Abstract
The risk factors and potential practice implications of radiation-induced pleural effusion (RIPE) are undefined. This study examined lung cancer patients treated with thoracic radiation therapy (TRT) having follow-up computed tomography (CT) or 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT. Increased volumes of pleural effusion after TRT without evidence of tumor progression was considered RIPE. Parameters of lung dose-volume histogram including percent volumes irradiated with 5-55 Gy (V5-V55) and mean lung dose (MLD) were analyzed by receiver operating characteristic analysis. Clinical and treatment-related risk factors were detected by univariate and multivariate analyses. 175 out of 806 patients receiving TRT with post-treatment imaging were included. 51 patients (24.9%) developed RIPE; 40 had symptomatic RIPE including chest pain (47.1%), cough (23.5%) and dyspnea (35.3%). Female (OR = 0.380, 95% CI: 0.156–0.926, p = 0.033) and Caucasian race (OR = 3.519, 95% CI: 1.327–9.336, p = 0.011) were significantly associated with lower risk of RIPE. Stage and concurrent chemotherapy had borderline significance (OR = 1.665, p = 0.069 and OR = 2.580, p = 0.080, respectively) for RIPE. Patients with RIPE had significantly higher whole lung V5-V40, V50 and MLD. V5 remained as a significant predictive factor for RIPE and symptomatic RIPE (p = 0.007 and 0.022) after adjusting for race, gender and histology. To include, the incidence of RIPE is notable. Whole lung V5 appeared to be the most significant independent risk factor for symptomatic RIPE.
Highlights
Thoracic radiation therapy (TRT) is an important component of multi-modality treatment for breast cancer, esophageal cancer, and lung cancer including small cell and non-small cell lung cancer (NSCLC) [1, 2]
This study demonstrated that radiation-induced pleural effusion (RIPE) occurred in 29.1% of patients treated with thoracic radiation therapy (TRT)
Lung dosimetric factors were significantly greater for patients with RIPE, but only V5 was statistically significant for symptomatic RIPE in this series
Summary
Thoracic radiation therapy (TRT) is an important component of multi-modality treatment for breast cancer, esophageal cancer, and lung cancer including small cell and non-small cell lung cancer (NSCLC) [1, 2]. The tolerance doses (TD) for less than 5% risk of lung injury within 5 years of radiation exposure for 1/3, 2/3 or 3/3 of lung volume were empirically considered to be 45, 30, and 17.5 Gy, respectively [20]. Dosimetric factors such as V20 and mean lung dose have been developed to assess the risk of symptomatic radiation-induced lung toxicity (RILT), primarily the development of pneumonitis and fibrosis [22, 31, 32]
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