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Zhou C, Qin Y, Zhao W, Liang Z, Li M, Liu D, Bai L, Chen Y, Chen Y, Cheng Y, Chu T, Chu Q, Deng H, Dong Y, Fang W, Fu X, Gao B, Han Y, He Y, Hong Q, Hu J, Hu Y, Jiang L, Jin Y, Lan F, Li Q, Li S, Li W, Li Y, Liang W, Lin G, Lin X, Liu M, Liu X, Liu X, Liu Z, Lv T, Mu C, Ouyang M, Qin J, Ren S, Shi H, Shi M, Su C, Su J, Sun D, Sun Y, Tang H, Wang H, Wang K, Wang K, Wang M, Wang Q, Wang W, Wang X, Wang Y, Wang Z, Wang Z, Wu L, Wu D, Xie B, Xie M, Xie X, Xie Z, Xu S, Xu X, Yang X, Yin Y, Yu Z, Zhang J, Zhang J, Zhang J, Zhang X, Zhang Y, Zhong D, Zhou Q, Zhou X, Zhou Y, Zhu B, Zhu Z, Zou C, Zhong N, He J, Bai C, Hu C, Li W, Song Y, Zhou J, Han B, Varga J, Barreiro E, Park HY, Petrella F, Saito Y, Goto T, Igai H, Bravaccini S, Zanoni M, Solli P, Watanabe S, Fiorelli A, Nakada T, Ichiki Y, Berardi R, Tsoukalas N, Girard N, Rossi A, Passaro A, Hida T, Li S, Chen L, Chen R. International expert consensus on diagnosis and treatment of lung cancer complicated by chronic obstructive pulmonary disease. Transl Lung Cancer Res 2023; 12:1661-1701. [PMID: 37691866 PMCID: PMC10483081 DOI: 10.21037/tlcr-23-339] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/04/2023] [Indexed: 09/12/2023]
Abstract
Background Lung cancer combined by chronic obstructive pulmonary disease (LC-COPD) is a common comorbidity and their interaction with each other poses significant clinical challenges. However, there is a lack of well-established consensus on the diagnosis and treatment of LC-COPD. Methods A panel of experts, comprising specialists in oncology, respiratory medicine, radiology, interventional medicine, and thoracic surgery, was convened. The panel was presented with a comprehensive review of the current evidence pertaining to LC-COPD. After thorough discussions, the panel reached a consensus on 17 recommendations with over 70% agreement in voting to enhance the management of LC-COPD and optimize the care of these patients. Results The 17 statements focused on pathogenic mechanisms (n=2), general strategies (n=4), and clinical application in COPD (n=2) and lung cancer (n=9) were developed and modified. These statements provide guidance on early screening and treatment selection of LC-COPD, the interplay of lung cancer and COPD on treatment, and considerations during treatment. This consensus also emphasizes patient-centered and personalized treatment in the management of LC-COPD. Conclusions The consensus highlights the need for concurrent treatment for both lung cancer and COPD in LC-COPD patients, while being mindful of the mutual influence of the two conditions on treatment and monitoring for adverse reactions.
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Affiliation(s)
- Chengzhi Zhou
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yinyin Qin
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wei Zhao
- Department of Respiratory and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhenyu Liang
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Min Li
- Department of Respiratory Medicine, Xiangya Cancer Center, Xiangya Hospital, Central South University, Changsha, China
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Li Bai
- Department of Respiratory Medicine, Xinqiao Hospital Army Medical University, Chongqing, China
| | - Yahong Chen
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Yan Chen
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuan Cheng
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Tianqing Chu
- Department of Respiratory Medicine, Shanghai Chest Hospital, Jiaotong University, Shanghai, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Haiyi Deng
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yuchao Dong
- Department of Pulmonary and Critical Care Medicine, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wenfeng Fang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiuhua Fu
- Division of Respiratory Diseases, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Beili Gao
- Department of Respiratory, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yiping Han
- Department of Respiratory Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yong He
- Department of Pulmonary and Critical Care Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Qunying Hong
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Hu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Hu
- Department of Medical Oncology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Liyan Jiang
- Department of Respiratory Medicine, Shanghai Chest Hospital, Jiaotong University, Shanghai, China
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fen Lan
- Department of Respiratory Medicine, The Second Affiliated Hospital of Zhejiang University of Medicine, Hangzhou, China
| | - Qiang Li
- Department of Respiratory Medicine, Shanghai Dongfang Hospital, Shanghai, China
| | - Shuben Li
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wen Li
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yaqing Li
- Department of Internal Medicine, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Wenhua Liang
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Gen Lin
- Department of Thoracic Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Xinqing Lin
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Ming Liu
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xiaofang Liu
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoju Liu
- Department of Gerontal Respiratory Medicine, The First Hospital of Lanzhou University, Lanzhou, China
| | - Zhefeng Liu
- Department of Oncology, General Hospital of Chinese PLA, Beijing, China
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Chuanyong Mu
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ming Ouyang
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianwen Qin
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Huanzhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Minhua Shi
- Department of Respiratory Medicine, The Second Affiliated Hospital of Suzhou University, Suzhou, China
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jin Su
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dejun Sun
- Department of Respiratory and Critical Care Medicine, Inner Mongolia Autonomous Region People’s Hospital, Hohhot, China
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Huaping Tang
- Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Huijuan Wang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Kai Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Zhejiang University of Medicine, Hangzhou, China
| | - Ke Wang
- Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Qi Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wei Wang
