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Chen F, Niu J, Wang M, Zhu H, Guo Z. Re-evaluating the risk factors for radiation pneumonitis in the era of immunotherapy. J Transl Med 2023; 21:368. [PMID: 37287014 DOI: 10.1186/s12967-023-04212-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
As one of the common complications of radiotherapy, radiation pneumonia (RP) limits the prognosis of patients. Therefore, better identifying the high-risk factors that lead to RP is essential to effectively prevent its occurrence. However, as lung cancer treatment modalities are being replaced and the era of immunotherapy has arrived, literature that reviews the parameters and mode of radiotherapy, chemotherapy drugs, targeted drugs and current hot immune checkpoint inhibitors related to RP is lacking. This paper summarizes the risk factors for radiation pneumonia by retrieving and analysing previously published literature and the results of large clinical trials. The literature primarily included retrospective analyses, including clinical trials in different periods and a part of the literature review. A systematic literature search of Embase, PubMed, Web of Science, and Clinicaltrials.gov was performed for relevant publications up to 6 Dec. 2022. Search keywords include, but are not limited to, "radiation pneumonia", "pneumonia", "risk factors", "immunotherapy", etc. The factors related to RP in this paper include physical parameters of radiotherapy, including V5, V20, and MLD; chemoradiotherapy mode and chemotherapy drugs, including paclitaxel and gemcitabine; EGFR-TKI; ALK inhibitors; antiangiogenic drugs; immune drugs and the underlying disease of the patient. We also introduce the possible mechanism of RP. In the future, we hope that this article not only sounds the alarm for clinicians but also helps to identify a method that can effectively intervene and reduce the occurrence of RP, significantly improve the quality of life and prognosis of patients, and more effectively improve the therapeutic effect of radiation therapy.
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Affiliation(s)
- Feihu Chen
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Jiling Niu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Min Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China.
| | - Zhijun Guo
- Department of Intensive Care Unit, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China.
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Chen HX, Xiang H, Xu WH, Li M, Yuan J, Liu J, Sun WJ, Zhang R, Li J, Ren ZQ, Zhang XM, Du B, Wan J, Wu BY, Zeng Q, He KL, Yang C. Manganese Superoxide Dismutase Gene–Modified Mesenchymal Stem Cells Attenuate Acute Radiation-Induced Lung Injury. Hum Gene Ther 2017; 28:523-532. [PMID: 27806643 DOI: 10.1089/hum.2016.106] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Hai-Xu Chen
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Hang Xiang
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Wen-Huan Xu
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Ming Li
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Jie Yuan
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
| | - Juan Liu
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
| | - Wan-Jun Sun
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
| | - Rong Zhang
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
| | - Jun Li
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
| | - Zhao-Qi Ren
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
| | - Xiao-Mei Zhang
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Bin Du
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
| | - Jun Wan
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Ben-Yan Wu
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Qiang Zeng
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Kun-Lun He
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Chao Yang
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
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Bütof R, Kirchner K, Appold S, Löck S, Rolle A, Höffken G, Krause M, Baumann M. Potential clinical predictors of outcome after postoperative radiotherapy of non-small cell lung cancer. Strahlenther Onkol 2014; 190:263-9. [PMID: 24413893 DOI: 10.1007/s00066-013-0501-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 11/06/2013] [Indexed: 12/25/2022]
Abstract
AIM The aim of this analysis was to investigate the impact of tumour-, treatment- and patient-related cofactors on local control and survival after postoperative adjuvant radiotherapy in patients with non-small cell lung cancer (NSCLC), with special focus on waiting and overall treatment times. PATIENTS AND METHODS For 100 NSCLC patients who had received postoperative radiotherapy, overall, relapse-free and metastases-free survival was retrospectively analysed using Kaplan-Meier methods. The impact of tumour-, treatment- and patient-related cofactors on treatment outcome was evaluated in uni- and multivariate Cox regression analysis. RESULTS No statistically significant difference between the survival curves of the groups with a short versus a long time interval between surgery and radiotherapy could be shown in uni- or multivariate analysis. Multivariate analysis revealed a significant decrease in overall survival times for patients with prolonged overall radiotherapy treatment times exceeding 42 days (16 vs. 36 months) and for patients with radiation-induced pneumonitis (8 vs. 29 months). CONCLUSION Radiation-induced pneumonitis and prolonged radiation treatment times significantly reduced overall survival after adjuvant radiotherapy in NSCLC patients. The negative impact of a longer radiotherapy treatment time could be shown for the first time in an adjuvant setting. The hypothesis of a negative impact of longer waiting times prior to commencement of adjuvant radiotherapy could not be confirmed.
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Affiliation(s)
- R Bütof
- Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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Colaco RJ, Huh S, Nichols RC, Morris CG, D’Agostino H, Flampouri S, Li Z, Pham DC, Bajwa AA, Hoppe BS. Dosimetric rationale and early experience at UFPTI of thoracic proton therapy and chemotherapy in limited-stage small cell lung cancer. Acta Oncol 2013; 52:506-13. [PMID: 23438357 DOI: 10.3109/0284186x.2013.769063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Concurrent chemoradiotherapy (CRT) is the standard of care in patients with limited-stage small cell lung cancer (SCLC). Treatment with conventional x-ray therapy (XRT) is associated with high toxicity rates, particularly acute grade 3+ esophagitis and pneumonitis. We present outcomes for the first known series of limited-stage SCLC patients treated with proton therapy and a dosimetric comparison of lung and esophageal doses with intensity-modulated radiation therapy (IMRT). MATERIAL AND METHODS Six patients were treated: five concurrently and one sequentially. Five patients received 60-66 CGE in 30-34 fractions once daily and one patient received 45 CGE in 30 fractions twice daily. All six patients received prophylactic cranial irradiation. Common Terminology Criteria for Adverse Events, v3.0, was used to grade toxicity. IMRT plans were also generated and compared with proton plans. RESULTS The median follow-up was 12.0 months. The one-year overall and progression-free survival rates were 83% and 66%, respectively. There were no cases of acute grade 3+ esophagitis or acute grade 2+ pneumonitis, and no other acute grade 3+ non-hematological toxicities were seen. One patient with a history of pulmonary fibrosis and atrial fibrillation developed worsening symptoms four months after treatment requiring oxygen. Three patients died: two of progressive disease and one after a fall; the latter patient was disease-free at 36 months after treatment. Another patient recurred and is alive, while two patients remain disease-free at 12 months of follow-up. Proton therapy proved superior to IMRT across all esophageal and lung dose volume points. CONCLUSION In this small series of SCLC patients treated with proton therapy with radical intent, treatment was well tolerated with no cases of acute grade 3+ esophagitis or acute grade 2+ pneumonitis. Dosimetric comparison showed better sparing of lung and esophagus with proton therapy. Proton therapy merits further investigation as a method of reducing the toxicity of CRT.
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Affiliation(s)
- Rovel J. Colaco
- University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
| | - Soon Huh
- University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
| | - Romaine C. Nichols
- University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
| | | | - Harry D’Agostino
- Department of Thoracic Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Stella Flampouri
- University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
| | - Zuofeng Li
- University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
| | - Dat C. Pham
- Department of Hematology and Medical Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Abubakr A. Bajwa
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Bradford S. Hoppe
- University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
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