Evaluation of Factors Affecting Development of Radiation Pneumonitis after Radiotherapy in Patients with Lung Cancer

Year 2017, Volume: 39 Issue: 3, 35 - 43, 12.10.2017

Melek Akçay , Alaattin Özen , Sema Uslu Hüseyin Yıldırım Evrim Metcalfe , Durmuş Etiz

https://doi.org/10.20515/otd.318366

Abstract

Abstract: In this
single-institution prospective study, we aimed to evaluate factors affecting
the development of radiation pneumonitis (RP) in patients with lung cancer following
3D conformal radiotherapy (3D-CRT) with normal dose-volume histograms (DVH)
limits. This study included 41 patients with lung cancer who received
definitive 3D-CRT between February 2012 and July 2013. Thirty (73.2%) of these
patients underwent concurrent chemotherapy, while eight (19.5%) underwent
adjuvant radiotherapy (RT). The median RT dose was 60 (range: 30-64) Gy. The
relationships between RP evolution and various treatment-related factors,
including DVH parameters, levels of pretreatment diffusing capacity of carbon
monoxide (D_LCO), serum procalcitonin, CRP, and TGF-β1 were analyzed.
Within the follow-up period (median: 8 months, range: 6-24 months), RP occurred
in 15 (36.6%) patients (grade I in 11 patients and grade II in 4 patients) and
only 2 patients received steroid therapy (methylprednisolone 1 mg/kg/day).
Univariate analysis revealed that lymph node involvement status, D_LCO,
and pretreatment serum procalcitonin levels were significantly associated with
RP incidence (p=0.018, 0.045, and 0.001, respectively). However, multivariate
analysis of the same factors indicated that only pretreatment serum
procalcitonin level was significantly associated with RP incidence (p=0.027).
In conclusion, our current data indicate that pretreatment serum procalcitonin
level can be used to predict RP in patients with lung cancer who are treated
with 3D-CRT with normal DVH limits.

Keywords

lung cancer, 3 dimensional conformal radiotherapy (3D-CRT), procalcitonin

Radyoterapi Uygulanan Akciğer Kanseri Tanılı Vakalarda Radyasyon Pnömonisi Gelişimini Etkileyen Faktörler

Abstract

Öz: Bu tek merkezli
prospektif çalışmada 3 boyutlu konformal radyoterapi (3BKRT) ile tedavi edilen
ve normal doz-volüm histogramına (DVH) sahip akciğer kanseri tanılı hastalarda
radyasyon pnömonisi (RP) gelişimini etkileyen faktörleri değerlendirmeyi
amaçlandı. Çalışmaya Şubat 2012-Temmuz 2013 tarihleri arasında küratif 3BKRT
uygulanan 41 akciğer kanseri tanılı hasta dahil edildi. Otuz (%73,2) hastaya eş
zamanlı kemoterapi verildi. Sekiz (%19,5) hastaya adjuvant radyoterapi (RT)
uygulandı. Medyan RT dozu 60 (30-64) Gy idi. Tedavi sonrası RP gelişimi ile DVH
parametreleri, tedavi öncesi karbon monoksit difüzyon kapasitesi (DLCO), serum
prokalsitonin, CRP ve TGF-β1 seviyeleri gibi hastaya özgü faktörler arasındaki
ilişki analiz edildi. Medyan 8 (6-24) aylık takip süresi içerisinde 15 (%36,6)
hastada RP gelişti (11 hastada grade I, 4 hastada grade II) ve sadece 2 hastaya
steroid (1 mg/kg/gün metilprednizolon) tedavisi uygulandı. Tek değişkenli
analizde lenf nodu tutulumu, DLCO ve tedavi öncesi serum prokalsitonin düzeyinin
RP gelişimi üzerine etkisi gösterildi (sırasıyla, p=0.018, 0,045, 0.001). Çok
değişkenli analizde sadece tedavi öncesi serum prokalsitonin düzeyi ile
istatistiksel anlamlı ilişki mevcut idi (p=0.027). Sonuç olarak tedavi öncesi
serum prokalsitonin düzeyi 3BKRT ile tedavi edilen ve normal DVH değerlerine
sahip akciğer kanseri tanılı hastalarda RP gelişimini tahmin etmede faydalı
olabilir. 

Keywords

3 boyutlu konformal radyoterapi (3BKRT), akciğer kanseri, prokalsitonin, radyasyon pnömonisi

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