- Department of Pulmonary and Critical Care Medicine, the First Hospital of China Medical University, Shenyang, China
| | - Xiaoping Wang
- Department of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
| | - Yuehong Wang
- Department of Respiratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhijie Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zirui Wang
- Department of Respiratory and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Lin Wu
- Thoracic Medicine Department II, Hunan Cancer Hospital, Changsha, China
| | - Di Wu
- Department of Respiratory Medicine, Shenzhen People’s Hospital, Shenzhen, China
| | - Baosong Xie
- Department of Respiratory Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Min Xie
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaohong Xie
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Zhanhong Xie
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Shufeng Xu
- Department of Respiratory and Critical Care Medicine, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Xiaoman Xu
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xia Yang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yan Yin
- Department of Pulmonary and Critical Care Medicine, the First Hospital of China Medical University, Shenyang, China
| | - Zongyang Yu
- Department of Pulmonary and Critical Care Medicine, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Jian Zhang
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Jianqing Zhang
- Second Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jing Zhang
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingying Zhang
- Department of Medical Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Diansheng Zhong
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiangdong Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yanbin Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo Zhu
- Chongqing Key Laboratory of Immunotherapy, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Chenxi Zou
- Department of Respiratory and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Nanshan Zhong
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chengping Hu
- Department of Pulmonary Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Song
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, China
| | - Jianying Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Baohui Han
- Department of Pulmonology, Shanghai Chest Hospital, Shanghai, China
| | - Janos Varga
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Esther Barreiro
- Pulmonology Department-Lung Cancer and Muscle Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Department of Medicine and Life Sciences (MELIS), Pompeu Fabra University (UPF), CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII) Barcelona, Spain
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Francesco Petrella
- Division of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Yuichi Saito
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Sara Bravaccini
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Michele Zanoni
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Piergiorgio Solli
- Department of Cardio-Thoracic Surgery and Hearth & Lung Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Universitàdella Campania Luigi Vanvitelli, Naples, Italy
| | - Takeo Nakada
- Division of Thoracic Surgery, Department of Surgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Yoshinobu Ichiki
- Department of General Thoracic Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | | | - Nicolas Girard
- Institut du Thorax Curie Montsouris, Institut Curie, Paris, France
- Paris Saclay, UVSQ, Versailles, France
| | - Antonio Rossi
- Oncology Center of Excellence, Therapeutic Science & Strategy Unit, IQVIA, Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Toyoaki Hida
- Lung Cancer Center, Central Japan International Medical Center, Minokamo, Japan
| | - Shiyue Li
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Liang’an Chen
- Department of Respiratory and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Rongchang Chen
- Shenzhen Institute of Respiratory Diseases, Shenzhen People’s Hospital, Shenzhen, China
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Ninomiya K, Arimura H, Yoshitake T, Hirose TA, Shioyama Y. Synergistic combination of a topologically invariant imaging signature and a biomarker for the accurate prediction of symptomatic radiation pneumonitis before stereotactic ablative radiotherapy for lung cancer: A retrospective analysis. PLoS One 2022; 17:e0263292. [PMID: 35100322 PMCID: PMC8803154 DOI: 10.1371/journal.pone.0263292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 01/18/2022] [Indexed: 12/25/2022] Open
Abstract
Objectives We aimed to explore the synergistic combination of a topologically invariant Betti number (BN)-based signature and a biomarker for the accurate prediction of symptomatic (grade ≥2) radiation-induced pneumonitis (RP+) before stereotactic ablative radiotherapy (SABR) for lung cancer. Methods A total of 272 SABR cases with early-stage non-small cell lung cancer were chosen for this study. The occurrence of RP+ was predicted using a support vector machine (SVM) model trained with the combined features of the BN-based signature extracted from planning computed tomography (pCT) images and a pretreatment biomarker, serum Krebs von den Lungen-6 (BN+KL-6 model). In all, 242 (20 RP+ and 222 RP–(grade 1)) and 30 cases (8 RP+ and 22 RP–) were used for training and testing the model, respectively. The BN-based features were extracted from BN maps that characterize topologically invariant heterogeneous traits of potential RP+ lung regions on pCT images by applying histogram- and texture-based feature calculations to the maps. The SVM models were built to predict RP+ patients with a BN signature that was constructed based on the least absolute shrinkage and selection operator logistic regression model. The evaluation of the prediction models was performed based on the area under the receiver operating characteristic curves (AUCs) and accuracy in the test. The performance of the BN+KL-6 model was compared to the performance based on the BN, conventional original pCT, and wavelet decomposition (WD) models. Results The test AUCs obtained for the BN+KL-6, BN, pCT, and WD models were 0.825, 0.807, 0.642, and 0.545, respectively. The accuracies of the BN+KL-6, BN, pCT, and WD models were found to be 0.724, 0.708, 0.591, and 0.534, respectively. Conclusion This study demonstrated the comprehensive performance of the BN+KL-6 model for the prediction of potential RP+ patients before SABR for lung cancer.
