Does the Lung Dose/Volume Constraint on V20 Reduce the Incidence of Radiation Pneumonitis Without Compromising Treatment Outcome in Patients With Locally Advanced Non-Small Cell Lung Cancer?

Abstract Background The relationship between lung dose-volume histogram (DVH) parameters and radiation pneumonitis (RP) associated with induction concurrent chemoradiotherapy (CCRT) followed by surgery in patients with non-small cell lung cancer (NSCLC) is unclear, particularly when concerning irradiation of the whole lung prior to resection. We performed this study to identify factors associated with grade ≥ 2 RP in such patients. Methods Patients who received induction CCRT (chemotherapy: cisplatin and docetaxel; radiotherapy: 46 Gy/23 fractions) between May 2003 and May 2017 were reviewed. The mean lung dose (MLD) and the percentage of the lung volume that received ≥5 Gy (V5) and ≥ 20 Gy (V20) were calculated. Factors associated with the development of grade ≥ 2 RP were analyzed. Results One hundred and eight patients were included in this study, 34 (31.5%) of whom experienced grade ≥ 2 RP. A V20 ≥ 21%, an MLD ≥10 Gy, and a lower lobe tumor location were significant predictors of grade ≥ 2 RP on univariate analysis (p = 0.007, 0.002, and 0.004, respectively). Moreover, an MLD ≥10 Gy and lower lobe location were significant predictors of grade ≥ 2 RP on multivariate analysis (p = 0.026 and 0.0043, respectively). The cumulative incidence rates of grade ≥ 2 RP at 6 months were 15.7 and 45.6% in patients with MLDs < 10 Gy and ≥ 10 Gy, respectively, and were 23.5 and 55.6% in patients with upper/middle lobe- vs. lower lobe-located tumors, respectively. Conclusions MLD and lower lobe location were predictors of grade ≥ 2 RP in patients who received induction CCRT. It is necessary to reduce the MLD to the greatest extent possible to prevent the occurrence of this adverse event.

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Incidence and dose-volume relationship of radiation pneumonitis after concurrent chemoradiotherapy followed by durvalumab for locally advanced non-small cell lung cancer

Clinical and Translational Radiation Oncology ◽

10.1016/j.ctro.2020.05.006 ◽

2020 ◽

Vol 23 ◽

pp. 85-88

Author(s):

Satoshi Saito ◽

Takanori Abe ◽

Nao Kobayashi ◽

Tomomi Aoshika ◽

Yasuhiro Ryuno ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Concurrent Chemoradiotherapy ◽

Radiation Pneumonitis ◽

Locally Advanced ◽

Small Cell ◽

Small Cell Lung ◽

Dose Volume ◽

Volume Relationship ◽

Relationship Of

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Functional dose-volume histograms for predicting radiation pneumonitis in locally advanced non-small cell lung cancer treated with late-course accelerated hyperfractionated radiotherapy

Experimental and Therapeutic Medicine ◽

10.3892/etm.2011.301 ◽

2011 ◽

Vol 2 (5) ◽

pp. 1017-1022 ◽

Cited By ~ 9

Author(s):

DONGQING WANG ◽

BAOSHENG LI ◽

ZHONGTANG WANG ◽

JIAN ZHU ◽

HONGFU SUN ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Radiation Pneumonitis ◽

Locally Advanced ◽

Small Cell ◽

Small Cell Lung ◽

Hyperfractionated Radiotherapy ◽

Dose Volume Histograms ◽

Dose Volume

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Ipsilateral lung dose volume parameters predict radiation pneumonitis in addition to classical dose volume parameters in locally advanced NSCLC treated with combined modality therapy

South Asian Journal of Cancer ◽

10.4103/2278-330x.126503 ◽

2014 ◽

Vol 03 (01) ◽

pp. 013-015 ◽

Cited By ~ 4

Author(s):

Sushma Agrawal ◽

Sunil Kumar ◽

Able Lawrence ◽

Maria K.J. Das ◽

Shaleen Kumar

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Radiation Pneumonitis ◽

Combined Modality Therapy ◽

Small Cell ◽

Clinical Factors ◽

Lung Dose ◽

Small Cell Lung ◽

Combined Modality ◽

Dose Volume

Abstract Purpose: The purpose was to determine the correlation of clinical factors and lung dose volume parameters with significant radiation pneumonitis (RP) in non-small cell lung cancer patients treated with combined modality therapy. Materials and Methods: Between January 2008 and December 2010, 52 patients of non-small cell lung cancer were treated with combined modality therapy with radical intent. Radiation pneumonitis was correlated with ipsilateral (V 20 ipsi, V 5 ipsi and MLD ipsi) and whole lung (V 20 , V 5 , and MLD) dose volume parameters. Clinical factors like pulmonary function tests (PFT), site of tumor, planning target volume, and type of treatment were also correlated with incidence of significant pneumonitis. Results: Out of 52 patients, 35.3% developed grade 2 or more pneumonitis. On univariate analysis, factors significantly correlating with radiation pneumonitis were V 5 (P = 0.002), V 5 ipsi (P = 0.000), V 20 (P = 0.019), V 20 ipsi (P = 0.004), MLD (P = 0.008) and MLD ipsi (P = 0.008). On multivariate analysis, V 5 ipsi was retained as the most significant factor. Concurrent chemoradiation caused significantly more RP than neoadjuvant chemoradiation (P = 0.004). A cutoff of 65% for V 5 ipsi had a sensitivity of 65% and a specificity of 91%. Conclusion: The correlation between pneumonitis and dosimetric constraints has been validated. Adding ipsilateral V 20 , V 5 , and MLD to the classical total lung constraints identifies patients likely to develop pulmonary toxicity in patients undergoing chemoradiation.

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