scholarly journals Predicting factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non-small cell lung cancer

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Hiroshi Mayahara ◽  
Kazuyuki Uehara ◽  
Aya Harada ◽  
Keiji Kitatani ◽  
Tomonori Yabuuchi ◽  
...  
Keyword(s):  
Pulmonary Fibrosis ◽  
Predictive Factors ◽  
Concurrent Chemoradiotherapy ◽  
Radiation Pneumonitis ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Small Cell ◽  
High Dose ◽  
Predicting Factors ◽  
Dose Volumes

Abstract Background Concurrent chemoradiotherapy (CCRT) followed by durvalumab is the standard of care for unresectable locally-advanced non-small cell carcinoma (LA-NSCLC). However, a major concern about administration of durvalumab after CCRT is whether the incidence of symptomatic radiation pneumonitis (RP) may increase or not. In the present analysis, we report the initial results of CCRT followed by durvalumab in patients with LA-NSCLC in a real-world setting with focus on predicting factors for symptomatic RP. Methods Patients who were pathologically diagnosed as NSCLC and initiated treatment with CCRT followed by durvalumab between July 2018 to December 2019 were eligible for this study. Patients were included if they completed the planned CRT course and administered at least one course of durvalumab. We retrospectively investigated the preliminary survival outcome and incidence and predicting factors for symptomatic RP. Results Of the 67 patients who planned CCRT, 63 patients completed the entire CCRT course. Of these, 56 patients proceeded to consolidation with durvalumab. The median time to eternal discontinuation of durvalumab was 9.7 months. The cumulative proportion of the patients who exhibited symptomatic RP was 30, 40 and 44% at 3, 6 and 12 months, respectively. In multivariate analyses, pulmonary fibrosis score and lung V40 were significant predictive factors for symptomatic RP (p < 0.001, HR: 7.83, 95% CI: 3.38–18.13, and p = 0.034, HR: 3.17, 95% CI: 1.09–9.19, respectively). Conclusions Pulmonary fibrosis sore and lung V40 were significant predictive factors for symptomatic RP. We should be cautious about the administration of durvalumab for patients having subclinical pulmonary fibrosis. To our best knowledge, this is one of the first report showing the predictive value of high dose volumes to the lung in patients with LA-NSCLC who received CCRT followed by durvalumab.

scholarly journals Predictive factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non-small cell lung cancer

2021 ◽  
Author(s):  
Hiroshi Mayahara ◽  
Kazuyuki Uehara ◽  
Aya Harada ◽  
Keiji Kitatani ◽  
Tomonori Yabuuchi ◽  
...  
Keyword(s):  
Pulmonary Fibrosis ◽  
Predictive Factors ◽  
Radiation Pneumonitis ◽  
Cell Cancer ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Small Cell ◽  
High Dose ◽  
Dose Volumes ◽  
To Receive

Abstract BackgroundConcurrent chemoradiotherapy (CCRT) followed by durvalumab is the standard of care for unresectable locally advanced non-small cell cancer (LA-NSCLC). However, a major concern about the administration of durvalumab after CCRT is whether the incidence of symptomatic radiation pneumonitis (RP) increases. In the present analysis, we report the initial results of CCRT followed by durvalumab in patients with LA-NSCLC in a real-world setting with a focus on predictive factors for symptomatic RP. MethodsPatients who were pathologically diagnosed with NSCLC and initiated treatment with CCRT followed by durvalumab between July 2018 and December 2019 were eligible for this study. Patients were included if they completed the planned CRT course and were administered at least one course of durvalumab. We retrospectively investigated the preliminary survival outcome and incidence and predictive factors for symptomatic RP. ResultsOf the 67 patients who were scheduled to receive CCRT, 63 completed the entire CCRT course. Of these patients, 56 proceeded to consolidation with durvalumab. The median time to eternal discontinuation of durvalumab was 9.7 months. The cumulative proportions of patients who exhibited symptomatic RP were 30, 40 and 44% at 3, 6 and 12 months, respectively. In multivariate analyses, the pulmonary fibrosis score and lung V40 were significant predictive factors for symptomatic RP (p < 0.001, HR: 7.83, 95% CI: 3.38-18.13, and p = 0.034, HR: 3.17, 95% CI: 1.09-9.19, respectively). ConclusionsThe pulmonary fibrosis sore and lung V40 are significant predictive factors for symptomatic RP. We should be cautious about the administration of durvalumab for patients with subclinical pulmonary fibrosis. To the best of our knowledge, this is one of the first reports showing the predictive value of high dose volumes to the lung in patients with LA-NSCLC who receive CCRT followed by durvalumab.