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Affiliation(s)
- Kenta Ninomiya
- Division of Medical Quantum Science, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Hidetaka Arimura
- Faculty of Medical Sciences, Division of Medical Quantum Science, Department of Health Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
- * E-mail: (HA); (TY)
| | - Tadamasa Yoshitake
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
- * E-mail: (HA); (TY)
| | - Taka-aki Hirose
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Higashi-ku, Fukuoka, Japan
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Berg J, Ramberg C, Haugstvedt JOS, Bengtson MB, Gabrielsen AM, Brustugun OT, Halvorsen AR, Helland Å. Lung Function After Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer, Changes and Predictive Markers. Front Oncol 2021; 11:674731. [PMID: 34109123 PMCID: PMC8181743 DOI: 10.3389/fonc.2021.674731] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/30/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction The present study explores changes in pulmonary function, symptoms and radiological signs of pneumonitis after curatively intended stereotactic body radiation therapy (SBRT). Methods All inoperable, early-stage non-small cell lung cancer patients treated with stereotactic body radiation therapy (SBRT) from 2014-2017 were included in this single-centre study. They were followed regularly for 12 months after treatment. The patients were classified into three groups based on radiology and symptomatology: no radiation pneumonitis, asymptomatic and symptomatic radiation pneumonitis. Results Forty-four patients with stage IA-IIB disease were treated with 45–56 Gy in 3–8 fractions. The median age was 75 years, 43% of the patients were female; 60% of the patients had a COPD in GOLD grade of 2-4, and 95.5% were active or former smokers. Symptomatic radiation pneumonitis occurred in 18% of the patients and asymptomatic pneumonitis as defined by radiology, in 39%. The mean of forced expiratory volume in 1 second (FEV1) and diffusion capacity for carbon monoxide (DLCO) decreases for all patients during the first years were higher than one would expect from physiologic ageing. FEV1 and DLCO in percent decrease 7-8% at 1-1.5 months in the symptomatic radiation pneumonitis group. CT scan findings consistent with radiation pneumonitis occurred after a median of 2.9 months in the symptomatic and 5.4 months in the asymptomatic radiation pneumonitis groups. In the group with symptomatic radiation pneumonitis, symptoms, as measured by the Clinical COPD questionnaire score, significantly increased at 3 and 6 months. Significant higher maximum doses to the critical lung volumes DC1000cm3 (1000 cm3 of lung receiving a given dose or less) and DC 1500cm3 (1500 cm3 of lung receiving a given dose or less) were observed in patients who developed radiation pneumonitis. Conclusion Early decrease in measured FEV1 and DLCO occurred before imaging changes and symptoms and might indicate the development of symptomatic radiation pneumonitis. The dose to critical lung volumes of DC1000 cm3 and DC1500 cm3 may predict the risk for the development of symptomatic radiation pneumonitis.
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Affiliation(s)
- Janna Berg
- Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Cancer Genetics, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Christina Ramberg
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | | | | | | | - Odd Terje Brustugun
- Department of Cancer Genetics, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Section of Oncology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Ann Rita Halvorsen
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Åslaug Helland
- Department of Cancer Genetics, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
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Uchiyama F, Nakayama H, Takeda Y, Wang W, Minamimoto R, Tajima T. Risk of radiation pneumonitis in patients with emphysema after stereotactic body radiotherapy for non-small cell lung cancer assessed by quantitative CT. Mol Clin Oncol 2020; 13:3. [PMID: 32754317 DOI: 10.3892/mco.2020.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/25/2020] [Indexed: 11/05/2022] Open
Abstract
Quantitative CT assessment of patients with pulmonary emphysema is used to measure pulmonary function. The present study evaluated whether the quantitative CT value can accurately estimate the risk of radiation pneumonitis (RP) after stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC) in patients with and without emphysema. A total of 80 patients with stage I NSCLC receiving SBRT at a dose of 50 or 60 Gy in five fractions at our hospital between November 2003 and October 2015 were included in the analysis. A total of 33 (41%) patients were diagnosed with emphysema on CT examination. Dosimetric parameters, quantitative CT percentage value of low attenuation area (LAA%) in the whole lung, and average whole lung CT density values were used to examine the risk of RP. Among the 80 patients, 26 (33%) and 3 (4%) experienced Grade 1 and Grade 2 RP, respectively, during the median observation period of 18.8 (1.8-106.8) months. The RP rate for patients with a LAA% (<-910 HU) of ≤25% was significantly higher than that of subjects with LAA% (<-910 HU) >25% (P=0.037). The RP rate in subjects with an average HU value of >-790 HU was significantly higher compared with that of patients with ≤-790 HU (P=0.036). Age (hazard ratio [HR]=2.46; P=0.03) and average HU (HR=3.39; P=0.02) were significantly associated with RP, whereas mean lung dose was not identified to be significant in multivariate analysis. The quantitative CT value was associated with RP after SBRT.
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Affiliation(s)
- Fumiya Uchiyama
- Department of Radiology, National Cancer Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Hidetsugu Nakayama
- Department of Radiation Oncology, National Cancer Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Yuichiro Takeda
- Department of Respiratory Medicine, National Cancer Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Wenjie Wang
- Department of Radiation Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 0086-215000, P.R. China
| | - Ryogo Minamimoto
- Department of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Tsuyosi Tajima
- Department of Radiology, National Cancer Center for Global Health and Medicine, Tokyo 162-8655, Japan
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Ikuyama Y, Ushiki A, Kosaka M, Akahane J, Mukai Y, Araki T, Kitaguchi Y, Tateishi K, Urushihata K, Yasuo M, Yamamoto H, Hanaoka M. Prognosis of patients with acute exacerbation of combined pulmonary fibrosis and emphysema: a retrospective single-centre study. BMC Pulm Med 2020; 20:144. [PMID: 32434532 PMCID: PMC7238596 DOI: 10.1186/s12890-020-01185-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous analyses of combined pulmonary fibrosis and emphysema (CPFE) cohorts have provided conflicting data on the survival of patients with CPFE. Therefore, the aim of this study was to investigate the clinical prognosis of acute exacerbations (AE) of CPFE. METHODS We retrospectively reviewed the medical records of patients who had been treated at the Shinshu University Hospital (Matsumoto, Japan) between 2003 and 2017. We identified 21 patients with AE of CPFE and 41 patients with AE of idiopathic pulmonary fibrosis (IPF) and estimated their prognoses using the Kaplan-Meier method. RESULTS Treatment content and respiratory management were not significantly different between the two groups before and after exacerbation. At the time of AE, the median serum Krebs von den Lungen-6 level was significantly lower in the CPFE group (Krebs von den Lungen-6: 966 U/μL; white blood cell count: 8810 /μL) than that in the IPF group (Krebs von den Lungen-6: 2130 U/μL, p < 0.001; white blood cells: 10809/μL, p = 0.0096). The baseline Gender-Age-Physiology scores were not significantly different between the two groups (CPFE, 4.5 points; IPF, 4.7 points; p = 0.58). Kaplan-Meier curves revealed that the survival time after AE for patients with CPFE was longer than that for patients with IPF (p < 0.001, log-rank test). CONCLUSIONS Survival prognoses after AE were significantly better for patients with CPFE than that for those with IPF. Our findings may improve the medical treatment and respiratory management of patients with AE-CPFE.
