characteristics (ROC) analysis revealed that the combination of age, PE, FVC, PO2 and MLD had a higher value to predict RP in SCC (AUC = 0.856 in Grade ≥2 RP and 0.882 in Grade ≥3 RP, respectively). Kaplan-Meier analysis revealed that the more severe the PE, the higher the incidence of RP in SCC. Our results revealed that PE was a high risk factor for locally advanced NSCLC patients followed definitive TRT, especially for SCC patients.
Highlights
Non-small cell lung cancer (NSCLC) is the most common cancer, and is the most common cause of cancer-related mortality globally
Grade ≥2 radiation pneumonitis (RP) was considered as a symptomatic RP that requires intervention treatment[13], and Grade ≥3 RP is regarded as severe RP that could lead to poor prognosis[14]
Some investigations have implied that V20 ≥ 25% or mean lung dose (MLD) ≥14 Gy would be a risk factor to increase the incidence of severe RP14, 16
Summary
Non-small cell lung cancer (NSCLC) is the most common cancer, and is the most common cause of cancer-related mortality globally. Pulmonary emphysema (PE) is a crucial subtype of COPD, which is defined pathologically as a group of diseases that demonstrate anatomical alterations in the lung characterized by the enlargement of air spaces distal to the terminal bronchiole and accompanied by destructive changes of the alveolar walls[9]. It remains unclear whether the presence of PE is associated with the incidence of RP or severity RP in patients with locally advanced NSCLC.
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