scholarly journals Prediction of radiation pneumonitis after definitive radiotherapy for locally advanced non-small cell lung cancer using multi-region radiomics analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Daisuke Kawahara ◽  
Nobuki Imano ◽  
Riku Nishioka ◽  
Kouta Ogawa ◽  
Tomoki Kimura ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Radiation Pneumonitis ◽  
Locally Advanced ◽  
Small Cell ◽  
Radiotherapy Planning ◽  
High Dose ◽  
Small Cell Lung ◽  
Definitive Radiotherapy

AbstractTo predict grade ≥ 2 radiation pneumonitis (RP) in patients with locally advanced non-small cell lung cancer (NSCLC) using multi-region radiomics analysis. Data from 77 patients with NSCLC who underwent definitive radiotherapy between 2008 and 2018 were analyzed. Radiomic feature extraction from the whole lung (whole-lung radiomics analysis) and imaging- and dosimetric-based segmentation (multi-region radiomics analysis) were performed. Patients with RP grade ≥ 2 or < 2 were classified. Predictors were selected with least absolute shrinkage and selection operator logistic regression and the model was built with neural network classifiers. A total of 49,383 radiomics features per patient image were extracted from the radiotherapy planning computed tomography. We identified 4 features and 13 radiomics features in the whole-lung and multi-region radiomics analysis for classification, respectively. The accuracy and area under the curve (AUC) without the synthetic minority over-sampling technique (SMOTE) were 60.8%, and 0.62 for whole-lung and 80.1%, and 0.84 for multi-region radiomics analysis. These were improved 1.7% for whole-lung and 2.1% for multi-region radiomics analysis with the SMOTE. The developed multi-region radiomics analysis can help predict grade ≥ 2 RP. The radiomics features in the median- and high-dose regions, and the local intensity roughness and variation were important factors in predicting grade ≥ 2 RP.

scholarly journals Prediction of radiation pneumonitis after definitive radiotherapy for locally advanced non-small cell lung cancer using multi-region radiomics analysis

2021 ◽  
Author(s):  
Daisuke Kawahara ◽  
Nobuki Imano ◽  
Riku Nishioka ◽  
Kouta Ogawa ◽  
Tomoki Kimura ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Radiation Pneumonitis ◽  
Locally Advanced ◽  
Small Cell ◽  
High Dose ◽  
Small Cell Lung ◽  
Definitive Radiotherapy ◽  
Local Intensity

Abstract Objective To predict grade 2 radiation pneumonitis (RP) in locally advanced non-small cell lung cancer (NSCLC) patients with high accuracy by using multi-region radiomics analysis.Material and Methods Data from 77 patients with NSCLC who underwent definitive radiotherapy from 2008 to 2018 were analyzed. Radiomic feature extraction from the whole lung (whole-lung radiomics analysis) and imaging- and dosimetric-based segmentation (multi-region radiomics analysis) were performed. The data were split into 2 sets: 54 tumors for model training and 23 tumors for model testing. Patients with RP grade ≥2 or RP grade <2 was classified. Models were built with least absolute shrinkage and selection operator logistic regression and applied to the set of candidate predictors. To build predictive models with clinical features, machine-learning methods with neural network classifiers were used. The precision, accuracy, and sensitivity by generating confusion matrices and the areas under the receiver operating characteristic curve (AUC) for each model were evaluated. Results A total of 49383 radiomics features per patient image were extracted from the radiotherapy planning computed tomography scan. We identified 4 features selected in the whole-lung radiomics analysis and 13 radiomics features selected in the multi-region radiomics analysis for the classification. Out of 13 features, the median and high-dose region were selected from the shape analysis. The features of local intensity roughness and variation were selected from the statistical and texture analysis. The accuracy, specificity, sensitivity, and AUC were 80.1%, 79.2%, 88.9%, and 0.84 for our new method of multi-region radiomics analysis, respectively, which was improved from 60.8%, 64.6%, 53.8%, and 0.62 for whole-lung radiomics analysis. Conclusions The developed multi-region radiomics analysis can help predict grade 2 RP for NSCLC after definitive radiotherapy. The radiomics features in the median- and high-dose regions, and that of local intensity roughness and variation were important factors in predicting grade 2 RP.