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Affiliation(s)
- Yuichi Ikuyama
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi Matsumoto, Nagano Prefecture, 390-8621, Japan
| | - Atsuhito Ushiki
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi Matsumoto, Nagano Prefecture, 390-8621, Japan.
| | - Makoto Kosaka
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi Matsumoto, Nagano Prefecture, 390-8621, Japan
| | - Jumpei Akahane
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi Matsumoto, Nagano Prefecture, 390-8621, Japan
| | - Yuichi Mukai
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi Matsumoto, Nagano Prefecture, 390-8621, Japan
| | - Taisuke Araki
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi Matsumoto, Nagano Prefecture, 390-8621, Japan
| | - Yoshiaki Kitaguchi
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi Matsumoto, Nagano Prefecture, 390-8621, Japan
| | - Kazunari Tateishi
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi Matsumoto, Nagano Prefecture, 390-8621, Japan
| | - Kazuhisa Urushihata
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi Matsumoto, Nagano Prefecture, 390-8621, Japan
| | - Masanori Yasuo
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi Matsumoto, Nagano Prefecture, 390-8621, Japan
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi Matsumoto, Nagano Prefecture, 390-8621, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi Matsumoto, Nagano Prefecture, 390-8621, Japan
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6
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A Novel Nomogram and Risk Classification System Predicting Radiation Pneumonitis in Patients With Esophageal Cancer Receiving Radiation Therapy. Int J Radiat Oncol Biol Phys 2019; 105:1074-1085. [DOI: 10.1016/j.ijrobp.2019.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/12/2019] [Accepted: 08/15/2019] [Indexed: 02/06/2023]
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7
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Ye L, Zhang Y, Li T, Zhang X, Shi S, Zhao Q, Zeng Z, He J. Emphysema quantification on computed tomography and its value in predicting radiation pneumonitis in lung cancer treated by stereotactic body radiotherapy. JOURNAL OF RADIATION RESEARCH 2019; 60:371-379. [PMID: 30968939 PMCID: PMC6530624 DOI: 10.1093/jrr/rrz007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/09/2019] [Indexed: 06/09/2023]
Abstract
A large portion of patients with early-stage non-small-cell lung cancer (NSCLC) who are receiving stereotactic body radiation therapy (SBRT) are medically inoperable due to compromised pulmonary function, and among these patients pulmonary emphysema (PE) is common. However, the relationship between PE and radiation-induced lung injuries remains unclear. In this study, we aimed to describe the full spectrum of computed tomography (CT) features after SBRT for NSCLC, and to explore their relationship with variables, including PE and dosimetric factors. In all, 71 patients were enrolled. PE was quantified as the percentage of low attenuation area [attenuation values of <-860 Hounsfield units (HU)] within the radiation field (%LAA-860). Spearman's correlation and logistic regression were used to explore factors related to radiological features and radiation pneumonitis (RP). At the 1-year follow-up, acute radiological changes included: (i) diffuse consolidation, 11.3%; (ii) patchy consolidation and ground-glass opacities, 42.3%; and (iii) patchy ground-glass opacity, 14.1%. Late morphological changes occurred in 61.9% of patients (50.7% with a modified conventional pattern, 5.6% with a mass-like pattern and 5.6% with a scar-like pattern). Lower %LAA-860 was the only factor that was significantly associated with consolidation changes at 6 months after SBRT [odds ratio (OR), 0.008; P = 0.009], and it was also a significant predictor for Grade ≥ 2 RP (OR, 0.003; P = 0.04). Our study showed that patients with PE can benefit from SBRT on the condition that good control of dose-volume constraints is achieved.
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Affiliation(s)
- Luxi Ye
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China
| | - Yujie Zhang
- Department of Radiation Physics, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China
| | - Tingting Li
- Department of Radiation Physics, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China
| | - Xingwei Zhang
- Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China
| | - Shiming Shi
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China
| | - Qianqian Zhao
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China
| | - Zhaochong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China
| | - Jian He
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, P.R. China
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8
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Stereotactic body radiotherapy in patients with chronic obstructive pulmonary disease and interstitial pneumonia: a review. Int J Clin Oncol 2019; 24:899-909. [PMID: 30937620 DOI: 10.1007/s10147-019-01432-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/19/2019] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiation therapy (SBRT) can yield excellent local tumor control, as well as survival benefit comparable to that of surgery for early-stage lung cancer. However, in terms of toxicity, SBRT might lead to fatal radiation pneumonitis. Lung diseases, such as chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD), are major risk factors for lung cancer. However, these patients are typically not candidates for the gold-standard treatment option, lobectomy, because of the perioperative risks. In addition, patients with poor respiratory function can be excluded in prospective clinical trials. Thus, SBRT for patients with pulmonary diseases is still challenging, but there appears to be a clinical role for this modality as an alternative treatment. However, there are few well-documented review articles on SBRT for patients with pulmonary diseases. Therefore, we aimed to review SBRT in the context of important patient-related factors, including COPD and ILD. SBRT is an acceptable alternative treatment option for patients with lung cancer who also have COPD with an equivalent risk of radiation pneumonitis to normal lung. However, latent ILD should be detected prior to treatment. The indication for SBRT should be decided by carefully considering the risks and benefit for patients with ILD.
