Abstract
ObjectivesTo observe the risk factors affecting the occurrence of RP after gemcitabine-based induction chemotherapy.MethodsBetween January 2010 and December 2017, patients with NSCLC received gemcitabine or docetaxel chemotherapy, followed by radiotherapy at Zhejiang cancer hospital were enrolled in this study. Patients were treated with gemcitabine or docetaxel induction chemotherapy, followed by radiotherapy or concurrent chemoradiotherapy. Acute radiation pneumonitis was scored post chemoradiotherapy.ResultsOne hundred and eighty-four patients with NSCLC were included in the gemcitabine group and 144 in the docetaxel group. The gemcitabine group experienced a higher incidence of grade ≥ 2 RP, compared with docetaxel group (25.5% Vs. 13.2%, P = 0.005). The optimal cutoff values of lung V5, V20, V30 and MLD were set at 44% (AUC [area under the curve] = 0.593), 24% (AUC = 0.607), 14.2% (AUC = 0.622) and 1226 cGy (AUC = 0.626). On multivariate analysis, only lung V30 was identified as a predictor for grade ≥ 2 RP (P = 0.03). The grade ≥ 2 RP rate was only 9.4% for the low-risk group (Lung V5 ≤ 44%, V20 ≤ 24%, V30 ≤ 14.2%, and MLD ≤ 1226 cGy) in patients received gemcitabine induction chemotherapy.ConclusionsGemcitabine chemotherapy before thoracic radiotherapy in NSCLC patients was related to a higher incidence of grade ≥ 2 RP, compared with docetaxel chemotherapy. The Lung dose-volume variable V30 was the best predictor of grade ≥ 2 RP.
Highlights
Concurrent chemoradiotherapy is the standard treatment for locally advanced non-small cell lung cancer (NSCLC) [1]
All patients in this study were treated with four cycles of gemcitabine plus cisplatin or docetaxel plus cisplatin followed by thoracic radiotherapy
In this study, gemcitabine chemotherapy before thoracic radiotherapy in NSCLC patients was related to a higher incidence of grade ≥ 2 radiation pneumonitis (RP), compared with docetaxel chemotherapy
Summary
Concurrent chemoradiotherapy is the standard treatment for locally advanced non-small cell lung cancer (NSCLC) [1]. Sheng et al Radiation Oncology (2019) 14:229 recommended for locally advanced non-resectable NSCLC patients in the current guidelines. Current guidelines do not routinely recommend induction chemotherapy for patients with non-small cell lung cancer who can receive concurrent chemoradiotherapy, according to the result of CALGB 39801 [4]. Gemcitabine, a cytosine nucleoside derivative, is one of the commonly used drugs in induction chemotherapy of NSCLC [6, 7]. It is not recommended for concurrent use with radiotherapy due to its obvious pulmonary toxicity [8, 9]. RP seriously affects the quality of life and long-term survival of lung cancer patients [11]
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