scholarly journals Severe and Fatal Multilobar Nonclassic Radiation Pneumonitis following Stereotactic Body Radiation Therapy (SBRT) for Treatment of Inoperable Non-Small-Cell Lung Cancer: A Report of Two Cases and Possible Enhancement by Concurrent Amiodarone

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Anastasios Georgiou ◽  
Adam Farmer
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Radiation Pneumonitis ◽  
Early Stage ◽  
Standard Of Care ◽  
Small Region ◽  
Small Cell ◽  
Normal Lung ◽  
High Dose ◽  
Stereotactic Body Radiation

Stereotactic body radiation therapy (SBRT) is considered the standard of care for treatment of inoperable early stage non-small cell carcinoma of the lung. SBRT delivers a very high dose of ionizing radiation to a relatively small region encompassing the tumor and spares a significant portion of the remaining lung from high doses. However, the conformal high dose comes at the expense of treating a larger volume of normal lung to lower doses. In general, this has been deemed to be acceptable with an overall lower risk of radiation pneumonitis. However, in the face of predisposing factors, the higher doses delivered by this technique may lead to an increase in radiation pneumonitis. We report on two patients being treated with SBRT in which severe radiation pneumonitis developed in spite of our radiation dosimetry being significantly below the acceptable limit for lung toxicity. Both patients developed a “fulminant” form of radiation pneumonitis with radiographic abnormalities well beyond the treated volume. In one patient, the disease proved fatal. Both patients were on amiodarone at the time SBRT was administered. Given the rarity of fulminant radiation pneumonitis, especially with the relatively small fields treated by SBRT, we suspect that amiodarone enhanced the pulmonary toxicity.

Carboplatin, S-1 and concurrent thoracic radiotherapy for elderly patients with locally advanced non-small cell lung cancer: a multicenter Phase I/II study

2019 ◽  
Vol 49 (7) ◽  
pp. 614-619 ◽  
Author(s):  
Seiji Niho ◽  
Yukio Hosomi ◽  
Hiroaki Okamoto ◽  
Keiji Nihei ◽  
Hiroshi Tanaka ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Elderly Patients ◽  
Phase I ◽  
Phase Ii ◽  
Radiation Pneumonitis ◽  
Phase Ii Study ◽  
Locally Advanced ◽  
Small Cell ◽  
Thoracic Radiotherapy ◽  
Small Cell Lung

Abstract Objectives We conducted a Phase I/II study of carboplatin, S-1 and concurrent thoracic radiotherapy (TRT) for elderly patients (71 years or older) with unresectable stage III non-small cell lung cancer (NSCLC). Materials and methods Patients received carboplatin (AUC 3-5) on Day 1 and S-1 (30–40 mg/m2 two times daily) on Days 1–14, every 2 weeks, for up to four cycles, plus concurrent TRT at a total dose of 60 Gy. The primary endpoint for the Phase II study was the 1-year progression-free survival (PFS) rate. Results Eighteen patients were enrolled in the Phase I study. Febrile neutropenia, a decreased platelet count and esophagitis were dose-limiting toxicities. The recommended doses for the Phase II study were determined to be an AUC of 3 for carboplatin, 40 mg/m2 twice daily for S-1. Twenty-eight patients were evaluated in the Phase II study. The 1-year PFS rate was 57.1% (90% CI 41.6–71.4%), and the median PFS was 16.8 months (95% CI 7.8–not assessable [NA]). The lower limit of the 90% CI for 1-year PFS exceeded the prespecified threshold value of 30%; therefore, the primary endpoint was met. Grades 3–4 toxicities included thrombocytopenia (21%) and hyponatremia (11%). Grade 3 radiation pneumonitis was observed in 18% of patients. No treatment-related deaths were observed. Conclusion Combination chemotherapy consisting of carboplatin plus S-1 and concurrent TRT had a promising efficacy in elderly patients with locally advanced NSCLC; however, radiation pneumonitis was frequently observed.

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