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9
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Maddalo M, Moschini I, Benecchi G, Calabri E, Rossi R, Losardo P, Bergamini M, Dell’Anna C, Ceccon G, Grondelli C, Nurmahomed S, Gianni S, Rossi R, Manicone M, Andreani S, Ghetti F, Salaroli F, Ghetti C, D’Abbiero N. 42. The role of emphysema on radiation-induced lung toxicity and the feasibility of a “functional treatment plan”. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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10
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Kasymjanova G, Jagoe RT, Pepe C, Sakr L, Cohen V, Small D, Muanza TM, Agulnik JS. Does the presence of emphysema increase the risk of radiation pneumonitis in lung cancer patients? ACTA ACUST UNITED AC 2018; 25:e610-e614. [PMID: 30607130 DOI: 10.3747/co.25.4093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction Radiotherapy (rt) plays an important role in the treatment of lung cancer. One of the most common comorbidities in patients with lung cancer is pulmonary emphysema. The literature offers conflicting data about whether emphysema increases the occurrence and severity of radiation pneumonitis (rp). As a result, whether high doses of rt (with curative intent) should be avoided in patients with emphysema is still unclear. Objective We measured the documented incidence of rp in patients with and without emphysema who received curative radiation treatment. Methods This retrospective cohort study considered patients in the lung cancer clinical database of the Peter Brojde Lung Cancer Centre. Data from the database has been used previously for research studies, including a recent publication about emphysema grading, based on the percentage of lung occupied by emphysema on computed tomography (ct) imaging. Results Using previously published methods, chest ct imaging for 498 patients with lung cancer was scored for the presence of emphysema. The analysis considered 114 patients who received at least 30 Gy radiation. Of those 114 patients, 64 (56%) had emphysema, with approximately 23% having severe or very severe disease. The incidence of rp was 34.4% in patients with emphysema (n = 22) and 32.0% in patients with no emphysema (n = 16, p = 0.48). No difference in the incidence of rp was evident between patients with various grades of emphysema (p = 0.96). Similarly, no difference in the incidence of rp was evident between the two treatment protocols-that is, definitive rt 17 (37%) and combined chemotherapy-rt 21 (31%, p = 0.5). Conclusions In our cohort, the presence of emphysema on chest ct imaging was not associated with an increased risk of rp. That finding suggests that patients with lung cancer and emphysema should be offered rt when clinically indicated. However, further prospective studies will be needed for confirmation.
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Affiliation(s)
- G Kasymjanova
- Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - R T Jagoe
- Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - C Pepe
- Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - L Sakr
- Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - V Cohen
- Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - D Small
- Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - T M Muanza
- Radiation Oncology, Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - J S Agulnik
- Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
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11
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Diabetes mellitus and radiation induced lung injury after thoracic stereotactic body radiotherapy. Radiother Oncol 2018; 129:270-276. [PMID: 30253874 DOI: 10.1016/j.radonc.2018.08.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radiographic radiation induced lung injury (RILI) is frequently observed after stereotactic body radiotherapy (SBRT). Models of radiographic change can identify patient risk factors that predict clinical toxicity. We examined the association between radiographic lung changes and lung tissue dose-density response over time with clinical risk factors for RILI, such as diabetes. METHODS 424 baseline and follow up CT scans at 3, 6, and 12 months post-treatment were analyzed in 116 patients (27 with diabetes) undergoing thoracic SBRT. Volumes of dense/hazy regions and lung parenchyma dose-density response curves were evaluated with respect to follow up time, diabetes, and other factors. RESULTS Dense and hazy tissue regions were larger in the diabetic population, with the effect most pronounced at 3 months. Similarly, dose-density response curves showed greater density change versus dose in the diabetic group (all p < 0.05). Diabetes, time, the interaction of diabetes and time, smoking status, African American race, baseline lung density, and tumor location were significantly associated with radiographic changes on mixed effect analyses. PTV size, pulmonary function, and medication exposure did not significantly impact RILI. Clinical grade 1-2 pneumonitis was more prevalent in diabetic patients (p = 0.02). However, radiographic change did not correlate with clinical pneumonitis. CONCLUSIONS The presence of diabetes and other clinical factors is associated with increased volume and density of radiographic RILI after lung SBRT, most prominently early after treatment. This is the first report demonstrating the increased severity of RILI after SBRT in diabetic patients. Increased caution treating diabetic patients may be warranted.
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12
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Caviezel C, von Rotz J, Schneiter D, Inci I, Hillinger S, Opitz I, Weder W. Improved postoperative lung function after sublobar resection of non-small-cell lung cancer combined with lung volume reduction surgery in patients with advanced emphysema. J Thorac Dis 2018; 10:S2704-S2710. [PMID: 30210822 DOI: 10.21037/jtd.2018.06.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Radiotherapy is recommended as primary local therapy for inoperable patients with non-small cell lung cancer (NSCLC). We hypothesized that selected patients with advanced emphysema could be candidates for surgery and improved functional outcome might result in addition to low mortality and morbidity and successful cancer control when sublobar resection in a lung volume reduction surgery (LVRS) concept is applied. Methods All patients with NSCLC and severe emphysema who underwent cancer resection in a LVRS concept between 2003 and 2015 were included for analysis. Postoperative 90-day mortality, complications, survival and lung function with forced expiratory volume in one second pre-operatively and three months postoperatively served as endpoints. Results Fourteen patients were included. Three procedures were bilateral and eleven unilateral, eight have been performed with thoracoscopy and six with conversion to an open procedure due to adhesions. In ten patients, tumor resection was atypical and in four patients an anatomic segmentectomy was performed. All patients had lung volume reduction. Prolonged air leak occurred in three patients. Perioperative 90-mortality was zero. Median pre-operative forced expiratory volume in one second was 32.5% and increased to 37% (P=0.002) 3 months following surgery. Three and 5-year survival rates were 50% and 35%, respectively. Conclusions Sublobar resection of NSCLC combined with LVRS in patients with severely impaired lung function due to emphysema can be performed with low mortality and morbidity making it an alternative treatment modality to radiotherapy. This approach allows cancer resection in marginal patients and improves emphysema symptoms simultaneously.
