1
|
Zhao J, Day RM, Jin JY, Quint L, Williams H, Ferguson C, Yan L, King M, Albsheer A, Matuszak M, Kong FMS. Thoracic radiation-induced pleural effusion and risk factors in patients with lung cancer. Oncotarget 2017; 8:97623-97632. [PMID: 29228638 PMCID: PMC5722590 DOI: 10.18632/oncotarget.18824] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 06/08/2017] [Indexed: 12/25/2022] Open
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.
Collapse
Affiliation(s)
- Jing Zhao
- Department of Oncology, Tongji Hospital, Tongji Medial College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Regina M Day
- Department of Pharmacology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jian-Yue Jin
- Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Department of Radiation Oncology, Radiation Physics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie Quint
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Hadyn Williams
- Department of Radiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Catherine Ferguson
- Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Li Yan
- Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Maurice King
- Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ahmad Albsheer
- Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Feng-Ming Spring Kong
- Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Department of Radiation Oncology, IU Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
2
|
Chernecky C, Sarna L, Waller JL, Brecht ML. Assessing Coughing and Wheezing in Lung Cancer: A Pilot Study. Oncol Nurs Forum 2007; 31:1095-101. [PMID: 15547632 DOI: 10.1188/04.onf.1095-1101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To establish reliability and validity of two self-report questionnaires, the Lung Cancer Cough Questionnaire and the Lung Cancer Wheezing Questionnaire. DESIGN Prospective, exploratory pilot study. SETTING Clinical oncology settings in the southern United States. SAMPLE 31 adult women with lung cancer. METHODS Content validity of both questionnaires was assessed through a comprehensive literature review and an expert judge panel. Concurrent validity was established by Spearman rank correlation coefficients and Wil-coxon Rank Sum tests with items from other valid tools. Test-retest reliability was assessed by percent agreement, kappa, paired t tests, and correlations. Internal consistency was determined by Cronbach's alpha. MAIN RESEARCH VARIABLES Cough, wheeze. FINDINGS Cronbach's alpha showed excellent internal consistency and percent agreement, and kappa showed similarity of item responses across test-retest administrations. Nonsignificant paired t tests indicated similar mean scores, and significant test-retest correlations supported test-retest reliability. CONCLUSIONS Preliminary testing indicates good reliability and validity for both questionnaires. Both instruments can identify people with problems of coughing and wheezing and have the potential for monitoring these symptoms over time and determining effectiveness of interventions. IMPLICATIONS FOR NURSING Assessment of coughing and wheezing is an important component of monitoring respiratory symptoms of lung cancer. Both of these symptoms can be amenable to interventions. Further research is needed to confirm psychometrics and sensitivity of these tools.
Collapse
|
3
|
Raghu G, Nyberg F, Morgan G. The epidemiology of interstitial lung disease and its association with lung cancer. Br J Cancer 2004; 91 Suppl 2:S3-10. [PMID: 15340372 PMCID: PMC2750810 DOI: 10.1038/sj.bjc.6602061] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The criteria and terminology for diagnosing interstitial lung disease (ILD), a diverse range of pulmonary fibrotic disorders that affect the alveoli of the lungs, have been variable and confusing; however, there have been recent major improvements to an internationally agreed classification. Evidence from recent analyses of populations suggests that the incidence and prevalence rates of ILD are on the increase, particularly when the broad definition of ILD is used. In most patients with ILD a cause is not identified; nevertheless, among the established causes are a number of drug therapies and infections. Occupational causes are lessening in importance, while cigarette smoking is now an established risk factor. Radiation therapy for cancer is a well-established cause of ILD that usually, but not always, localises within the radiation portal and may occur later after completion of therapy. Similarly, exposure to drugs long after radiation therapy may be an aetiological factor for the development of ILD later in life, although the magnitude of this risk requires further epidemiological investigation. The possibility that ILD and lung cancer are associated has been recognised for >50 years, but it remains unclear whether ILD precedes lung cancer or vice versa. In this review, we examine the epidemiology of ILD and the basis for its association with lung cancer.
Collapse
Affiliation(s)
- G Raghu
- Department of Medicine, University of Washington Medical Center, Campus Box 356522, Seattle, WA 98195-6522, USA.
| | | | | |
Collapse
|
4
|
Lee TK, Stupans I. Radioprotection: the non-steroidal anti-inflammatory drugs (NSAIDs) and prostaglandins. J Pharm Pharmacol 2002; 54:1435-45. [PMID: 12495545 DOI: 10.1211/00223570254] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Clinical and experimental studies of the acute and late effects of radiation on cells have enhanced our knowledge of radiotherapy and have led to the optimisation of radiation treatment schedules and to more precise modes of radiation delivery. However, as both normal and cancerous tissues have similar response to radiation exposure, radiation-induced injury on normal tissues may present either during, or after the completion of, the radiotherapy treatment. Studies on both NSAIDs and prostaglandins have indeed shown some evidence of radioprotection. Both have the potential to increase the survival of cells but by entirely different mechanisms. Studies of cell kinetics reveal that cells in the mitotic (M) and late G2 phases of the cell cycle are generally most sensitive to radiation compared with cells in the early S and G1/G0 phases. Furthermore, radiation leads to a mitotic delay in the cell cycle. Thus, chemical agents that either limit the proportion of cells in the M and G2 phases of the cell cycle or enhance rapid cell growth could in principle be exploited for their potential use as radioprotectors to normal tissue during irradiation. NSAIDs have been shown to exert anti-cancer effects by causing cell-cycle arrest, shifting cells towards a quiescence state (G0/G1). The same mechanism of action was observed in radioprotection of normal tissues. An increase in arachidonic acid concentrations after exposure to NSAIDs also leads to the production of an apoptosis-inducer ceramide. NSAIDs also elevate the level of superoxide dismutase in cells. Activation of heat shock proteins by NSAIDs increases cell survival by alteration of cytokine expression. A role for NSAIDs with respect to inhibition of cellular proliferation possibly by an anti-angiogenesis mechanism has also been suggested. Several in-vivo studies have provided evidence suggesting that NSAIDs may protect normal tissues from radiation injury. Prostaglandins do not regulate the cell cycle, but they do have a variety of effects on cell growth and differentiation. PGE(2) mediates angiogenesis, increasing the supply of oxygen and nutrients, essential for cellular survival and growth. Accordingly, PGE(2) at sufficiently high plasma concentrations enhances cellular survival by inhibiting pro-inflammatory cytokines such as TNF-alpha and IL-1beta. Thus, PGE(2) acts as a modulator, rather than a mediator, of inflammation. Prospective studies have suggested the potential use of misoprostol, a PGE(1) analogue, before irradiation, in prevention of radiation-induced side effects. The current understanding of the pharmacology of NSAIDs and prostaglandins shows great potential to minimise the adverse effects of radiotherapy on normal tissue.
Collapse
Affiliation(s)
- Tat Khuen Lee
- Center for Pharmaceutical Research, School of Pharmaceutical Molecular and Biomedical Sciences, University of South Australia, SA, 5000, Australia
| | | |
Collapse
|