Severity of radiation pneumonitis, from clinical, dosimetric and biological features: a pilot study

Radiation Oncology

Ramon Palmero¹  Laura Rodríguez²  Arturo Navarro-Martin³  José Ignacio Martínez⁴  Susana Padrones⁴  Noelia Cubero⁵  Samantha Aso⁶  Rosa López⁶  María Molina⁷  Federico Manresa⁷  Richard Castillo⁸  Edward Castillo⁹  Thomas Guerrero^1,10  Ana Montes^1,11 

[1] Department of Medical Oncology, Catalan Institute of Oncology: L’Hospitalet de Llobregat, Barcelona, Spain;Department of Nuclear Medicine, Bellvitge Universitary Hospital; L’Hospitalet de Llobregat, Barcelona, Spain;Department of Radiation Oncology, Catalan Institute of Oncology, L’Hospitalet de Llobregat, Feixa Llarga 199-203, 08908, Barcelona, Spain;Department of Respiratory Medicine, Bellvitge University Hospital; L’Hospitalet de Llobregat, Feixa Llarga S/N, 16th Floor, 08907, Barcelona, Spain;Department of Respiratory Medicine, Bellvitge University Hospital; L’Hospitalet de Llobregat, Feixa Llarga S/N, 16th Floor, 08907, Barcelona, Spain;CIBER of Respiratory Diseases (CIBERES), ISCIII, Barcelona, Spain;Department of Respiratory Medicine, Bellvitge University Hospital; L’Hospitalet de Llobregat, Feixa Llarga S/N, 16th Floor, 08907, Barcelona, Spain;Laboratory of Respiratory Medicine, IDIBELL, Barcelona University; L’Hospitalet de Llobregat, Barcelona, Spain;Department of Respiratory Medicine, Bellvitge University Hospital; L’Hospitalet de Llobregat, Feixa Llarga S/N, 16th Floor, 08907, Barcelona, Spain;Laboratory of Respiratory Medicine, IDIBELL, Barcelona University; L’Hospitalet de Llobregat, Barcelona, Spain;CIBER of Respiratory Diseases (CIBERES), ISCIII, Barcelona, Spain;Divisions of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA;Divisions of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA;Department of Computational and Applied Mathematics, Rice University, Houston, TX, USA;Divisions of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA;Department of Computational and Applied Mathematics, Rice University, Houston, TX, USA;The University of Texas Health Science Center, Houston, TX, USA;Laboratory of Respiratory Medicine, IDIBELL, Barcelona University; L’Hospitalet de Llobregat, Barcelona, Spain;CIBER of Respiratory Diseases (CIBERES), ISCIII, Barcelona, Spain;

关键词: Non-small cell lung cancer;    Radiation pneumonitis;    Lung function;    Wound healing;   

DOI  :  10.1186/s13014-020-01694-1

来源: Springer

【 摘 要 】

Background and objectiveRadiation pneumonitis (RP) could be a lethal complication of lung cancer treatment. No reliable predictors of RP severity have been recognized. This prospective pilot study was performed to identify early predictors of high grade lung toxicity and to evaluate clinical, biological or dosimetric features associated with different grades of toxicity.MethodSixteen patients with non-small cell lung cancer with indication of concurrent chemoradiotherapy using 60 Gy/2 Gy/fraction starting at cycle one of platinum based chemotherapy were included. Bronchoalveolar lavage (BAL), pulmonary function testing (PFT), and 18F-2-fluoro-2-deoxy-D-glucose positron-emission tomography was performed before radiotherapy (RT), after three weeks of treatment, and two months post-RT. For analysis, patients were grouped by grade (low [G1-G2] vs. high [G3-G5]). The two groups were compared to identify predictors of RP. Protein expression BAL and lung tissue metabolism was evaluated in two patients (RP-G1 vs. RP-G3). Categorical variables such as comorbidities, stages and locations were summarized as percentages. Radiation doses, pulmonary function values and time to RP were summarized by medians with ranges or as means with standard deviation. Longitudinal analysis PFT was performed by a T-test.ResultsAll 16 patients developed RP, as follows: G1 (5 pts; 31.3%); G2 (5 pts; 31.3%); G3 (5 pts; 31.3%); and G5 (1 pts; 6.1%). Patients with high grade RP presented significant decrease (p = 0.02) in diffusing lung capacity for carbon monoxide (DLCO) after three weeks of RT. No correlation between dosimetric values and RP grades was observed. BAL analysis of the selected patients showed that CXCL-1, CD154, IL-1ra, IL-23, MIF, PAI-1 and IFN-γ were overexpressed in the lungs of the RP-G3 patient, even before treatment. The pre-RT SUVmax value in the RP-G3 patient was non-significantly higher than in the patient with RP-G1.ConclusionsRT induces some degree of RP. Our data suggest that decrease in DLCO% is the most sensitive parameter for the early detection of RP. Moreover, we detect biological differences between the two grades of pneumonitis, highlighting the potential value of some cytokines as a prognostic marker for developing high grade lung toxicity. Further multicenter studies with larger sample size are essential to validate these findings.

【 授权许可】

CC BY