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Affiliation(s)
- Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Julia von Rotz
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
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13
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Saito T, Nakayama H, Yamada T, Shiraishi S, Tokuuye K. Is severe emphysema, as defined by quantitative CT measurement, a negative risk factor of radiation fibrosis? Br J Radiol 2018; 91:20170921. [PMID: 29651875 DOI: 10.1259/bjr.20170921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate whether patients with emphysema, as evaluated by quantitative CT image measurement, are at risk of developing radiation pneumonitis (RP) after radiotherapy (RT) for non-small cell lung cancer (NSCLC). METHODS Between March 2011 and June 2015, 68 consecutive patients with Stage I NSCLC treated with a RT dose of 75 Gy given in 30 fractions were enrolled. The median age was 79 years and there were 45 males and 23 females. The number of patients with T1 and T2 were 49 and 19, respectively. The severity of emphysema was evaluated by the percentages of the low attenuation area (LAA) of ≤-860 or -950 Hounsfield unit (HU) and average HU in the whole lung. RESULTS The mean difference percentages of LAA of ≤-860 (p = 0.0004) or -950 HU (p = 0.005) and average HU (p = 0.001) in patients with RP were significantly lower than those in patients without RP. The area under curve (AUC) of average HU was significantly higher than AUC of LAA of ≤-860 (p < 0.0001) or -950 HU (p < 0.0001). The RP rate after RT was significantly lower when the average HU values were ≤-850 HU (p = 0.0003). CONCLUSION Patients with emphysema evaluated by average HU (≤-850 HU) in the whole lung were found to be at low risk of RP after RT. Advances in Knowledge: Quantitative measurement of average HU from CT images was predicted of RP after RT.
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Affiliation(s)
- Tatsuhiko Saito
- 1 Department of Radiology, Tokyo Medical University Hospital , Tokyo , Japan
| | - Hidetsugu Nakayama
- 1 Department of Radiology, Tokyo Medical University Hospital , Tokyo , Japan.,2 Departments of Radiation Oncology, National Center for Global Health and Medicine , Tokyo , Japan
| | - Takafumi Yamada
- 1 Department of Radiology, Tokyo Medical University Hospital , Tokyo , Japan
| | - Sachica Shiraishi
- 1 Department of Radiology, Tokyo Medical University Hospital , Tokyo , Japan
| | - Koichi Tokuuye
- 1 Department of Radiology, Tokyo Medical University Hospital , Tokyo , Japan
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Ueyama T, Arimura T, Takumi K, Nakamura F, Higashi R, Ito S, Fukukura Y, Umanodan T, Nakajo M, Koriyama C, Yoshiura T. Risk factors for radiation pneumonitis after stereotactic radiation therapy for lung tumours: clinical usefulness of the planning target volume to total lung volume ratio. Br J Radiol 2018; 91:20170453. [PMID: 29565649 DOI: 10.1259/bjr.20170453] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To identify risk factors for symptomatic radiation pneumonitis (RP) after stereotactic radiation therapy (SRT) for lung tumours. METHODS We retrospectively evaluated 68 lung tumours in 63 patients treated with SRT between 2011 and 2015. RP was graded according to the National Cancer Institute-Common Terminology Criteria for Adverse Events version 4.0. SRT was delivered at 7.0-12.0 Gy per each fraction, once daily, to a total of 48-64 Gy (median, 50 Gy). Univariate analysis was performed to assess patient- and treatment-related factors, including age, sex, smoking index (SI), pulmonary function, tumour location, serum Krebs von den Lungen-6 value (KL-6), dose-volume metrics (V5, V10, V20, V30, V40 and VS5), homogeneity index of the planning target volume (PTV), PTV dose, mean lung dose (MLD), contralateral MLD and V2, PTV volume, lung volume and the PTV/lung volume ratio (PTV/Lung). Performance of PTV/Lung in predicting symptomatic RP was also analysed using receiver operating characteristic (ROC) analysis. RESULTS The median follow-up period was 21 months. 10 of 63 patients (15.9%) developed symptomatic RP after SRT. On univariate analysis, V10, V20, PTV volume and PTV/Lung were significantly associated with occurrence of RP ≥Grade 2. ROC curves indicated that symptomatic RP could be predicted using PTV/Lung [area under curve (AUC): 0.88, confidence interval (CI: 0.78-0.95), cut-off value: 1.09, sensitivity: 90.0% and specificity: 72.4%]. CONCLUSION PTV/Lung is a good predictor of symptomatic RP after SRT. Advances in knowledge: The cases with high PTV/Lung should be carefully monitored with caution for the occurrence of RP after SRT.
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Affiliation(s)
- Tomoko Ueyama
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Takeshi Arimura
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Koji Takumi
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Fumihiko Nakamura
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Ryutaro Higashi
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Soichiro Ito
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Yoshihiko Fukukura
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Tomokazu Umanodan
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Masanori Nakajo
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Chihaya Koriyama
- 2 Department of Epidemiology and Preventive Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Takashi Yoshiura
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
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15
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Yamamoto T, Kadoya N, Sato Y, Matsushita H, Umezawa R, Kubozono M, Ishikawa Y, Kozumi M, Takahashi N, Morishita Y, Katagiri Y, Sato K, Ito K, Takeda K, Jingu K. Prognostic Value of Radiation Pneumonitis After Stereotactic Body Radiotherapy: Effect of Pulmonary Emphysema Quantitated Using CT Images. Clin Lung Cancer 2017; 19:e85-e90. [PMID: 28655592 DOI: 10.1016/j.cllc.2017.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/28/2017] [Accepted: 05/30/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim of this study was to determine the prognostic factors of radiation pneumonitis (RP) after stereotactic body radiotherapy (SBRT). PATIENTS AND METHODS A total of 50 patients (36 male and 14 female) were treated with SBRT for 42 primary lung cancers and 8 metastatic lung cancers. SBRT was performed with 48 Gy in 4 fractions to the isocenter or with 40 Gy in 4 fractions covering 95% of the planning target volume. Percentage of low attenuation area (%LAA) was defined as percentage of the lung area with attenuation of -860 Hounsfield units (HU) or lower (%LAA-860) or of -960 HU or lower (%LAA-960). The dosimetric parameter of V20 Gy, which means percentage volume of the lung receiving 20 Gy or more, was recalculated. RP was assessed using Common Terminology Criteria for Adverse Events version 4.0. RESULTS The median follow-up period was 39.0 months (range, 7.2-94.5 months). RP of Grade 0, Grade 1, and Grade 2 to 3 was diagnosed in 11, 29, and 10 patients, respectively. Multivariate analyses (MVA) for Grade 1 showed that higher %LAA-860 and higher %LAA-960 were significantly associated with a lower rate of Grade 1 RP. MVA for Grade 2 to 3 showed that lower Brinkman index and lower lung V20 Gy were significantly associated with a lower rate of Grade 2 to 3 RP, and, in contrast, %LAA-860 and %LAA-960 had no association with Grade 2 to 3 RP. CONCLUSION This result suggests that high %LAA is associated with radiological changes (Grade 1) but that %LAA has no correlation with Grade 2 to 3 RP because symptomatic RP might also be affected by other factors.
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Affiliation(s)
- Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshinao Sato
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaki Kubozono
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Maiko Kozumi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yohei Morishita
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Katagiri
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyokazu Sato
- Radiation Technology, Tohoku University Hospital, Sendai, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ken Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Pulmonary emphysema is a risk factor for radiation pneumonitis in NSCLC patients with squamous cell carcinoma after thoracic radiation therapy. Sci Rep 2017; 7:2748. [PMID: 28584268 PMCID: PMC5459844 DOI: 10.1038/s41598-017-02739-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/18/2017] [Indexed: 12/05/2022] Open
Abstract
Pulmonary emphysema (PE) has been demonstrated to have a high prevalence in patients with locally advanced non-small cell lung cancer (NSCLC). A total of 153 patients with locally advanced NSCLC were enrolled in this study to investigate the association between PE and radiation pneumonitis (RP) after definitive thoracic radiation therapy (TRT). The incidence of RP in Grade 2, 3 and 5 were 11.1%, 9.8% and 0.7%, respectively. Univariate analysis revealed that age, PE, forced vital capacity (FVC), arterial partial pressure of oxygen (PO2) and mean lung dose (MLD) were significantly associated with the risk of Grade ≥2 or Grade ≥3 RP in patients with squamous cell carcinoma (SCC, P < 0.05). Logistic analysis demonstrated that PE was an independent risk factor of RP in SCC (P < 0.05). Receiver operating characteristics (ROC) analysis revealed that the combination of age, PE, FVC, PO2 and MLD had a higher value to predict RP in SCC (AUC = 0.856 in Grade ≥2 RP and 0.882 in Grade ≥3 RP, respectively). Kaplan-Meier analysis revealed that the more severe the PE, the higher the incidence of RP in SCC. Our results revealed that PE was a high risk factor for locally advanced NSCLC patients followed definitive TRT, especially for SCC patients.
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Okubo M, Itonaga T, Saito T, Shiraishi S, Mikami R, Nakayama H, Sakurada A, Sugahara S, Koizumi K, Tokuuye K. Predicting risk factors for radiation pneumonitis after stereotactic body radiation therapy for primary or metastatic lung tumours. Br J Radiol 2017; 90:20160508. [PMID: 28195507 PMCID: PMC5605097 DOI: 10.1259/bjr.20160508] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 12/13/2016] [Accepted: 02/13/2017] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To investigate risk factors for radiation-induced pneumonitis (RP) after hypofractionated stereotactic body radiotherapy (SBRT) in patients with lung tumours. METHODS From May 2004 to January 2016, 66 patients with 71 primary or metastatic lung tumours were treated with SBRT; these 71 cases were retrospectively analyzed for RP. To explore the risk factors for RP, the following factors were investigated: age, sex, performance status, operability, number of treatments, respiratory gating, pulmonary emphysema, tumour location and subclinical interstitial lung disease (ILD). Irradiated underlying lung volumes of more than 5 Gy, 10 Gy, 20 Gy and 30 Gy (Lung V5, V10, V20 and V30), mean lung dose and volumes of gross tumour volume (in cubic centimetre) and planning target volume were calculated for possible risk factors of RP. RESULTS The median follow-up period was 32 months. RP of Grade 2 or more, according to the Common Terminology Criteria for Adverse Events v. 4.0, was detected in 6 (8.4%) of the 71 cases. Grade 5 RP was identified in two cases. Of the risk factors of RP, subclinical ILD was the only factor significantly associated with the occurrence of RP of Grade 2 or more (p < 0.001). Both cases with Grade 5 RP had ILD with a honeycombing image. CONCLUSION Subclinical ILD was the only significant factor for Grade 2-5 RP. In addition, the cases with honeycombing had a high potential for fatality related to severe RP. Patients with subclinical ILD should be carefully monitored for the occurrence of severe RP after SBRT. Advances in knowledge: Hypofractionated SBRT for primary or metastatic lung tumours provides a high local control rate and safe treatment.
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Affiliation(s)
- Mitsuru Okubo
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Tomohiro Itonaga
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Tatsuhiko Saito
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Sachika Shiraishi
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Ryuji Mikami
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hidetugu Nakayama
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Akira Sakurada
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Shinji Sugahara
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kiyoshi Koizumi
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Koichi Tokuuye
- Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan
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SABR vs. Limited Resection for Non-small Cell Lung Cancer: Are We Closer to an Answer? Curr Treat Options Oncol 2016; 17:27. [DOI: 10.1007/s11864-016-0407-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Binkley MS, Shrager JB, Chaudhuri A, Popat R, Maxim PG, Shultz DB, Diehn M, Loo BW. Time course and predictive factors for lung volume reduction following stereotactic ablative radiotherapy (SABR) of lung tumors. Radiat Oncol 2016; 11:40. [PMID: 26975700 PMCID: PMC4791793 DOI: 10.1186/s13014-016-0616-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/08/2016] [Indexed: 12/03/2022] Open
Abstract
Background Stereotactic ablative volume reduction (SAVR) is a potential alternative to lung-volume reduction surgery in patients with severe emphysema and excessive surgical risk. Having previously observed a dose-volume response for localized lobar volume reduction after stereotactic ablative radiotherapy (SABR) for lung tumors, we investigated the time course and factors associated with volume reduction. Methods We retrospectively identified 70 eligible patients receiving lung tumor SABR during 2007-2013. We correlated lobar volume reduction (relative to total, bilateral lung volume [TLV]) with volume receiving high biologically effective doses (VXXBED3) and other pre-treatment factors in all patients, and measured the time course of volume changes on 3-month interval CT scans in patients with large V60BED3 (n = 21, V60BED3 ≥4.1 % TLV). Results Median CT follow-up was 15 months. Median volume reduction of treated lobes was 4.5 % of TLV (range 0.01–13.0 %), or ~9 % of ipsilateral lung volume (ILV); median expansion of non-target adjacent lobes was 2.2 % TLV (−4.6–9.9 %; ~4 % ILV). Treated lobe volume reduction was significantly greater with larger VXXBED3 (XX = 20–100 Gy, R2 = 0.52–0.55, p < 0.0001) and smaller with lower pre-treatment FEV1% (R2 = 0.11, p = 0.005) in a multivariable linear model. Maximum volume reduction was reached by ~12 months and persisted. Conclusions We identified a multivariable model for lobar volume reduction after SABR incorporating dose-volume and pre-treatment FEV1% and characterized its time course. Electronic supplementary material The online version of this article (doi:10.1186/s13014-016-0616-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael S Binkley
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Joseph B Shrager
- Stanford Cancer Institute, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA.,Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, USA
| | - Aadel Chaudhuri
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Rita Popat
- Department of Health Research & Policy, Stanford University School of Medicine, Stanford, USA
| | - Peter G Maxim
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA.,Stanford Cancer Institute, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - David Benjamin Shultz
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA. .,Stanford Cancer Institute, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA. .,Institute for Stem Cell Biology & Regenerative Medicine, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA.
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA. .,Stanford Cancer Institute, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA.
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Takenaka R, Shibamoto Y, Miyakawa A, Hashizume C, Baba F. The Fate of Residual Tumor Masses That Persist After Stereotactic Body Radiotherapy for Solitary Lung Nodules: Will They Recur? Clin Lung Cancer 2015; 17:406-411. [PMID: 26781347 DOI: 10.1016/j.cllc.2015.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/07/2015] [Accepted: 12/09/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND After stereotactic body radiotherapy (SBRT) to the lung, radiation pneumonitis and fibrotic changes often develop, and the tumor shadow usually becomes indistinguishable from the fibrotic shadow. Occasionally, however, a residual mass in patients with no or mild radiation pneumonitis will be observed on serial computed tomography (CT) scans. The purpose of the present study was to evaluate the fate of such residual masses and, if possible, to determine the types of tumor at increased risk of local recurrence. PATIENTS AND METHODS A total of 50 patients (underlying disease: primary lung cancer in 45, local recurrence in 2, and metastasis in 3) were selected because they had been followed up for > 2 years or until death and had observable CT changes and measurable tumor size for > 1 year, regardless of the influence of radiation pneumonitis. The patients' outcomes were compared according to various patient and tumor characteristics, including the presence and absence of emphysema, tumor size, and tumor shrinkage rate. The median follow-up period was 52 months. RESULTS Of the 50 patients, only 8 developed local recurrence. The local control rate was 81% at 3 years and 73% at 5 years. The local control rates were similar between patients with a high tumor shrinkage rate and those with a low rate. The patients with emphysema exhibited a lower local control rate. CONCLUSION The persistence of lung masses for > 1 year after SBRT is not necessarily indicative of an increased risk of local recurrence. A low tumor shrinkage rate also was not predictive of recurrence.
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Affiliation(s)
- Ran Takenaka
- Department of Radiology, Narita Memorial Hospital, Toyohashi, Japan; Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akifumi Miyakawa
- Department of Radiation Oncology, Nanbu Tokushukai General Hospital, Yaese, Okinawa, Japan
| | | | - Fumiya Baba
- Nagoya City West Medical Center, Nagoya, Japan
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